Clinical Reasoning: The “why” behind everything!

Clinical reasoning or clinical judgement is the justification or interpretation of the assessment and diagnosis by a therapist with regard to the treatment or rehabilitation protocol designed by her/him for the patient. To put simply it is the explanation of why the therapist is treating the patient in a specific fashion chosen by him/her and what results can be expected.

Why is clinical reasoning necessary?

Specific conditions have specific impairments and are diagnosed and confirmed by finding the reason behind the impairments. It is expected that every therapist comes up with a definitive diagnosis of the condition and its management with sufficient reasoning to prove the same. This can only be achieved by a detailed assessment and hypothesis of the possible anomalies that may be causing the complaints. This is done by ruling out conditions from the differential diagnosis by key findings obtained by examining the patient.

When a therapist has followed the above mentioned procedure giving clinical reasoning for the condition and understanding of how his treatment protocol will be effective becomes clear in his mind. Making it simpler to explain it to the patient and other therapists.

To discern, let us consider a common knee pain. Patient complains of - Knee pain, swelling over the knee and morning stiffness. Instead of assessing the patient for the most probable condition. Create a list of differential diagnosis- OA, RA, Bursitis, Tendonitis etc and perform detailed assessment for all of them. If the tests come out negative for bursitis and tendonitis, then it most probably is patellofemoral OA.

Why is it OA and not the rest?

Here the practitioner gives the clinical reason! There was no tenderness at the tendon(ruling out tendonitis) or the location of the pain was not specific to a bursa(ruling out bursitis) and the Clarke Test came out positive, indicating cartilage damage. The OA can be then confirmed using an investigation(XRay).

How can it affect your practice and treatment outcomes?

When a therapist understands the underlying flaw and works to correct it instead of just giving treatment based on the patients complaints, the results seen are more effective and long lasting.

For instance when a patient complains of restricted shoulder ranges. The possible causes can be abnormal posture, overused muscles, capsular adhesions. Interestingly all cause pain. If the therapist doesn’t know the why behind the pain, he’ll just treat the pain and not the cause.

Understanding the exact pathology causing it and designing the protocol around it is essential instead of just pain relieving modalities and range of motion improving exercises.

Why is it even more important in this era of social media?

While social media is a boon and a great place to learn new techniques from skilled professionals across the globe it is also a

sensitive source to pick up protocols from. The information regarding why or how a technique is being applied can only be explained up to a certain limit due to the restraints set by the social media content allowance.

Majority of the techniques shown are being performed by therapists who understand the condition and the effect of treatment really well. It is thus necessary and wise for therapists who wish to adapt these techniques should first understand the effect of the treatment and the sort of pathologies that it can be applied for. A detailed understanding will also give them clarity in reasoning why these techniques may prove beneficial for their patients as well.

We also recommend getting in touch with the therapists by sending them a formal message to understand their treatment approach better. Most therapists do respond to genuine queries and help in better understanding.

How to decide what exercises can actually be applied?

As mentioned above after detailed examination and proper understanding of the condition and awareness of treatment options for the same a therapist can have a better scenario when looking for exercises and treatment modules that can be adapted. Exercises should be based to treat the patient with respect to its underlying pathology and not just his symptoms, not to forget his functional requirements. Once this is clear a therapist can experiment with variable exercise protocols that he feels can help the patient’s underlying cause and thus improve his symptoms. Giving reasoning for these exercises gets much simpler now as

the therapist shall now be aware of the purpose of him making the judgement of adapting this protocol.

Clarifying the difference between Explanation and Reasoning

Explaining the patient an exercise protocol in a simpler language so that he understands it better is very different than clinical reasoning. Clinical reasoning is the why behind a therapist’s judgement of a diagnosis and his treatment options.

We hope this blog helped you with understanding the significance of clinical reasoning better. We would urge you to take the extra efforts and design treatment protocols in a well reasoned format. This shall not only make us good practitioners but also benefit our patients significantly.

Do share this blog with anyone you think this shall be helpful for. Thank you for reading!

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