Clinical Reasoning

Clinical Reasoning is the process by which a therapist interacts with a patient, collecting information, generating and testing hypotheses, and determining optimal diagnosis and treatment based on the information obtained.  Treatment choice and patient management should be based on clinical reasoning using information gathered from the following categories.

Pathobiological mechanisms

• mechanisms relating to tissues - tissues injured, nature of injury, stage of healing
  
• mechanisms relating to pain - input (nociceptive, peripheral neurogenic, central, autonomic), processing (feelings, memories), output (motor, sympathetic).
  

Dysfunction/Impairment

• clinical manifestations of the pathobiological processes, these are the patients main problems at that time.
  

Sources

• the actual anatomical location of the pathobiological mechanisms.
  

Contributing Factors

• any factor relating to the predisposition, development and maintenance of the problem such as previous injury, past medical history, yellow flags, family history etc.
  

Precautions

• red flags - need referral on for appropriate medical intervention.
  
• yellow flags - highlight the need for a more detailed psychosocial assessment.
  
• SIN factor - severity, irritability, nature.

Prognosis

• to predict potential improvement identify positive and negative prognostic indicators.  Consider age, occupation, hobbies, previous treatment response, stage and stability od condition, general health, past medical history,  pain mechanisms.
  

Management

• optimal management with a dynamic clinical working diagnosis should follow if all the above categories have been cosidered.