Clinical reasoning in osteopathy – More than just principles?

Published:January 24, 2011DOI:https://doi.org/10.1016/j.ijosm.2010.11.003

      Abstract

      Clinical reasoning is an integral part of clinical practice, and importantly for osteopaths, encompasses more than just the formulation of a diagnosis. With the advent of evidence-based practice health professionals are required to make explicit the strategies behind their clinical decisions. With many other health professions taking a critical view of their models of practice, there is an equal requirement for the osteopathic profession to reflect on and improve the transparency of clinical practice models used in osteopathy. This paper discusses the role of clinical reasoning in professional practice and the existing research in a number of health professions. It considers the need of such research in the osteopathic profession, and goes on to outline the methods by which clinical reasoning can be made visible through research.

      Keywords

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      References

        • General Osteopathc Council
        Surveys and statistics.
        (Available from)2010
        • National Institute for Health and Clinical Excellence
        Low back pain: early management of persistent non-specific low back pain (Clinical guideline 88).
        (Available from)2009
        • General Osteopathic Council
        Survey and statistics.
        (Available from)2001
        • The Department of Health
        Quality agenda. The Government’s Expenditure Plans 2000-2001: departmental report.
        (Available from)2000
        • Jones M.
        • Edwards I.
        • Gifford L.
        Conceptual models for implementing biopsychosocial theory in clinical practice.
        Man Ther. 2002; 7: 2-9
        • Jones M.A.
        Clinical reasoning in manual therapy.
        Phys Ther. 1992; 72: 875-884
        • Borrell-Carrio F.
        • Suchman A.L.
        • Epstein R.M.
        The biopsychosocial model 25 Years later: principles, practice, and scientific Inquiry.
        Ann Fam Med. 2004; 2: 576-582
        • Elstein A.S.
        • Shulman L.S.
        • Sprafka S.A.
        Medical problem solving: an analysis of clinical reasoning.
        Harvard University Press, Cambridge, Mass.; London1978
      1. Edwards I. Unpublished paper cited by Jones M: clinical reasoning and pain. Man Ther 1995;1

      2. Edwards I. Clinical reasoning in three different fields of physiotherapy. A qualitative case study approach. University of South Australia, Adelaide 2001;Vols. I and II. Unpublished PhD Dissertation

