Clinical Reasoning For Clinical Decisions Of Shoulder Pain

Published on: 2018/05/11

Dr. Bhavna Mhatre, PT. Physiotherapy School & Centre, Seth G.S Medical College & KEM Hospital, Mumbai, India


Introduction to direct access or first contact practice has increased accountability of Physiotherapist within the profession and outside including competing health practitioners and health-conscious consumer. Hence, a recognize  need to define and promote those characteristics that lead to superior clinical performance exists within the profession in order to firmly establish physiotherapist as autonomous, competent health care professionals capable of sound clinical decision making and effective patient management.

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Clinical reasoning, Physiotherapy, Shoulder pain management case study

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Clinical reasoning: What is the clinical reasoning behind physiotherapy?

It is the process of thinking and decision making that is necessary for clinical practice, which forms the basis for the diagnosis and management of the patients. It is a process in which the physiotherapist interacts with the patients and his/her family members.

The main aim of clinical reasoning is to find out the best course of action based on the clinical choices, professional knowledge, and judgment.

In the recent years, a lot of focus has been on clinical reasoning owing to an increase in accountability with respect to the decisions made to achieve a desirable outcome. With the increase in accountability, This reasoning helps a physiotherapist to improve decision-making and enables constant learning.

Clinical reasoning process for shoulder pain

The process mainly involves diagnostic reasoning. In many cases, narrative reasoning or patient interaction helps to assess the physiological conditions and also how the pain/disability is affecting the person’s life.

Through clinical reasoning, the physiotherapist draws a meaningful story or therapeutic story of the patient which helps him to design a course of action.

In this paper, Dr. Bhavna Mhatre discusses the clinical reasoning process for a patient with shoulder pain. She explains how clinical decisions are made regarding treatment courses. Clinical reasoning case study – Read more on Clinical Reasoning For Clinical Decisions Of Shoulder Pain by Dr. Bhavna Mhatre

What are the models of Clinical reasoning?

There are three main models of clinical reasoning. They are:

  1. Hypothetico-deductive reasoning – a process which begins as soon as a physiotherapist meets the patient. This model involves continuous data collection.
  2. Pattern recognition – a process followed by novice physiotherapists or beginners
  3. Problem-solving

Critical thinking vs clinical reasoning

Critical thinking is a higher level thinking process to define a patient’s problem. It is not a mere acquisition of information but the manner in which the information is gathered. Critical thinking is a process of continuous evaluation of information and also analyses of the results. Clinical reasoning, on the other hand, involves decision making with respect to choices and course of actions.

Why is it important for physiotherapists?

Clinical reasoning helps a physiotherapist understand the physiological and psychological aspects of a patient. This helps him to design a course of action with the available clinical choice which will be suitable for the patient. Clinical reasoning is a skill that needs to be developed by physiotherapists to give the best treatment for the patients