Clinical Reasoning
Indha elavula nee potuko 
Objectives
• What is Clinical Reasoning ?
• What Are The Factors Influencing In Clinical
Decision Making.
• Decision Tree Process And The Mental
Strategies During Decision Tree Process
• Models Of Clinical Reasoning
• Clinical Reasoning Steps
• Clinical Reasoning Overview
What Is clinical Reasoning
Clinical reasoning can be defined as the
cognitive processes, or thinking used in the
evaluation and management of a patient.
Clinical reasoning is “the sum of the thinking
and decision-making processes associated
with clinical practice”.
Factors Influencing Clinical Decision
Making
 Clinician goals , values, belief
 Psychosocial skills
 Knowledge &expertise
 Problem solving strategies
 Procedural skills
 Environment(resources , time, finance)
Patient / Client Centered Model
Models Of Clinical Reasoning
Pattern Recognition
Hypothetico – Deductive Reasoning and
Problem Solving
Pattern Recognition
It Used By The Experts.
• Pattern recognition is a characteristic of all
mature thought. In .both everyday life and in the
realm of manual therapy, knowledge is stored in
our memory in chunks or patterns that facilitate
more efficient communication and thinking.
• The experienced situations that individuals use to
recognize and interpret other situations.
• In manual therapy. patterns exist not only in classic diagnostic
syndromes and associated management strategies but also in the
patho-biological mechanisms associated with those syndromes and
the multitude of environmental. physical. psychological (cognitive
and affective). social. behavioral and cultural factors that
contribute to the development and maintenance of patients
problems.
• For example. it is possible to recognize the typical clinical features
of a shoulder subacromial impingement problem. as well as
different patterns of common anatomical. biomechanical. motor
patterning and technique/equipment factors that can contribute to
this disorder.
• Importantly patients can have the same pathology but quite
different contributing factors. necessitating different and very
individualized management if success is to be realized and
maintained.
 Manual therapists also must be able to recognize patterns of
biomedical factors that contraindicate manual therapy. such
as clinical red flags .
 Pattern recognition is required to generate hypotheses and
hypothesis testing provides the means by which those
patterns are refined proved reliable and new patterns are
learned.
 While expert therapists are able to function largely on pattern
recognition. Novices who lack sufficient knowledge and
experience to recognize clinical patterns will rely on the
slower hypothesis testing approach to work through a
problem.
 It has been suggested that it takes at least 10years of
experience to obtain proficiency in any profession .
Hypothetico – Deductive Reasoning
• Is Also Called BACKWARD REASONING.
• It used By the Novice therapist.
• In which it involves in:• Cue Identification
• Proposing The Hypothesis
• Gathering The Supporting Data
• Evaluating The Hypothesis
• Determining The Appropriate Action
Hypothetico – Deductive Reasoning
• Understanding the clinical reasoning underlying a
physiotherapist’s assessment and management of a
patient requires consideration of the thinking process
of the therapist, the patient and the shared decision
making between the two.
• In all physiotherapy settings, the physiotherapist’s
reasoning begins with the initial data/cues obtained
(e.g. referral, observation of the patient). This
preliminary information will evoke a range of
impressions or working interpretations. While typically
not thought of as such, they can be considered
hypotheses in the sense that these initial
interpretations are not fixed, final decisions.
• Hypothesis generation involves a combination
of specific data interpretations or inductions
and the synthesis of multiple clues or
deductions. In most settings the initial
hypotheses are quite broad, for example in an
outpatient setting.
• Initial hypotheses may be physical,
psychological or socially related, with or
without a ‘diagnostic’ implication.
CLINICAL REASONING STEPS
• Examination
• History
• Systems review
• Tests & measure
HISTORY(APTA)
• General demographics, social h\o,
• work place, growth & development,
• living environment,general health status.
• Social health habits,family h\o,
• medical \ surgical h\o,
• chief complaints, functional status &
• activity level,medications,other clinical tests
SYSTEMS REVIEW
• Screening examination, quickly scan body
systems
• Determine areas of intact function &
dysfunction
• Identify risk factors
• Screen inv observation, chart review, oral h\o,
brief examination.
TESTS & MEASURES
• Provide objective data to determine degree of
specific function &dysfunction
• Eg :1. ROM
2. MMT
3. JOINT PLAY
4. MUSCLE LENGTH
5. SPECIAL TESTS
EVALUATION
• Data to be analyzed and organized
• Problem listing
• Level of impairment, degree of functional loss,
disability
• Functional classification (ICF)
Body structures
Activity limitation
Participation restriction
Clinical Reasoning Overview