Clinical Reasoning Framework Part I

Clinical Reasoning Framework Part I
 


There are many different models for clinical reasoning framework during an assessment:  One simple model is:


Test-->  Rx-->  Retest-->  Teach

The "test" represents a limitation/pain.  "Rx" represents a treatment to address the limitation/pain.  "Retest" is performing the original test once again.  "Teach" occurs after the retest is changed in a positive manner and the treatment is taught to the patient. 

I would like to break this down a bit more today.
 
How do we come to the proper “test” to perform?  In my opinion the best test should be part of an activity or motion pattern, a position that is bothersome or reproduces the concordant symptoms. A test can also be a specific limitation or positive finding such as ROM, strength, gait deviation etc.  We can obtain this “test” through several mechanisms:

1.       Listening – This may be done during the subjective exam.  It may also be obtained through objective data collection as the patient verbalizes specific sensation.
2.       Looking- This is almost always obtained through objective data collection, via measurements (degrees etc.), movement patterns (gait etc.)  Occasionally the patient may wince, or guard with movement patterns that may be observed.
3.       Feeling – This also typically obtained through objective data collection and consists of joint mobility, swelling, tone, palpation etc.

Data collection is illustrated through this model below:

 Clinical reasoning invertabelt

Part II of Clinical Reasoning Framework examines treatment validation through retesting.