Osteopaths' clinical reasoning during consultation with patients experiencing acute low back pain: A qualitative case study approach

BackgroundThe clinical reasoning strategies employed in healthcare have been well established in a wide range of health professions. Currently, there is little literature pertaining to the diagnostic process of osteopaths and the clinical reasoning strategies utilised in osteopathy.AimTo investigate the processes of clinical reasoning utilised by osteopaths in the diagnostic hypothesis generation for patients with acute low back pain.MethodsTwo 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.ResultsThree 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.ConclusionsThe 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.