Case study 2: Deductive versus inductive reasoning strategies Case Example Hypothetico-Deductive Reasoning
Application to Orthopedics
Deductive reasoning: ● Gathers relevant patient history. ● Multiple hypotheses are formulated based upon patient interview. ● Hypotheses are ruled in or out based upon results of tests and measures and patient interview to determine cause and effect. ● Performs additional tests and measures if necessary to determine health condition. Inductive reasoning: ● Understanding the patient’s story. ● Through inductive reasoning the therapist identifies the important contextual factors. ● Identifies the “pattern”
A 44-year-old female runner with knee pain.
The novice therapist asks the patient the following questions: ● When did the pain begin/incident? ● Where is the pain? ● When do you experience pain? ● How would you rate your pain? ● Does your pain limit your function? The novice therapist then: ● Considers hypotheses of lateral meniscus tear, iliotibial band syndrome, and osteoarthritis. ● Performs a checklist of tests and measures (observation of edema, A/ PROM, strength, posture, gait on level surfaces, stair climbing, squat, and special tests (McMurray, Thomas, and so on). The novice therapist interprets the results of the tests and measures and determines the patient demonstrates iliotibial band tightness, edema, negative McMurray test, decreased quad and hamstring strength, pain upon descending stairs at lateral knee WITHOUT popping or clicking. The novice therapist considers iliotibial band syndrome. The expert therapist ascertains from the patient her concern of 2 months of knee pain after running, inability to walk downstairs without pain, inability to transfer patients as part of her job as a Neuro PT, and provide financially for her family: ● The contextual factors important in this case are the family dynamics (financially providing for her family as pain interferes with job responsibilities), educational level of patient, determination in returning to pain free work and running. ● The therapist quickly recognizes the familiar movement/pain pattern of descending stairs without any popping/catching at the knee common in runners with tight iliotibial band and no pain/stiffness in the morning. The therapist asks about past medical history and running history and recognizes that the runner’s symptoms are similar to other runners who have had iliotibial band syndrome.
A 44-year-old runner with knee pain.
that exists between all patients that have this particular health condition.
● Clinical practice guidelines. Clinical prediction rules. ● Algorithms. The clinical mentor to a recently graduated clinician could facilitate the inductive reasoning process by asking the therapist to reflect upon the following questions: ● What was the most successful aspect of your interaction with the patient? Why do you think it was successful? ● What was the least successful aspect of your interaction with the patient? Why do you think it was unsuccessful? ● What will you do differently next time to make this a successful session for the patient? ● Reflection : Thinking about a situation or experience to gain a deeper level of understanding and knowledge. ● Workplace learning : Training prior to full time employment in the setting in which one plans to work. ● Teaching in Higher Ed This website has broad and general information about teaching in general and includes podcasts that are easy to listen to for short periods of time. Website : https://teachinginhighered.com Additional resources ● Jensen G. M., Gwyer, J., Hack, L. M., & Shepard, K. (Eds.). Expertise in physical therapy practice (2nd ed., pp. 240-253). St. Louis, MO: Elsevier. ● Jensen, G. M., Mostrom, E., & Shepard, K. F. In G. Jensen & E. Mostrom (Eds.) (2013). Handbook of teaching and learning for physical therapists (3rd ed., pp. 36-52). St. Louis, MO: Elsevier.
The case above highlights the differences in the clinical reasoning process of a student/novice learner using deductive reasoning versus a more experienced therapist using inductive reasoning. A novice learner requires more structure and organization to guide him or her thought process and action, thus deductive reasoning is the primary reasoning strategy. A clinical instructor can facilitate the clinical reasoning process of the student or novice learner by encouraging the learner to use the deductive tools described above including: ● International Classification of Functioning, Disability and Health Framework (ICF Framework). ● Patient management model. Glossary ● Clinical reasoning : The process of using reflection to determine an effective plan of care in collaboration with the patient and family. ● Narrative : The process of reflecting on an important experience, either positive or negative, to gain additional learning. Resources ● American Physical Therapy Association, Academy of Education This website has numerous documents and links applicable to clinical educators in physical therapy. Website : https://aptaeducation.org/ ● American Physical Therapy Association, Academy of Pediatric Physical Therapy This website lists numerous fact sheets related to pediatric physical therapy practice and education. Fact sheets are documents providing a brief summary of information relevant to physical therapists. Under BEST PRACTICE, click on Clinical Reasoning. Website : https://pediatricapta.org/fact-sheets/
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