- 作者：Simon A. Roots ; simonroots23@gmail.com" class="auth_mail" title="E-mail the corresponding author ; Elizabeth Niven ; Robert W. Moran
- 关键词：Acute low back pain ; Clinical reasoning ; Osteopathy ; Video analysis
- 刊名：International Journal of Osteopathic Medicine
- 出版年：2016
- 出版时间：March 2016
- 年：2016
- 卷：19
- 期：Complete
- 页码：20-34
- 全文大小：612 K
Aim
To investigate the processes of clinical reasoning utilised by osteopaths in the diagnostic hypothesis generation for patients with acute low back pain.
Methods
Two methods were employed: a thematic analysis in conjunction with content analysis which involved a novel ‘consultation mapping’ approach. Three osteopaths were video recorded taking a case history and performing examination procedures. Following conclusion of each consultation, participants viewed a video recording of the consultation, and provided a commentary which was audio recorded. All audio and video recordings were later transcribed for analysis.
Results
Three themes were identified from the data which broadly represented three existing clinical reasoning strategies: Implicit cognitive evaluations not apparent to an external observer (pattern recognition); Iterative processing of cues assembled through clinical interactions (hypothetico-deductive reasoning); Collaborative interaction between patient and practitioner (collaborative reasoning). Each consultation was then ‘mapped’, and content analysis showed dynamic transitioning between three levels of pattern recognition (‘light’, ‘moderate’, ‘heavy’) of hypothetico-deductive reasoning. Collaborative reasoning occurred consistently at the commencement and conclusion of each consultation.
Conclusions
The clinical reasoning strategies employed by osteopaths in this study were pattern recognition, hypothetico-deductive reasoning and collaborative reasoning. Each strategy was characterised by a theme which described its meaning.