One workbook and a four-day workshop changed how therapists reach clinical decisions — and the change was still there a month later

Physical therapists in Myanmar largely work from the physician's prescription rather than through a decision-making process of their own profession. Can that behaviour be changed, and if so, what actually has to be fixed?

The study used the PRECEDE-PROCEED planning model, which forces you to find the causes before designing the remedy. The PRECEDE phases mapped current practice through 18 in-depth interviews with therapists of at least two years' experience, one focus group and a questionnaire, with content analysis yielding ten categories. The PROCEED phases produced a 14-chapter clinical decision-making workbook and a four-day intensive workshop in Yangon with 34 participants, measured three times: before, immediately after, and one month later.

• The cause sat in how people were taught and where they worked, not in the individuals. Participants described an education built on lectures and predetermined right answers rather than weighing options, and a workplace where critical thinking from evidence was not encouraged.
• Before the workshop, examination was cursory and prescription-led. Standardised tests were used infrequently and retesting to detect change was uncommon. Less experienced therapists were the most likely to follow the prescription without modification.
• After the workshop the proportion whose routine examination had changed differed significantly (Cochran's Q, χ²(2) = 62.312, p < 0.0005), as did how often they asked about personal factors, environment and comorbidities (χ² = 251.9, p < 0.001).
• The change did not evaporate when the workshop ended — the one-month follow-up found participants still holding to the new approach.
• The clearest shift was in what came first. Pain used to be the impairment addressed at the outset; afterwards almost all participants began with the patient's overall health condition, community participation and surrounding circumstances.

For anyone designing professional training, the lesson is in the sequence: this work did not start by writing a curriculum but by identifying the predisposing and reinforcing factors that kept the old behaviour in place, then built content against them. And what worked was a workbook usable afterwards combined with hands-on practice, rather than lectures alone — a pattern the authors note could transfer to therapists taught and practising in similar ways elsewhere.