Clinical Reasoning

Clinical Reasoning is the process by which a therapist interacts with a patient, collecting information, generating and testing hypotheses, and determining optimal diagnosis and treatment based on the information obtained. Treatment choice and patient management should be based on clinical reasoning using information gathered from the following categories.

Original Editor - Rachael Lowe

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Pathobiological Mechanisms[edit | edit source]

mechanisms relating to tissues - tissues injured, nature of injury, stage of healing
mechanisms relating to pain - input (nociceptive, neurogenic), processing (central, cognitive), output (motor, sympathetic).

Nature (Biomechanical)
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There are 3 primary forces the human body must dissipate. The biomechanical nature of the condition helps the clinician to determine which of these forces may be the primary contributor to a patient's symptoms. For example: tension overload may be the primary biomechanical nature of a patient who is experiencing patellar tendonitis.

Nature (Centrally Mediated)[edit | edit source]

Central symptoms or dysfunction is a complex cause of symptoms, impairments, funcitonal limitations and/or disability.

Dysfunction/Impairment
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Clinical manifestations of the pathobiological processes, these are the patients main problems at that time.

dysfunction - general physical dysfunction as described by the patient such as limitations in activity
restriction in participation
impairment - specific impairments in body functions and structures identified on examination.

Patho-Anatomic Hypothesis
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The actual anatomical location of the pathobiological mechanisms. What discrete anatomical structure is generating the primary complaint. More...

Contributing Factors
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Any factor relating to the predisposition, development and maintenance of the problem

physical - previous injury, nerve root involvement, pain provoked by multiple trunk movemements, reduced muscle control, reduced physical fitness
psychosocial - yellow flags determine a patients potential to proceed to chronicity.
environmental
emotional
behavioural
ergonomic
cultural

Patient Identified Problems (PIP)
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These are the patient identified problem(s), either in a symptom AND/OR functional limitation/disability level.

Non Patient Identified Problems (NPIP)
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This is essentially a problem list generated by the clinician. This is an ongoing process of evaluation as the subjective examination and physical examination is taking place.

Precautions
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red flags - need referral on for appropriate medical intervention.
yellow flags - highlight the need for a more detailed psychosocial assessment.
SIN factor - severity, irritability, nature.

Prognosis
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To predict potential improvement identify positive and negative prognostic indicators. Consider age, occupation, hobbies, previous treatment response, stage and stability od condition, general health, past medical history, pain mechanisms.

Phase of Healing
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The phase of tissue healing is closely related to the prognosis of the patient.

Primary phases of healing include:

Management
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Optimal management with a dynamic clinical working diagnosis should follow if all the above categories have been cosidered.