Severity, Irritability, Nature, Stage and Stability (SINSS): Difference between revisions
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The clinician should consider the patients' irritability when planning the evaluation and subsequent interventions. This understanding helps the clinician provide the most effective treatment. The clinician should also consider the extent to which they challenge the patient. This helps to prevent exacerbating the patients' symptoms unnecessarily<ref name=":0" />. | The clinician should consider the patients' irritability when planning the evaluation and subsequent interventions. This understanding helps the clinician provide the most effective treatment. The clinician should also consider the extent to which they challenge the patient. This helps to prevent exacerbating the patients' symptoms unnecessarily<ref name=":0" />. | ||
==== Nature ==== | ==== Nature ==== | ||
Nature | [[Multidimensional Nature of Pain|Nature]] is a broad term relating to the diagnosis, the type of symptoms, personal characteristics/[[Psychosocial Considerations in Patellofemoral Pain|psychosocial]] factors and [[Red Flags in Spinal Conditions|red]] and [[Yellow Flags|yellow flags]]. Within this category a clinician should be able to recognize if the condition is within their scope of practice<ref name=":0" />. | ||
==== Stage ==== | ==== Stage ==== | ||
Revision as of 15:45, 23 November 2022
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Overview[edit | edit source]
The Severity, Irritability, Nature, Stage and Stability (SINSS) model is a clinical reasoning construct to provide clinicians with a structured framework for taking subjective history, in order to determine an appropriate objective examination and treatment plan, and reduce clinical reasoning errors[1].
The SINSS model helps the physiotherapist to find out detailed information about the patients' condition, filter and group the information, prioritize their problem list and determine which tests should be used and when. This ensures information isn't omitted and the patient isn't under or over examined and/or treated[1].
Model[edit | edit source]
Severity[edit | edit source]
Severity relates to the intensity of the symptoms, including subjective pain level. Amount, type and pattern of pain should be established. Pain can be measured in a multitude of ways, such as through the visual analogue scale. Using tools to help gauge the patient’s pain will help assist the clinician in objectively categorizing the symptoms. A patient’s perception of their pain can have a great impact on their recovery. A key determinant in the way severity is measured is the extent to which the patient’s activities of daily living (ADLs) are affected, as generally the more severe one’s pain is the more their ADLs are affected.
Considering the patient’s severity includes determining the suitable intensities used for the examination process. Assessing the severity further lends itself to assessing the patient’s prognosis and outcome which supports the therapist in their overall treatment of the patient. [1]
Irritability[edit | edit source]
Irritability can be assessed by establishing the level of activity required to aggravate the symptoms, how severe the symptoms are and how long it then takes for the symptoms to subside[2]. Irritability can also be judged by the ratio or aggravating factors to easing factors. The concept of tissue irritability was initially proposed by Maitland as the tissues ability to handle physical stress, however there are not widely used reliable or valid classifications for irritability[3].
The clinician should consider the patients' irritability when planning the evaluation and subsequent interventions. This understanding helps the clinician provide the most effective treatment. The clinician should also consider the extent to which they challenge the patient. This helps to prevent exacerbating the patients' symptoms unnecessarily[1].
Nature[edit | edit source]
Nature is a broad term relating to the diagnosis, the type of symptoms, personal characteristics/psychosocial factors and red and yellow flags. Within this category a clinician should be able to recognize if the condition is within their scope of practice[1].
Stage[edit | edit source]
Stage refers to the stage of healing that the patient is in at the time of the evaluation. The values for the stage are acute, subacute, chronic, or overlap multiple stages. For example, a patient could be experiencing an acute phase of a chronic condition.
Symptom timelines: [edit | edit source]
- Acute: typically days-weeks (<3 weeks)
- Subacute: typically weeks (3-6 weeks)
- Chronic: typically weeks-months (>6 weeks)
- Acute stage of a chronic condition: recent exacerbation of symptoms of a condition that the patient has been experiencing for >6 weeks
- Subacute stage of a chronic condition: later stage of exacerbation of symptoms of a condition that the patient has been experiencing for >6 weeks.[1]
Every patient does not necessarily experience every stage of healing. The clinician may need to take into consideration a settled phase that occurs after the subacute phase and before the chronic stage is reached. [4]
Stability[edit | edit source]
In the gathering of subjective information from the patient, the clinician can begin to determine the progression of the condition and if it has been improving, staying the same, or worsening.[5]
Understanding the fragility of the tissues through other parts of the SINSS model helps the clinician determine where the intervention starts. For example, the consideration of the stages of healing when deciding to use palliative versus more corrective interventions.
Conclusion[edit | edit source]
There are multiple models of clinical reasoning. This presents a methodical approach that requires research to further understand its relativity to patient outcomes.
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Petersen EJ, Thurmond SM, Jensen GM. Severity, Irritability, Nature, Stage, and Stability (SINSS): A clinical perspective. J Man Manip Ther. 2021 Oct;29(5):297-309
- ↑ Barakatt ET, Romano PS, Riddle DL, Beckett LA. The Reliability of Maitland's Irritability Judgments in Patients with Low Back Pain. J Man Manip Ther. 2009;17(3):135-40.
- ↑ Kareha SM, McClure PW, Fernandez-Fernandez A. Reliability and Concurrent Validity of Shoulder Tissue Irritability Classification. Phys Ther. 2021 Mar 3;101(3):pzab022.
- ↑ Baker SE, Painter EE, Morgan BC, Kaus AL, Petersen EJ, Allen CS et al. Systematic Clinical Reasoning in Physical Therapy (SCRIPT): Tool for the Purposeful Practice of Clinical Reasoning in Orthopedic Manual Physical Therapy. Physical Therapy 2016;97.
- ↑ Koury MJ, Scarpelli E. A Manual Therapy Approach to Evaluation and Treatment of a Patient With a Chronic Lumbar Nerve Root Irritation. Physical Therapy 1994;74:548-560.
