Clinical Reasoning in Physical Therapy

Clinical Reasoning Fundamentals

• Clinical reasoning is a complex cognitive process crucial for evaluating and managing patient medical problems. It involves diagnosing, making treatment decisions, and estimating prognosis.
• This skill distinguishes physical therapists from other professionals, not simply prescribing exercises but comprehensively understanding and managing patients' issues.

SINSS Model: A Systematic Approach

• The SINSS model systematically gathers information for diagnosis, treatment/referral, intervention, and patient education.
• Severity: Focuses on the impact of pain on daily activities (using a 0-10 pain scale; categorizing as high, moderate, or low).
• Irritability: Assesses the ratio of aggravating to easing factors, considering how easily pain is triggered and how quickly it subsides; crucial in determining intervention aggressiveness.
• Nature: Identifies the specific diagnosis, condition, and pain type (e.g., nociceptive, neuropathic, central, viscerogenic, autonomic); distinguishes between mechanical (variable onset, improves with rest) and inflammatory (insidious onset, worse with rest) pain. Pain characteristics (e.g., muscle-cramping, nerve-sharp, bone-dull) are also noted.
• Stage: Classifies symptoms duration as acute (<3 weeks), subacute (3-6 weeks), or chronic (>6 weeks) affecting expected tissue healing time.
• Stability: Evaluates symptom progression over time (improving, worsening, no change, or inconsistent).

Symptom Behavior Model: Testing Hypotheses

• This model is a framework for testing hypotheses derived from the SINSS assessment by testing, treatment, and retesting, demonstrating improvement, and understanding the reasoning behind it.
• Asterisk Signs: Measurable activities or movements that reproduce a patient's symptoms (e.g. walking time, range of motion). Crucially, values for these signs need to be tracked objectively.
• Subjective vs. Objective: Considers both patient-reported information (e.g., aggravating factors) and objectively measured data (e.g., range of motion, strength).
• Intervention and Retesting: Based on SINSS and asterisks, an intervention is performed, with asterisks retested (objective during the session, subjective in the next). Showing tangible results is vital.
• "Be Like Costco": Implies the need for tangible, demonstrable results to patients.

Patient Case Example (37-year-old Male with Low Back Pain)

• Acute low back pain, developing 2 days after a gym squat.
• Initial pain: 7/10, reduced to 5/10.
• Pain description: deep aching with sharp stabs.
• Limited ability to sit >10 minutes and reduced range of motion during bending and rotation.

Learning Objectives

• Defining clinical reasoning, its importance in practice, the usage of the SINSS model, the Symptom Behavior model and applying SINSS to patient cases.

Key Takeaways

• Systematic Approach: SINSS and the Symptom Behavior Model offer structured processes for gathering information, formulating hypotheses, and evaluating interventions.
• Patient-Centered Care: The models highlight understanding how the patient's condition affects their daily lives and demonstrating progress/reasoning.
• Data-Driven Decision Making: Quantitative data (pain scales, ROM) guide treatment choices.
• Importance of Retesting: Regular retesting is crucial for evaluating intervention effectiveness.

Explore the fundamentals of clinical reasoning vital for physical therapists. This quiz covers essential concepts like the SINSS model, which aids in diagnosis, treatment decisions, and patient education. Test your understanding of how to evaluate and manage patient medical problems effectively.