Clinical reasoning in osteopathy : an investigation of diagnostic hypothesis generation for patients with acute low back pain

Abstract

BACKGROUND: The clinical reasoning strategies employed in healthcare have been well established in a wide range of health professions. Currently, there is little literature pertaining to the diagnostic process of osteopaths and the clinical reasoning strategies utilised in osteopathy.

AIM:To investigate the processes of clinical reasoning utilised by osteopaths in the diagnostic hypothesis generation for patients with acute low back pain.

METHODS: Two methods were employed: a thematic analysis in conjunction with content analysis which involved a novel ‘consultation mapping’ approach. Three osteopaths were video recorded taking a case history and performing examination procedures. Following conclusion of each consultation, participants viewed a video recording of the consultation, and provided a commentary which was audio recorded. All audio and video recordings were later transcribed for analysis.

RESULTS: Three themes were identified from the data which broadly represented three existing clinical reasoning strategies: Implicit cognitive evaluations not apparent to an external observer (pattern recognition); Iterative processing of cues assembled through clinical interactions (hypothetico-deductive reasoning); Collaborative interaction between patient and practitioner (collaborative reasoning). Each consultation was then ‘mapped’, and content analysis showed dynamic transitioning between three levels of pattern recognition (‘light’, ‘moderate’, ‘heavy’) of hypothetico-deductive reasoning. Collaborative reasoning occurred consistently at the commencement and conclusion of each consultation.

CONCLUSIONS:The clinical reasoning strategies employed by osteopaths in this study were pattern recognition, hypothetico-deductive reasoning and collaborative reasoning. Each strategy was characterised by a theme which described its meaning.