Diagnostic reasoning in osteopathy – A qualitative study

Abstract

Background: The clinical reasoning processes which result in the forma-tion of a diagnosis, are fundamental for safe, effective and efficient clinical prac-tice and are central to professional autonomy and accountability. While research has identified the diagnostic reasoning approaches taken by a range of healthcare professions, there is limited understanding of how osteopaths formulate diagnoses in clinical practice. Objectives: The aim of this research was to explore the diagnostic reasoning of experienced osteopaths in the UK. Methods: A qualitative constructivist grounded theory approach was taken in this study, which was situated in the interpretive research paradigm. A total of seven-teen face-to-face semi-structured interviews were conducted with twelve experi-enced osteopaths. Participants were purposefully and theoretically sampled to take part in this study. Data collection methods involved semi-structured interviews with participants and observation and video-recording of clinical appointments, which were followed by video-prompted reflective interviews. The constant comparative method of analysis was used to code and analyse data. Results: The findings suggest that when formulating a diagnosis practitioners adopted two diagnostic reasoning approaches, namely hypothetico-deductive reasoning and pattern recognition. In this study, there was interplay of these reasoning approaches as a result of the perceived level of complexity and degree of familiarity of the patient presentation. Conclusions: Experienced osteopaths adopted diagnostic reasoning approaches which are akin to other healthcare professions including medicine and physio-therapy. Metacognitive and refl xivity skills were central for safe and effective diagnostic reasoning. Further work is required to explore the transferability of these findings with practitioners of different levels of clinical experience and who work in different clinical settings.

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

“…8 The process of refining, accepting and discarding hypotheses evident in this study is consistent with hypothetico-deductive reasoning approaches described in a wide range of other health professions including: medicine, 32,50 physiotherapy 2,51 and osteopathy. 27,36 The application of both pattern recognition and hypothetico-deductive reasoning together is consistent with diagnostic reasoning literature in medicine 32,34,52 and physiotherapy. 2,53,54 As a component of diagnostic reasoning, palpation was utilised by the participating osteopaths, especially during periods of uncertainty to complement physical assessment procedures (such as orthopaedic and special testing).…”

“…An "interplay" of both of these strategies was observed, where the perceived degree of complexity and familiarity determined which strategy would be used. 27 In the context of the current study, findings from the consultation maps identified that all participating osteopaths predominantly utilised hypothetico-deductive reasoning and pattern recognition, transitioning dynamically between both strategies during the observed clinical encounters. This transitioning is consistent with the work of Thomson et al 27 and, to our knowledge, is the second study to illustrate the dynamic use of both diagnostic reasoning strategies in an osteopathic consultation.…”

“…In a recent grounded theory investigation, Thomson et al 27 describes the use of hypotheticodeductive reasoning and pattern recognition in the diagnostic reasoning process of osteopaths. An "interplay" of both of these strategies was observed, where the perceived degree of complexity and familiarity determined which strategy would be used.…”

“…5 Elstein et al's patient simulation study, which investigated the diagnostic clinical decision making of doctors, 8 was the seminal work on clinical reasoning in healthcare, and generated substantial early interest in clinical reasoning in medicine, 9e11 and other allied health including nursing, 12e14 occupational therapy 7,15e17 and physiotherapy. 3,18 However, in comparison to other allied health, there has been little investigation of clinical reasoning in osteopathy, with only a small volume of recently emerging research on aspects such as osteopaths' conceptions of clinical practice, 19e21 clinical reasoning education and assessment, 22e29 the application of clinical reasoning strategies, 27 and the role of palpation. 28,29 Jensen et al 30 note that decision making and clinical reasoning is both an intricate and essential dimension of expertise.…”

“…16 One particular area of research interest is the utilisation of 'clinical reasoning strategies', a term used to refer to the methods, approaches, structures and organisations selected to guide the process of clinical reasoning. 15 Of these strategies, it has been recognised in both theory, 36 and from research, 27 that osteopaths utilise the clinical reasoning strategies of hypothetico-deductive reasoning and pattern recognition. However, the extent to which these strategies are used, the relationship between the two, and the presence of other processes in the clinical reasoning of osteopaths have not been extensively investigated.…”