From technique to sensitivity: the transformation of clinical and ethical reasoning in physiotherapy students in the context of chronic neurodegenerative diseases

The evolution of Physiotherapy requires a shift from the biomedical model towards bioethical and humanistic approaches. This study explores how final-year students perceive their professional role when dealing with patients with complex neurodegenerative conditions, where traditional technical success is challenged by the irreversibility of the deterioration. Qualitative research based on interpretative description. Thirty final-year students from the University of Almería (Spain) took part, divided into five working groups. Three training sessions and discussions were held on Amyotrophic Lateral Sclerosis (ALS), Alzheimer’s disease, stroke and Rett syndrome. The data were analysed using thematic analysis and triangulation by researchers external to the study, with reflexivity ensured through logbooks. A shift in clinical reasoning was identified, with sensitivity taking precedence over technique. Students redefined therapeutic success in terms of “comfort” and support, valuing “microscopic achievements” such as the preservation of dignity and the alleviation of distress. Of particular note is the ability to adapt ethical principles according to the patient’s cognitive integrity (autonomy in ALS versus protection in Alzheimer’s) and the integration of the carer as an inseparable part of the therapeutic process. Future physiotherapists perceive humanization and the empathetic interpretation of non-verbal cues as essential therapeutic tools. Unlike previous studies focused on clinical experience, this research explores pre-clinical ethical maturation, offering a unique perspective on the educational foundation and humanistic predisposition of future graduates prior to their immersion in the healthcare system. It is imperative that academic curricula formally integrate competencies in bioethics, palliative care and emotional management to prepare graduates for extreme vulnerability and prevent early professional burnout.