I've had a few new clients lately who were surprised when I've sat down with them to go through goal setting, and then use this to guide assessment and therapy planning. On questioning these clients, they reported that the physios they've seen before just followed an exercise sheet and they just went through the list... ticking boxes.
So, I thought I'd put down some words on my thoughts of the clinical reasoning process and what you should expect from your physio.
Clinical reasoning is the process of thinking and decision making that guides the practice of physiotherapy. It involves gathering and interpreting information, generating and testing hypotheses, applying evidence and experience, and evaluating outcomes and actions. Clinical reasoning is essential for providing effective and safe physiotherapy interventions that are tailored to the individual needs and goals of each client.
Clinical reasoning is especially important in neurological physiotherapy, where clients present with complex and diverse conditions that affect their movement, function and quality of life. Neurological physiotherapists work with clients who have acquired or congenital disorders of the brain, spinal cord or peripheral nerves, such as stroke, traumatic brain injury, spinal cord injury, multiple sclerosis, Parkinson's disease, cerebral palsy and peripheral neuropathy. These conditions can cause a range of impairments and disabilities that affect the motor, sensory, cognitive and emotional domains of functioning.
Neurological physiotherapists use clinical reasoning to assess, diagnose, treat and evaluate clients with neurological conditions. They use a biopsychosocial approach that considers not only the biological aspects of the condition, but also the psychological and social factors that influence the client's health and well-being. They also use a client-centred approach that respects the client's preferences, values and goals, and involves them in shared decision making.
The process of clinical reasoning in neurological physiotherapy can be divided into four main stages:
- Data collection: This involves gathering relevant information from various sources, such as the client's history, physical examination, medical records, imaging results, standardised tests and outcome measures. The physiotherapist uses observation, questioning, objective measures and other techniques to collect data that can help identify the client's problems and potential solutions.
- Data analysis: This involves interpreting and synthesizing the data collected to form a clinical impression or diagnosis. The physiotherapist uses reasoning strategies such as pattern recognition, hypothetico-deductive reasoning, narrative reasoning and abductive reasoning to generate and test hypotheses about the client's condition and its underlying causes. The physiotherapist also uses evidence from research and clinical guidelines to support their reasoning and judgment.
- Intervention planning: This involves selecting and implementing appropriate physiotherapy interventions that address the client's problems and goals. The physiotherapist uses reasoning strategies such as pragmatic reasoning, ethical reasoning and collaborative reasoning to choose the best course of action for the client. The physiotherapist also considers the available resources, time constraints and potential risks and benefits of each intervention.
- Intervention evaluation: This involves monitoring and measuring the effects of the physiotherapy interventions on the client's outcomes. The physiotherapist uses reasoning strategies such as reflective reasoning, critical thinking and feedback to evaluate the effectiveness and efficiency of their interventions. The physiotherapist also modifies or adapts their interventions based on the client's response and progress.
Clinical reasoning is a dynamic and iterative process that requires constant learning and improvement. Neurological physiotherapists need to update their knowledge and skills regularly to keep up with the advances in neuroscience and neurorehabilitation. They also need to reflect on their own practice and seek feedback from their clients, colleagues and mentors to enhance their clinical reasoning abilities.
At Cortex Neuro Rehab, Ashan Weerakkody is a highly qualified and experienced neurological physiotherapist who uses clinical reasoning to provide evidence-based and person-centred care for our clients. We use a holistic approach that addresses not only the physical aspects of neurological conditions, but also the cognitive, emotional and social aspects. We also work collaboratively with other health professionals that you're involved with to ensure that you receive comprehensive and integrated care.
If you or someone you know has a neurological condition that affects your movement or function, or if you have any questions about neurological physiotherapy or clinical reasoning, please contact us today. We would love to hear from you and help you achieve your rehab goals.
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