Objective: To examine physiotherapists’ understanding of compensatory strategies and how they select them for gait impairments in people with Parkinson’s disease (PwP).

Background: Compensatory strategies are widely used to manage gait impairments in PwP, but their effectiveness depends on individualisation. Previous research suggests physiotherapists often rely on trial and error, contributing to variable outcomes and reliance on clinical judgement. However, how these strategies are conceptualised and selected remains poorly understood.

Method: A qualitative two-stage focus group design was used. Fourteen physiotherapists with experience treating PwP were purposively recruited via the Singapore Physiotherapy Association. Data were analysed using framework analysis.

Results: Physiotherapists conceptualised compensatory strategies as mechanisms for redirecting motor control when automatic gait control was impaired. Although all participants were familiar with the term “compensatory strategies”, none had been exposed to a formalised framework. Familiarity and confidence varied across strategy types. External cues, internal cues, and changes in balance requirements were well understood and commonly applied, whereas “alternatives to normal walking” were the least recognised and utilised. Although physiotherapists varied in how they interpreted and selected strategies, decisions were shaped by patient presentation and contextual demands. These patterns reveal the structure of physiotherapists’ decision-making when selecting compensatory strategies, highlighting tacit aspects of their clinical reasoning. Findings were synthesised into tables linking influencing factors to strategy selection and a chart illustrating this decision-making process.

Conclusion: This study provides a novel account of physiotherapists’ clinical reasoning when selecting compensatory strategies for PwP. The findings reveal the thought processes underpinning strategy selection and translate experiential knowledge into practical frameworks that can support clinical practice, guide physiotherapy education, and promote more consistent, individualised rehabilitation. Future work should examine factors influencing the implementation and sustained use of these strategies.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/physiotherapists-clinical-reasoning-when-selecting-compensatory-strategies-for-gait-impairments-in-parkinsons-disease/