Clinical Decision Making in the Identification of Patients Likely to Benefit From Spinal Manipulation: A Traditional Versus an Evidence-Based Approach

The role of clinician emotion in clinical reasoning: Balancing the analytical process

“…The musculoskeletal physiotherapy literature surrounding therapists and reasoning suggests that clinicians commonly may generate initial hypotheses and subsequently test them via questioning or physical examination procedures (hypotheticodeductive) in a deductive way from a general presentation resulting to one that is more specific (Jones 1995;Loftus and Smith 2008). They attempt to recognise clinical patterns that have been experienced before (pattern-recognition) (Patel et al 1997), clinicians may create an understanding of the patient story (narrative reasoning) (Mattingly 1991;Mattingly and Fleming 1994) or identify a number of clinical variables that when presented together suggest a treatment plan (clinical prediction) (Childs et al 2004). In addition to these commonly cited musculoskeletal models there are other less familiar methods of reasoning identified such as ethical and procedural: Ethical reasoning requires the knowledge of ethical principles, codes of conduct and professional standards and applies these when confronted by a clinical dilemma (Barnitt & Partridge 1997;Edwards and Delaney 2008).…”

“…This interactive process then further evidences the clinical decision (Childs et al 2003;Curran et al 2006;Doody & McAteer 2002;Noll et al 2001;Orme & Maggs 1993). Musculoskeletal physiotherapy research has seen common reference to models such as hypothetico-deductive, pattern-recognition, narrative reasoning and clinical prediction (Childs et al 2004;Jensen et al 2000;Jones et al 2008;Mattingly and Fleming 1994). Models such as these and others have described the components of the process of reasoning and explained temporal sequencing, however they take little account of the role of emotion and physical responses that the clinician may experience when reasoning through a patient presentation.…”

“…This synthesising process involves considering many facets of patient data, clinician experience, clinician knowledge, and the literature (Higgs and Jones 2008;Simmons 2010). This interactive process then further evidences the clinical decision (Childs et al 2003;Curran et al 2006;Doody & McAteer 2002;Noll et al 2001;Orme & Maggs 1993). Musculoskeletal physiotherapy research has seen common reference to models such as hypothetico-deductive, pattern-recognition, narrative reasoning and clinical prediction (Childs et al 2004;Jensen et al 2000;Jones et al 2008;Mattingly and Fleming 1994).…”

Use of Lumbosacral Region Manipulation and Therapeutic Exercises for a Patient With a Lumbosacral Transitional Vertebra and Low Back Pain

“…The patient in this case report presented with 3 of the 5 clinical predictors for success reported by Flynn et al 17 There is also additional evidence for the effectiveness of manipulation for the treatment of patients with LBP. 10,[15][16][17] The lumbosacral region manipulation (LSM) (Figure 2) used in the Flynn et al 17 study is one technique that has been shown to be effective in the treatment of LBP. 10,16,17 The term lumbosacral region is used because it is not known whether this method results in manipulation of the L4-L5, L5-S1, or the sacroiliac joints.…”

“…10,[15][16][17] The lumbosacral region manipulation (LSM) (Figure 2) used in the Flynn et al 17 study is one technique that has been shown to be effective in the treatment of LBP. 10,16,17 The term lumbosacral region is used because it is not known whether this method results in manipulation of the L4-L5, L5-S1, or the sacroiliac joints. 17 It is also reported that the LSM does not require identification or targeting of a specific segment with hypomobility in order to be effective.…”