From Evidence to Bedside: A Qualitative Study of Mindlines in Critical-Care Physiotherapy Practice.
Abstract
Background
Translating evidence-informed recommendations into routine critical-care physiotherapy remains challenging because clinical decision-making occurs within dynamic and context-dependent environments. The mindlines model provides a conceptual perspective for understanding how clinicians integrate research evidence with experiential, social, and contextual knowledge during everyday practice. However, its application in critical-care physiotherapy remains poorly understood.
Objective
To explore how physiotherapists working in critical-care units develop and apply mindlines during clinical decision-making and how evidence-informed recommendations are integrated into routine practice.
Methods
A qualitative exploratory study was conducted using semi-structured interviews with 22 experienced physiotherapists from diverse critical-care settings. Participants had 5-20 years of ICU experience and were recruited through purposive sampling. Data were analysed using reflexive thematic analysis following an inductive approach, with interpretation informed by the mindlines model. Reporting adhered to the COREQ. 32-item checklist.
Results
Five interconnected themes were identified: (1) experience as the primary driver of clinical reasoning, (2) interdisciplinary collaboration shaping decision-making, (3) contextual adaptation of evidence-informed recommendations, (4) time constraints influencing engagement with formal evidence and (5) organisational variation across institutional settings. Participants described integrating research evidence with accumulated clinical experience, multidisciplinary interactions, and contextual factors to support patient-specific decision-making in complex critical-care environments.
Conclusion
Clinical decision-making in critical-care physiotherapy reflects the integration of evidence-informed recommendations with experiential, collaborative, and contextual knowledge through clinicians' mindlines. Recognising these knowledge-translation processes may inform educational, implementation, and organisational strategies that strengthen evidence-informed physiotherapy practice in critical-care settings.