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Questions and Answers
What is clinical reasoning?
What is clinical reasoning?
A complex cognitive process that is essential to evaluate and manage a patient's medical problem.
What does the acronym SINSS stand for?
What does the acronym SINSS stand for?
Severity, Irritability, Nature, Stage, Stability
What are the three levels of severity?
What are the three levels of severity?
How is irritability determined?
How is irritability determined?
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The "nature" of pain includes the diagnosis and the type of pain the patient is experiencing.
The "nature" of pain includes the diagnosis and the type of pain the patient is experiencing.
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What are the three stages of pain?
What are the three stages of pain?
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How is stability defined?
How is stability defined?
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What is the Symptom Behavior Model?
What is the Symptom Behavior Model?
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The Symptom Behavior Model emphasizes the patient's responsibility to monitor their symptoms.
The Symptom Behavior Model emphasizes the patient's responsibility to monitor their symptoms.
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The Symptom Behavior Model involves ______ signs, which can be ______ or ______.
The Symptom Behavior Model involves ______ signs, which can be ______ or ______.
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Why is it important to show the patient their improvement?
Why is it important to show the patient their improvement?
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Study Notes
Clinical Reasoning
- Clinical reasoning is a complex cognitive process crucial for evaluating and managing patient medical problems.
- It involves diagnosing the patient's problem, making therapeutic decisions, and estimating the prognosis.
- This skill distinguishes physical therapists from personal trainers.
Objectives
- Define clinical reasoning and its importance in clinical practice.
- Understand and apply the SINSS model of clinical reasoning.
- Understand the Symptom Behavior Model of clinical reasoning.
- Apply SINSS to patient cases.
SINSS Model
- A useful tool for systematic clinical reasoning.
- Used to determine diagnosis.
- Helps in treatment and referral decisions.
- Guides the development of intervention plans.
- Educates patients about their prognosis.
- Key elements include: severity, irritability, nature, stage, and stability.
Severity
- Measured on a 0-10 verbal scale (Numeric Pain Rating Scale).
- Assesses the impact of pain on daily activities (e.g., work, recreation).
- Grades pain as high, moderate, or low.
Irritability
- Determined by the ratio of factors aggravating pain to easing pain.
- Considers the time it takes for pain to increase and decrease following aggravating or easing factors.
- Crucial for determining appropriate examination and intervention techniques.
- Rated as high, moderate, or low.
Nature
- Describes the specific diagnosis or condition the patient is experiencing.
- Includes pain types, like:
- Nociceptive (mechanical or inflammatory).
- Neuropathic.
- Central.
- Viscerogenic.
- Autonomic.
Stage
- Categorizes the duration of symptoms:
- Acute (less than 3 weeks).
- Subacute (more than 3 weeks but less than 6 weeks).
- Chronic (greater than 6 weeks).
- Stage impacts intervention choices based on tissue healing timelines.
Stability
- Evaluates the progression of symptoms over time.
- Categories include:
- Improving (symptoms decreasing in intensity, frequency, or location).
- Worsening (symptoms increasing in intensity, frequency, or location).
- No change (neither better nor worse in symptoms).
- Inconsistent (sometimes better, sometimes worse).
Symptom Behavior Model
- A framework for testing hypotheses developed through SINSS clinical reasoning.
- Key characteristic is Test-Treat-Retest.
- It is the physical therapist's job to demonstrate improvement, not the patient's to know if they're improving.
- Involves using asterisk signs (activities or movements that reproduce symptoms), subjective information, and objective data to track and document changes.
Application (Patient Case)
- A 37-year-old male presents with acute low back pain after squatting.
- Initial pain level was 7/10, now 5/10.
- Experiences intermittent sharp stabs of pain with an underlying aching sensation.
- Limited ability to sit, stand, and rotate.
- Improvement takes 15 minutes or more.
Additional Considerations
- Using SINSS to justify the assessment.
- Identifying subjective and objective asterisk(s).
- Discussion of the case as a class.
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Description
Explore the complex cognitive process of clinical reasoning essential for evaluating and managing patient medical problems. This quiz covers the importance of clinical reasoning, the SINSS model, and its application in therapy. Test your understanding of key concepts and enhance your clinical practice skills.
