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

Abstract

OBJECTIVES: The authors aimed to (1) identify factors informing physical therapists' 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 gray literature sources were searched from database inception to February 26, 2025. STUDY SELECTION CRITERIA: Qualitative studies examining physical therapists' clinical reasoning for therapeutic exercise or physical activity prescription in musculoskeletal populations were included. DATA SYNTHESIS: Following pilot screening, 2 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: Overall, 21 910 titles and abstracts were screened, and 40 studies met the eligibility criteria. Analysis identified 23 factors that informed clinical reasoning, grouped into 4 categories: (1) patient factors, (2) physical therapist factors, (3) therapeutic exercise and physical activity factors, and (4) health care context factors. Mapping demonstrated alignment of patient and health care context factors across multiple ICF domains, whereas physical therapist and intervention factors were not captured within the ICF. CONCLUSION: Physical therapists' clinical reasoning for therapeutic exercise and physical activity prescription in musculoskeletal populations was multidimensional and intersectional. We identified factors that may support physical therapy education, mentorship, and clinical practice in clinical reasoning for therapeutic exercise and physical activity prescription. JOSPT Open 2026;4(4):395-419. Epub 18 August 2026. doi:10.2519/josptopen.2026.0240.