Osteopathic clinical reasoning for the diagnosis and management of pelvic girdle pain associated with pregnancy : an interpretive descriptive study

Abstract

Background: There is an increase in the amount of research on clinical reasoning in a wide range of healthcare professions but the availability of clinical reasoning literature in osteopathy remains limited. Pregnant women consult osteopaths for pelvic girdle related issues, although there appears to be no research investigating clinical reasoning of osteopaths with these women.

Aims: (1) To explore the osteopathic clinical reasoning for the diagnosis and management of pelvic girdle pain (PGP) in pregnancy; and (2) To identify the key differences between the clinical reasoning of experienced osteopaths with, and without, a specific interest in obstetrics .

Methods: Five consultations were video recorded and followed by an audio-recorded semi-structured interview reflecting on the video previously recorded. Each interview was transcribed for further thematic analysis.

Results: Three themes were identified from the data which represented the different facets/aspects of clinical reasoning: (1) Setting up the field to activate the process of clinical reasoning (2) The dynamics of reasoning: the strategies used to organise and interpret information and (3) A subtle difference shaped by contextual variances.

Conclusion: Osteopathic clinical reasoning for the diagnosis and management of PGP was somewhat similar from one practitioner to another. However, key elements such as faster access to a broader knowledge base, higher certainty and ability to prioritize questioning for patient’s safety were found in experienced osteopaths with specific interest in obstetrics. Further research should be undertaken regarding the similarities and differences between osteopaths with different levels of experience in clinical management of women with pregnancy related PGP.