Clinical Reasoning “Breadth” and “Depth” of Physical Therapists in the Post-operative Management of Femoral Neck Fracture: An ICF-Based Descriptive Study

The quality of physiotherapists’ clinical reasoning is a key determinant of patient recovery, yet objective descriptors of its multilayered nature remain scarce. Using the International Classification of Functioning, Disability and Health (ICF), we quantified two complementary indices—breadth and depth—to chart how physiotherapists (PTs) appraise a standardised postoperative femoral neck fracture case over time. Twenty-two PTs reviewed structured simulated patient information on postoperative day 7 (POD7) and day 30 (POD30). At each time-point they listed, within every ICF domain, up to five problems and associated interventions. Breadth was defined as the number of unique problems named in the Body Functions domain (range 1–5). Depth was the mean count of ICF domains—Body Functions, Activities & Participation, Environmental Factors—explicitly linked at the same rank (range 1–3); ranks without a Body Functions entry were excluded. Pairwise changes were analysed with Wilcoxon’s signed-rank test (α = 0.05). Breadth declined significantly from POD7 (mean ± SD = 2.73 ± 1.24) to POD30 (2.14 ± 1.08; p = 0.041), indicating more selective problem lists as acute issues resolved. Conversely, depth showed a non-significant upward trend (2.45 ± 0.42 vs 2.69 ± 0.49; p = 0.067), suggesting broader cross-domain reasoning. Ninety-five per cent of participants achieved full three-domain linkage in at least one rank at both assessments. On POD7 the most frequent Body Functions problems were reduced muscle power (86 %), pain (73 %) and restricted joint mobility (55 %). Only three therapists had > 10 years of clinical experience; their depth scores did not differ from those of less-experienced colleagues (p = 1.00). Across the first postoperative month, PTs progressively narrow the set of body-level impairments they prioritise while modestly expanding their reasoning to encompass activity limitations and environmental barriers. Simultaneously mapping breadth and depth provides a concise yet sensitive lens for tracking temporal shifts in clinical reasoning and for benchmarking educational interventions.