Knowledge-based Clinical Reasoning and Decision Making

This section looks at types of clinical decision-making and in particular the difference between practical knowledge and the kind of knowledge found in research. In patient care, Evidence-Based Practice is a triad of influences: Patient - Provider - Research.

When we talk about 'Evidence Based Practice' we mean providing physical therapy to our patients and clients using methods that are supported practice patterns, clinical reasoning, and research. In this section, we ask the question: when are everyday clinical practice patterns enough and when do we need to go research for evidence of clinical effectiveness for PT interventions? From single case studies to statistical analysis of multiple studies, PTs and PTAs are charged to constantly refine, implement, and assess treatment techniques and outcomes so we may develop our "best practices" as a profession.

The following exercise is adapted from work done by the National Center for the Study of Adult Learning and Literacy [NCSALL, 2007].

Please spend a moment or two drawing both sides of a penny. It is important that you do this entirely from your own memory and without looking at a real example of a penny. Once you have finished please compare your drawing with a real penny

  

Now complete the activity below to relate the photo album activity to clinical reasoning

  

There are a number of implications for your role as PTA. Firstly, given your role in assessing treatment response and outcomes, it is important to clarify and test out your subjective impressions of the patient's performance/outcome with some hard evidence. On what exactly do you base your view of the treatment outcome? It can very much help to have the views of others as these can help you to tell the difference between your subjective impressions and a more objective view. The more objective view is one that others also see.

If you are the only one with a particular impression it may be worth questioning yourself as to whether this view is well founded or not.

Secondly, you need to practice developing the habit of always basing your own assessments on clear evidence and justifying your choice of method by pointing to retrievable evidence. To find strong evidence you need to search the literature (and we will show you the way!)

Self-Reflection Questions

Consider the following:

• When is 'a clinical opinion' good enough?
• When is more exact knowledge necessary?
• To whom or what do you turn for knowledge of just a second opinion?
• What do you do to confirm your treatment assessment?

Please take a few moments to record your answers to these questions before revealing the next part of the discussion

  

 

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