Factors influencing clinical decision-making in inpatient rehabilitation: A scoping review

ObjectiveTo synthesize research about clinical reasoning and decision-making among therapists in inpatient rehabilitation facilities about how they organize care and use their treatment time.Data sourcesPubMed, CINAHL, and PsycINFO were searched for relevant empirical studies published prior to January 13, 2026.Review methodsScoping review. The review process was organized using Covidence. Included studies featured descriptions of clinical decisions explained by occupational therapists, physical therapists, and speech therapists in inpatient rehabilitation facilities. Two reviewers coded the extracted themes through inductive analysis using Dedoose.ResultsOf 1239 articles identified through the search process, 51 met inclusion criteria. We identified six factors across studies that contributed to therapists' clinical decision-making including: (1) consideration of non-medical circumstances (with sub-themes of understanding the patient's perspective, presence of families and caregivers, and assessment of patient resources); (2) collaboration and roles within care teams; (3) within-session communication techniques; (4) knowledge-base and the influence of experience; (5) medical and safety considerations; and (6) balancing institutional priorities within treatment. We created a concept map showing connections across these six factors.ConclusionThe process of making decisions about therapy time and organization of care within inpatient rehabilitation settings is complex and requires integration of multiple factors. Therapists usually prefer familiar approaches to complex or time-intensive ones, and local culture shapes decision-making norms. Future research may examine how these factors relate to patient outcomes and implementation of practice changes such as introduction of new evidence-based treatments or assessment tools.