Clinical Reasoning in Manual Therapy

Clinical reasoning refers to the cognitive processes or thinking used in the evalua-tion and management of a patient. In this article, clinical reasoning research and expert-novice studies are examined to provide insight into the growing un-derstanding of clinical reasoning and the nature of expertise. Although bypothetic~deductive method of reasoning are used by clinicians at all leuels of experience, experts appear to poses a superior otganization of knowledge. Ex-perts oflen reach a diagnosis based on pure pattern recognition of clinical pat-terns. With an atypical problem, however, the expert, like the novice, appears to rely more on bypotheticedeductive clinical reasoning. Five categories of hypothe-ses are pmposed for physical therapists wing a bypothetico-deductive method of clinical reasoning. A model of the clinical reasoning proces for physical therapists is presented to bring attention to the hypothesis generation, testing, and modijica-tion that I feel should take place through all aspects of the patient encounter. Examples of common errors in clinical reasoning are highlighted, and sugges-tions for facilitating clinical reasoning in our students are made. [Jones MA. Clinical reasoning in manual therapy. Pbys Ther 1992; 72:875-884.