        • Fleming M.H.
        Clinical reasoning in medicine compared with clinical reasoning in occupational therapy.
        Am J Occup Ther. 1991; 45: 988-996
        • Jensen G.M.
        • Gwyer J.
        • Shepard K.F.
        Expert practice in physical therapy.
        Phys Ther. 2000; 80 (28-43; discussion): 44-52
        • Benner P.E.
        From novice to expert: excellence and power in clinical nursing practice.
        Addison-Wesley Pub. Co., Nursing Division, Menlo Park, Calif.1984
        • Higgs J.
        • Jones M.A.
        Clinical reasoning in the health professions.
        in: Higgs J. Jones M. Clinical reasoning in the health professions. 2nd ed. Butterworth-Heinemann, Oxford2000: 3-14
        • Higgs J.
        • Jones M.
        • Edwards I.
        • Beeston S.
        Clinical reasoning and practice knowledge.
        in: Higgs J. Richardson B. Dahlgren M.A. Developing practice knowledge for health professionals. Butterworth Heinemann, Edinburgh2004: 181-199
        • Higgs J.
        • Jones M.A.
        Clinical reasoning: an introduction.
        in: Higgs J. Jones M. Clinical reasoning in the health professions. 2nd ed. Butterworth-Heinemann, Oxford2000 (xiv, 322 pp.)
        • Mattingly C.
        What is clinical reasoning?.
        Am J Occup Ther. 1991; 45: 979-986
        • Mattingly C.
        The narrative nature of clinical reasoning.
        Am J Occup Ther. 1991; 45: 998-1005
        • Fleming M.H.
        The therapist with the three-track mind.
        Am J Occup Ther. 1991; 45: 1007-1014
        • Edwards I.
        • Jones M.
        • Carr J.
        • Braunack-Mayer A.
        • Jensen G.M.
        Clinical reasoning strategies in physical therapy.
        Phys Ther. 2004; 84: 312-330
        • Edwards I.
        • Jones M.
        • Higgs J.
        • Trede F.
        • Jensen G.
        What is collaborative reasoning?.
        Adv Physiother. 2004; 6: 70-83
        • Benner P.
        • Tanner C.
        • Chesla C.
        From beginner to expert: gaining a differentiated clinical world in critical care nursing.
        ANS Adv Nurs Sci. 1992; 14: 13-28
        • Payton O.D.
        Clinical reasoning process in physical therapy.
        Phys Ther. 1985; 65: 924-928
        • Rogers J.C.
        • Holm M.B.
        Occupational therapy diagnostic reasoning: a component of clinical reasoning.
        Am J Occup Ther. 1991; 45: 1045-1053
        • Tanner C.A.
        • Padrick K.P.
        • Westfall U.E.
        • Putzier D.J.
        Diagnostic reasoning strategies of nurses and nursing students.
        Nurse Res. 1987; 36: 358-365
        • Doody C.
        • McAteer M.
        Clinical reasoning of expert and novice physiotherapists in an outpatient orthopaedic setting.
        Physiotherapy. 2002; 88: 258-268
        • Unsworth C.A.
        The clinical reasoning of novice and expert occupational therapists.
        Scand J Occup Ther. 2001; 8: 163-173
        • Benner P.A.
        • Tanner C.A.
        • Chesla C.A.
        Expertise in nursing practice: caring, clinical judgement and ethics.
        Springer Pub. Co, New York1996
        • Mattingly C.
        • Fleming M.H.
        Clinical reasoning: forms of inquiry in a therapeutic practice.
        F.A. Davis, Philadelphia1994
        • Jensen G.M.
        • Gwyer J.M.
        • Hack L.M.
        • Shepard K.F.
        Expertise in physical therapy practice.
        Oxford: Butterworth-Heinemann, Boston, Mass1999
        • Sluijs E.M.
        Patient education in physiotherapy: towards a planned approach.
        Physiotherapy. 1991; 77: 503-508
        • Fisher A.
        • Fonteyn M.
        An exploration of an innovative methodological approach for examining nurses’ heuristic use in clinical practice.
        Sch Inq Nurs Pract. 1995; 9 (263-76; discussion): 277-279
        • Schell B.
        • Cervero R.
        Clinical reasoning in occupational therapy: an integrative review.
        Am J Occup Ther. 1993; 47: 605
        • Unsworth C.A.
        Clinical reasoning: how do pragmatic reasoning, worldview and client-centredness fit?.
        Br J Occup Ther. 2004; 67: 10-19
        • Goethals S.
        • Gastmans C.
        • de Casterle B.D.
        Nurses’ ethical reasoning and behaviour: a literature review.
        Int J Nurs Stud. 2010; 47: 635-650
        • Gordon M.
        • Murphy C.P.
        • Candee D.
        • Hiltunen E.
        Clinical judgment: an integrated model.
        ANS Adv Nurs Sci. 1994; 16: 55-70
        • Beeston S.
        • Simons H.
        Physiotherapy practice: practitioners’ perspectives.
        Physiother Theory Pract. 1996; 12: 231-242
        • Edwards I.
        • Delany C.
        Ethical reasoning.
        in: Higgs J. Jones M. Loftus S. Christensen N. Clinical reasoning in the health professions. 3rd ed. Elsevier Butterworth-Heinemann, Oxford2008 (xiii, 504 pp.)
        • Higgs J.
        Clinical reasoning in the health professions.
        3rd ed. Elsevier Butterworth-Heinemann, Oxford2008
        • Jones M.
        • Jensen G.
        • Edwards
        Clinical reasoning in physiotherapy.
        in: Higgs J. Jones M. Loftus S. Christensen N. Clinical reasoning in the health professions. 3rd ed. Elsevier Butterworth-Heinemann, Oxford2008 (xiii, 504 pp.)
        • Jones M.A.
        • Rivett D.A.
        Introduction to clinical reasoning.
        in: Jones M.A. Rivett D.A. Clinical reasoning for manual therapists. Butterworth Heinemann, Edinburgh; New York2004 (xiv, 445 pp.)
        • Embrey D.G.
        • Guthrie M.R.
        • White O.R.
        • Dietz J.
        Clinical decision making by experienced and inexperienced pediatric physical therapists for children with Diplegic Cerebral Palsy.
        Phys Ther. 1996; 76: 20-33
        • Jensen G.M.
        • Shepard K.F.
        • Gwyer J.
        • Hack L.M.
        Attribute dimensions that distinguish master and novice physical therapy clinicians in orthopedic settings.
        Phys Ther. 1992; 72: 711-722
        • Jensen G.M.
        • Shepard K.F.
        • Hack L.M.
        The novice versus the experienced clinician: insights into the work of the physical therapist.
        Phys Ther. 1990; 70: 314-323
        • Resnik L.
        • Jensen G.M.
        Using clinical outcomes to explore the theory of expert practice in physical therapy.
        Phys Ther. 2003; 83: 1090-1106
        • Swanson H.L.
        Influence of metacognitive knowledge and aptitude on problem solving.
        J Educ Psychol. 1990; 82: 306-314
        • Terry W.
        • Higgs J.
        Educational programmes to develop clinical reasoning skills.
        Aust J Physiother. 1993; 37: 47-51
        • Groen G.J.
        • Patel V.L.
        Medical problem-solving: some questionable assumptions.
        Med Educ. 1985; 19: 95-100
        • Barrows H.S.
        • Feltovich P.J.
        The clinical reasoning process.
        Med Educ. 1987; 21: 86-91
        • Smith A.E.
        Osteopathic diagnosis: history taking.
        Br Osteopathic J. 1971; 5: 10-15
        • Smith A.E.
        Osteopathic diagnosis.
        Br Osteopathic J. 1971; 5: 2-8
      3. Esteves E. J. Clinical reasoning in osteopathy: a Comparative study of experienced and Advanced beginner Practitioners. Oxford Brookes Univ 2004;Unpublished thesis in partial fulfilment of the master of Arts in education

