Open Access Open Access  Restricted Access Subscription Access


Amir Ur Rehman, Muhammad A Siddiqui, Suhel Ashraff, Abdul Ghafoor Sajjad, Haider Darain


This paper aims to describe the clinical reasoning behind the diagnosis and management process used by a physiotherapist working in a musculoskeletal outpatient department. The therapist was videotaped while attending to a patient having osteoarthritis of left knee, which he came across in his initial phase of musculoskeletal practice. In the analysis, the therapist was trying to reflect on his practice describing the thoughts and consideration on which he had diagnosed the condition of patient as osteoarthritis of knee. The model called hypothetico deductive reasoning served as the mainframe work for the reflection of practice employed by this physiotherapist. This paper explores these findings and relating them to the research in the field of reasoning. 


Clinical knowledge, clinical reasoning, collaboration, diagnosis, illness experience, individual patient, musculoskeletal care, osteoarthritis, pain experience, person-centered healthcare, physiotherapy, reflective practice, relationship-centered care,

Full Text:



Higgs, J. (1993). Physiotherapy, professionalism, and self-directed learning. Journal of the Singapore Physiotherapy Association 14, 8-11.

Harris, I.B. (1993). New expectations for professional competence. In: Educating Professionals: Responding to New Expectations for Competence and Accountability. pp. 17-52. San Francisco: Jossey-Bass.

Feltovich, P.J., Johnson, P.E., Moller, J.H. & Swanson, D.B. (1984). The role and development of medical knowledge in diagnostic expertise. In: Readings in Medical Artificial Intelligence, pp. 275-319. Boston, MA: Addison Wesley.

Jones, J.A. (1988). Clinical reasoning in nursing. Journal of Advanced Nursing 13, 185-192.

Jones, M., Gail, J. & Edward, I. (2000). Clinical Reasoning in physiotherapy. In: Clinical Reasoning in the Health Professions, pp. 116-127. Oxford: Butterworth-Heinemann.

Higgs, J. & Hunt, A. (1999). Rethinking the beginning practitioner: introducing the "Interactional Professional.” In: Educating Beginning Practitioners. Higgs J, Edwards H, (eds.), pp. 10.-18. Melbourne: Butterworth-Heinemann.

Higgs, J. & Jones, M.A. (2000). Clinical reasoning in the health professions. In: Clinical Reasoning in the Health Professions. 2nd edn., pp. 3-14. Boston: Butterworth-Heinemann.

Rothstein, J.M., Echternach, J.L. & Riddle, D.L. (2003). The hypothesis-oriented algorithm for clinicians II (HOAC II): a guide for patient management. Physical Therapy 83, 455-470.

Elstein, A.S., Shulman, L.S. & Sprafka, S.A. (1978). Medical Problem solving: An Analysis of Clinical Reasoning. Cambridge, MA: Harvard University Press.

Higgs, J. & Titchen, A. (2000). Knowledge and reasoning. In: Clinical Reasoning in the Health Professions. Higgs J, Jones MA, (eds.), pp. 23-32.Oxford: Butterworth-Heinemann.

Arocha, J.F., Patel, V.L. & Patel, Y.C. (1993). Hypothesis generation and the coordination of theory and evidence in novice diagnostic reasoning. Medical Decision Making 13, 198-211.

Nickerson, R.S., Perkins, D.N. & Smith, E.E. (1985). The teaching of thinking. Hillsdale, NJ: Lawrence Erlbaum.

Polanyi, M. (1958). Personal knowledge: Towards a post critical philosophy. London: Falmer press.

Schmidt, H.G., Boshuizen, H.P.A. & Norman, G.R. (1992). Reflections on the nature of expertise in medicine. In: Deep Models for Medical Knowledge Engineering. Keravnou E, (ed.), pp. 231-248. Amsterdam, The Netherlands: Elsevier.

Thomas-Edding, D. (1987). Clinical problem solving in physical therapy and its implications for curriculum development. In: Proceedings of the Tenth International Congress of the World Confederation for Physical Therapy, May 17-22, Sydney, Australia. London, United Kingdom: World Confederation for Physical Therapy, 100-104.

Jones, M.A. (1992). Clinical reasoning in manual therapy. Physical Therapy 72, 875-884.

Fleming, M.H. (1991). The therapist with the three-track mind. American Journal of Occupational Therapy 45 (11) 1007-1014.

Schon, D.A. (1983). The Reflective Practitioner: How Professionals Think in Action. New York: Basic books.

Padrick, K., Tanner, C., Putzier, D. & Westfall, U. (1987). Hypothesis evaluation: A component of diagnostic reasoning. In: Classification of Nursing Diagnosis: proceeding of the seventh conference, pp. 299-305. Torento: Mosby.

Borkan, J.M., Quirk, M. & Sullivan, M. (1991). Finding meaning after the fall: injury narratives from elderly hip fracture patients. Social Sciences and Medicine 33, 947-957.

Malt, U.F. & Olafson, O.M. (1995). Psychology appraisal, and emotional response to physical injury: a clinical and phenomenological study of 109 adults. Psychiatric Medicine 10, 117-134.

Edwards, I., Jones, M., Carr, J., Braunack-Mayer, A. & Jensen, G. (2004). Clinical reasoning strategies in physical therapy. Physical Therapy 84 (4) 312-335.

Charles, C., Gafni, A. & Whelan, T.(1999).Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Social Science and Medicine 49 (5) 651-661.

Ridderikhoff, J. (1989). Methods in Medicine: a descriptive study of physician’s behaviour. Dordrecht: Kluwer.

Mattingly, C. & Fleming, M. (1994). Clinical Reasoning: forms of inquiry in therapeutic practice. Philadelphia: F.A. Davis Company.

Clarke, R. (1988). Problem-Learning. In: The Medical Teacher.Cox KR. and Ewan CE. (eds.). Edinburgh: Churchill Livingstone.

Norman, G.R. (1998). Problem-solving skill, Solving Problems and Problem-based Learning. Medical Education 22, 279-286.

Bordage, G. & Lemieux, M. (1991).Semantic structures and diagnostic thinking of expert and novices. Academic Medicine 9, 70-71.

Bordage, G., Grant, J. & Marsden, P. (1990). Quantitative assessment of diagnostic ability. Medical Education 24, 413-425.



  • There are currently no refbacks.