Factors That Inform Clinical Reasoning for Therapeutic Exercise and Physical Activity Prescription in Musculoskeletal Physiotherapy: A Scoping Review of Qualitative Studies

OBJECTIVE: To (1) identify factors informing physiotherapists’ clinical reasoning for therapeutic exercise and physical activity prescription in musculoskeletal populations, and (2) map these factors to the International Classification of Functioning, Disability and Health (ICF).

DESIGN: Scoping review.

LITERATURE SEARCH: Eight electronic databases and grey literature sources were searched from database inception to February 26, 2025.

STUDY SELECTION CRITERIA: Qualitative studies examining physiotherapists’ clinical reasoning for therapeutic exercise or physical activity prescription in musculoskeletal populations were included.

DATA SYNTHESIS: Following pilot screening, two reviewers independently screened citations and extracted data. Inductive qualitative content analysis was used to identify codes representing factors that informed clinical reasoning, which were organized into categories and subcategories. Identified factors were mapped to ICF domains using established linking rules.

RESULTS: 21,910 titles and abstracts were screened, and 40 studies met the eligibility criteria. Analysis identified 23 factors that informed clinical reasoning, grouped into four categories: (1) patient factors, (2) physiotherapist factors, (3) therapeutic exercise and physical activity factors, and (4) healthcare context factors. Mapping demonstrated alignment of patient and healthcare context factors across multiple ICF domains, while physiotherapist and intervention factors were not captured within the ICF.

CONCLUSION: Physiotherapists’ clinical reasoning for therapeutic exercise and physical activity prescription in musculoskeletal populations was multidimensional and intersectional. We identified factors that may support physiotherapy education, mentorship, and clinical practice in clinical reasoning for therapeutic exercise and physical activity prescription.