        • Sprafka S.A.
        Clinical problem solving.
        in: Ward R. Foundations for osteopathic medicine. 2nd ed. Lippincott Williams & Wilkins, Philadelphia2003: 257-279
        • Richardson B.
        • Higgs J.
        • Dahlgren M.A.
        Recognisng practice epistemology in the health professions.
        in: Higgs J. Richardson B. Dahlgren M.A. Developing practice knowledge for health professionals. Butterworth Heinemann, Edinburgh2004: 1-14
        • Sackett D.L.
        • Rosenberg W.M.
        • Gray J.A.
        • Haynes R.B.
        • Richardson W.S.
        Evidence based medicine: what it is and what it isn’t.
        BMJ. 1996; 312: 71-72
        • Portney L.G.
        Evidence-based practice and clinical decision making: it’s not just the research course anymore.
        J Phys Ther Educ. 2004; 18: 46-51
        • Higgs J.
        • Titchen A.
        Towards professional artistry and creativity in practice.
        in: Higgs J. Titchen A. Professional practice in health, education and the creative arts. Blackwell Science, Oxford2001: 273-290
        • GOsC
        General Osteopathic Council. Standard 2000. Framework and standard.
        GOsC, London2000
        • Higgs J.
        • Titchen A.
        Rethinking the practice-knowledge Interface in an Uncertain world: a model for practice development.
        Br J Occup Ther. 2001; 64: 526-533
        • Still A.T.
        Osteopathy: research & practice.
        Kirksville, 1910
        • Special Committee on Osteopathic Principles and Osteopathic Technique by Kirksville College of Osteopathy and Surgery
        The osteopathic concept. An interpretation.
        J Osteopathy. 1953; 60: 7-10
        • Rogers F.
        • D’Alonzo Jr., G.
        • Glover J.
        • Korr I.
        • Osborn G.
        • Patterson M.
        • et al.
        Proposed tenets of osteopathic medicine and principles for patient care.
        J Am Osteopath Assoc. 2002; 102: 63-65
        • Still A.T.
        Philosophy of osteopathy.
        Kirksville, 1899
        • Arocha J.F.
        • Patel V.L.
        Methods in the study of clinical reasoning.
        in: Higgs J. Jones M. Loftus S. Christensen N. Clinical reasoning in the health professions. 3rd ed. Elsevier Butterworth-Heinemann, Oxford2008 (xiii, 504 p)
        • Loftus S.
        • Smith M.
        A history of clinical reasoning research.
        in: Higgs J. Jones M. Loftus S. Christensen N. Clinical reasoning in the health professions. 3rd ed. Elsevier Butterworth-Heinemann, Oxford2008 (xiii, 504 p)
        • Patel V.L.
        • Groen G.J.
        • Arocha J.F.
        Medical expertise as a function of task difficulty.
        Mem Cognit. 1990; 18: 394-406
        • Gillette N.P.
        • Mattingly C.
        Clinical reasoning in occupational therapy.
        Am J Occup Ther. 1987; 41: 399-400
        • Unsworth C.
        Review of methodologies for researching clinical reasoning.
        in: Schell B.A.B. Schell J.W. Clinical and professional reasoning in occupational therapy. Lippincott Williams & Wilkins, Philadelphia, Pa.; London2008: 371-400
        • Fowler L.P.
        Clinical reasoning strategies used during care planning.
        Clin Nurs Res. 1997; 6: 349-361
        • Webb E.
        • Campbell D.
        • Schwartz R.
        • Sechrest L.
        Unobtrusive measures: nonreactive research in the social sciences.
        1966 (Chicago)
        • Unsworth C.A.
        Using a head-mounted video camera to explore current conceptualizations of clinical reasoning in occupational therapy.
        AJOT: Am J Occup Ther. 2005; 59: 31