Clinical reasoning and evidence-based practice in physiotherapy are the new buzz-word phrases in physiotherapy recently. Every physio has it drilled into them that their diagnoses, advice and treatment must be well clinically reasoned and treatment must be evidenced based. But what does this really mean?
Clinical reasoning means evaluating the clinical information gained from the patient – what the patient has said about their pain, how the injury happened, what makes it better, what makes it worse, how the symptoms differ throughout the day, all classified as subjective information.
Then there is also seeing how the patient moves, testing what muscles or joints restrictions the patient has, testing muscle strength and using “special tests” that identify specific structures that might be injured – all classified as objective information.
Once the physio has the subjective and objective information they must then come up with a hypothesis of what the problem is. Once the problem has been clinically reasoned then a treatment plan can be designed – whether this is physiotherapy or onward referral to other healthcare professionals.
Evidence based practice means choosing treatment strategies that are shown to be effective though clinical experience and also supported by research finding from clinical trials.
Unfortunately, it takes between 10-20 years for evidence from peer-reviewed research to become part of mainstream physiotherapy practice. And there are thousands or research papers published every week so keeping up to date with all this research becomes a huge task.
As a physic it is vital that we understand how to find the relevant research, how to appraise it and how to apply it to our practice.
But we also need to remember that evidence based practice is not just about using treatment that has been proven to work through research papers, it’s also about using clinical experience on what works for specific types of patients as well as meeting the patients expectations.
This might otherwise be known as the placebo effect – using a treatment method that has little or no scientific evidence, but something that the patient believes in and feels makes them better.
A good physiotherapist will be able to evaluate all of this and have the knowledge and experience to know what to use in each situation to get the best outcome for the patient.