Clinical Reasoning using the SINSS Model

• Clinical reasoning is a vital cognitive process for evaluating and managing a patient's medical issues.
• It includes diagnosing the patient's problem, deciding on the best treatment, and estimating the patient's prognosis.
• Clinical reasoning sets medical professionals apart from personal trainers.

Objectives

• The goal is to define clinical reasoning and highlight its importance in clinical practice.
• Learning to apply the SINSS model in clinical reasoning is crucial.
• Understanding the Symptom Behavior Model is another key objective.
• Applying the SINSS model to real patient cases helps solidify understanding.

SINSS Model

• The SINSS model is a useful tool for systematic clinical reasoning.
• It aids in diagnosis, treatment/referral decisions, intervention planning, and patient education on prognosis.
• SINSS stands for Severity, Irritability, Nature, Stage, and Stability.

Severity

• Severity can be classified as high, moderate, or low.
• It considers the impact on daily activities, work, and recreation.
• Severity can be measured using a 0-10 verbal scale known as the Numeric Pain Rating Scale.

Irritability

• Irritability is the ratio between aggravating and easing factors.
• It considers how much aggravating factor it takes to increase pain.
• It also considers how long it takes for the pain to subside once the aggravating factor is removed or a relieving factor is applied.
• Irritability is a key factor in determining the aggressiveness of the examination or intervention techniques.
• A high irritability means to avoid over-examining or overtreating.
• A low irritability means to avoid under-examining or undertreating.
• Irritability can be classified as high, moderate, or low.

Nature

• Nature includes the specific diagnosis or condition the patient is experiencing and the nature of the pain itself.
• Types of pain include nociceptive, neuropathic, central, viscerogenic, and autonomic.
• Nociceptive pain is either mechanical, or it is inflammatory.

Nature: Mechanical vs Inflammatory Back Pain

• Mechanical back pain can occur at any age, while inflammatory back pain typically begins before age 45.
• Mechanical pain has an acute onset, whereas inflammatory pain has an insidious onset.
• Mechanical pain may worsen with movement or exercise, but inflammatory pain tends to improve.
• Mechanical pain improves with rest; inflammatory pain does not.
• Mechanical pain has little to no morning stiffness, while inflammatory pain has early morning stiffness lasting over 30 minutes.
• Pain at night is a key sign of inflammatory pain, and may wake the patient.

Nature: Pain Descriptions and Related Structures

• Cramping, dull, aching pain is often associated with muscle issues.
• Dull, aching pain often indicates issues with ligaments or joint capsules.
• Sharp, shooting pain can indicate a nerve root problem.
• Sharp, bright, lightning-like pain often indicates a nerve issue.
• Burning, pressure-like, stinging, aching pain can indicate a sympathetic nerve issue.
• Deep, nagging, dull pain is often associated with bone issues.
• Sharp, severe, intolerable pin can be a fracture.
• Throbbing, diffuse pain indicates a vascular problem.

Stage

• Stage refers to the duration of the symptoms.
• Acute: less than 3 weeks.
• Subacute: more than 3 weeks but less than 6 weeks.
• Chronic: greater than 6 weeks.
• The stage will affect interventions based on tissue healing timeframes.

Stability

• Stability refers to the progression of symptoms over time.
• Improving: symptoms decrease in intensity, frequency, or location, and less pain medication is needed.
• Worsening: symptoms increase in intensity, frequency, or location.
• No change: symptoms remain the same.
• Inconsistent: sometimes better, sometimes worse.

Symptom Behavior Model

• The Symptom Behavior Model is a framework for testing hypothesis lists developed through SINSS clinical reasoning.
• Test-Treat-Retest is a hallmark of this model.
• "It is not your patient's job to know if they are getting better, it's your job to show them".

Asterisk Signs

• Asterisk signs are activities or movements that reproduce the patient's symptoms.
• These are called "comparable signs".
• Defined values that can be tracked and retested are important.
• Subjective information is reported by the patient.
• Objective data is collected during examination, including ROM, strength and outcome measures.

Applying the Symptom Behavior Model

• Base interventions on SINSS and asterisk signs.
• Retest asterisk signs, usually objective ones, in-session.
• Inquire subjective signs at the next session to see progress based on the intervention.
• Show the patient their improvement and explain why it matters to them.

Explore clinical reasoning, a key cognitive process in medicine. Learn to apply the SINSS model for diagnosis, treatment planning, and patient education. Understand Severity, Irritability, Nature, Stage, and Stability in patient assessment.