PHTY102 Lecture Notes - Lecture 12: Knee Replacement, Patient Participation, Physical Therapy
13. Clinical reasoning in physiotherapy
• Define clinical reasoning in relation to physiotherapy intervention
o The decision-making process used to determine the diagnosis and management of
patients' problems
o The thinking and decision making associated with clinical practice that enables
therapists to take the best-judged action for individual patients
o A within-context way of thinking and decision making in professional practice to
guide practice actions
o What is it
• What questions do you need to ask
• What are the client's major problems
• What assessments need to be done
• Is there a diagnosis/prognosis
• What is the client hoping to gain from intervention
• Do you know enough at this point to help this client
• Do you need to seek advice from a colleague
o Informed by
• Practitioners unique frame of reference
• Workplace context
• Practice models
• Patient context
• Draws on critical conversations, knowledge generation, up to date evidence
and reflection
o Requirements for physiotherapy clinical reasoning
• Knowledge
▪ Ability to develop, organise and access own unique multidimensional
knowledge base for practice
• Cognitive abilities
▪ To identify and process multiple data inputs to understand clients and
their problems
▪ Make decisions for action
• Metacognitive and reflective capabilities
▪ To monitor, critique and refine clinical knowledge and reasoning
• Social capabilities
▪ To interact effectively with clients, carers and other health care
professionals
• Emotional capabilities
▪ To make ethical decisions in the face of challenging circumstances and
form effective relationships
• Outline the relevance of clinical reasoning for physiotherapy practice
o Drive for active consumer involvement - collaborative decision making - patient-
centred care
o Health professionals accountable for their decisions and service provision to
patients, health sector managers, policy-makers and colleagues
o Increasing legal requirements for comprehensive, relevant and appropriate
information exchange between health professionals and patients
o Goal of clinical reasoning is wise action
• Making the best judgement in a specific context
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• Identify and outline the key steps for using clinical reasoning in physiotherapy
intervention
o Models of clinical reasoning
• Hypothetico-deductive
▪ Most common
▪ Clinician generates hypothesis based on data from patient
• History taking physical exam, specific tests
▪ Hypothesis is then tested, further hypotheses generated until
management pathway clearly defined
▪ Quantitative investigation
▪ Action feedback cycle - iterative (repetitive approach)
• Pattern recognition
▪ Clinician associates problems of current patient with previously seen
clinical problems - adopts a previously-successful management strategy
▪ Draws upon existing practice-based knowledge
▪ Typical clinical presentations
▪ Downside - decisions may be made on poor knowledge base
• Narrative
▪ Process of enquiry, examination and reflective management
▪ Clinician attempts to understand patient's problem, perspective and the
context of the problem
▪ Collaborative reasoning between patient and clinician, effective
communication by the clinician, and ongoing reasoning until a plan of
management is agreed upon
▪ Interpretive or qualitative investigation
o Clinical reasoning in physiotherapy practice
• Assessment - physical examination of impairment, activity, participation
parameters
• Diagnosis - working hypothesis - not static
• Treatment planning - what does the patient/client want?
• Implementation and evaluation (outcome measures) of treatment
• Prognosis - based on previous experience with the condition
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