Clinical Reasoning in Physical Therapy
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Questions and Answers

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?

Severity, Irritability, Nature, Stage, Stability

What are the three levels of severity?

  • Low, medium, high
  • High, moderate, low (correct)
  • Minor, moderate, major
  • Mild, moderate, severe

How is irritability determined?

<p>The speed at which the patient's pain increases with aggravating factors, in relation to the amount of time it takes to ease with relieving factors. (D)</p> Signup and view all the answers

The "nature" of pain includes the diagnosis and the type of pain the patient is experiencing.

<p>True (A)</p> Signup and view all the answers

What are the three stages of pain?

<p>Acute, subacute, chronic (B)</p> Signup and view all the answers

How is stability defined?

<p>The progression of symptoms over time, including improvement, worsening, no change, or inconsistency. (D)</p> Signup and view all the answers

What is the Symptom Behavior Model?

<p>A framework for testing hypothesis lists developed through the SINSS model of clinical reasoning.</p> Signup and view all the answers

The Symptom Behavior Model emphasizes the patient's responsibility to monitor their symptoms.

<p>False (B)</p> Signup and view all the answers

The Symptom Behavior Model involves ______ signs, which can be ______ or ______.

<p>asterisk, objective, subjective</p> Signup and view all the answers

Why is it important to show the patient their improvement?

<p>Because it motivates the patient to continue with treatment and empowers them to feel confident in their recovery.</p> Signup and view all the answers

Flashcards

What is clinical reasoning?

A complex cognitive process used to evaluate and manage patient medical issues.

What is diagnosis?

The act of determining the nature and severity of a patient's condition.

What is therapeutic decision-making?

The process of deciding on the best course of treatment or management for a patient's condition.

What is prognosis?

Predicting the likely outcome of a patient's condition and their recovery.

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What is the SINSS model?

A tool for systematic clinical reasoning that helps in understanding a patient's condition and guiding treatment decisions.

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What is Severity?

The intensity of pain or discomfort experienced by the patient, measured on a scale.

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What is Irritability?

The ease with which a patient's pain is aggravated or calmed by various factors.

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What is Nature?

The underlying cause or nature of the patient's pain and condition.

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What is Stage?

The duration of the patient's symptoms, categorized into acute, subacute, or chronic.

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What is Stability?

The progression of a patient's symptoms over time, indicating improvement, worsening, or stability.

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What is the Symptom Behavior Model?

A framework used to test hypotheses and guide treatment based on the SINSS model.

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What are asterisk signs?

Activities or movements that consistently reproduce the patient's symptoms.

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What is subjective information?

Information obtained from the patient about their condition, including their symptoms, concerns, and experiences.

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What is objective information?

Data collected during the examination, such as range of motion, strength, and other objective findings.

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What is showing patient improvement?

The process of demonstrating to the patient the improvement they've made through targeted interventions.

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What is acute pain?

A patient experiencing new pain that has been present for less than 3 weeks.

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What is subacute pain?

A patient experiencing pain that has been present for more than 3 weeks but less than 6 weeks.

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What is chronic pain?

A patient experiencing pain that has been present for longer than 6 weeks.

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What is nociceptive pain?

Pain originating from tissues and structures that respond to mechanical stimuli, such as pressure or movement.

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What is neuropathic pain?

Pain arising from damage or dysfunction of the nervous system.

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What is central pain?

Pain originating from the central nervous system, such as the brain or spinal cord.

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What is viscerogenic pain?

Pain originating from the internal organs or viscera.

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What is autonomic pain?

Pain associated with changes in the autonomic nervous system, such as sweating, heart rate changes, or blood pressure fluctuations.

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What is pain that worsens with movement?

Pain that worsens with movement or activity.

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What is pain that improves with movement?

Pain that improves with movement or activity.

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What is pain at rest?

Pain that is present even at rest.

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What is morning stiffness?

Pain that is worse in the morning and improves as the day progresses.

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What is pain that wakes you up at night?

Pain that wakes a patient up from sleep.

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What is a patient case?

A set of information gathered from a patient to inform clinical reasoning and treatment decisions.

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Applying SINSS to patient cases.

Applying the SINSS model to a patient's case.

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Identifying subjective and objective asterisk signs.

Identifying subjective and objective asterisk signs in a patient's case.

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Discuss as a class.

To thoroughly discuss a patient case with other professionals, sharing insights and perspectives.

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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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Related Documents

Intro to Clinical Reasoning PDF

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.

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