Influence of a Disrupted Practice Context on Occupational Therapists' Clinical Reasoning: A Qualitative Study

Background: Clinical reasoning in occupational therapy involves integrating client factors, professional knowledge, and practice context to guide decision-making. The COVID-19 pandemic disrupted health care contexts, potentially affecting therapists' reasoning. This study explored the factors that influenced occupational therapists' clinical reasoning during this crisis. Method: A qualitative descriptive study was conducted using semi-structured remote interviews with 11 occupational therapists in Quebec, Canada. The 60-min interviews, realized in 2021 and 2022, were recorded, transcribed verbatim, and analyzed inductively to identify reasoning-related themes. Deductive analysis involved coding text segments based on the 14 domains of the Theoretical Domains Framework. Transcripts were coded by two authors using QDA Miner software. Results: The sample included mostly women with clinical experience ranging from 4 to 34 years. In addition to the 14 TDF domains identified through deductive analysis, the inductive analysis revealed 11 key themes, including “weight given to client/family,” “client safety," or “ethical reasoning.” The therapists indicated that priority was given to the client's preferences. Their adaptation to the disrupted context was based on professional experience. In their view, demonstrated creativity and resilience reflected good professional adaptability. Anchoring in core occupational therapy values and ethics emerged as providing direction when evidence was limited. Conclusion: Therapists' professional values served as guides for navigating uncertainty. A client-centered approach took on greater importance in disrupted contexts. Findings indicate that using resilience and reflection can enhance context-adaptive reasoning.