Introduction to Clinical Reasoning

This flashcard set covers the fundamental concepts of clinical reasoning, pain types (nociceptive, neuropathic, nociplastic), healing phases, and hypothesis frameworks as presented by Ken Niere.

Clinical Reasoning (Mark Jones 1997)

Thought processes and decision making associated with a therapist’s examination and management of a patient.

Pattern Recognition (Experiential / Forward Reasoning)

A fast and efficient reasoning process where examination findings enable solution recognition without specific hypothesis testing; used by clinicians for familiar problems but a common source of errors.

Hypothetico-Deductive (Backward) Reasoning

A slower but safer reasoning process incorporating pattern recognition and testing of competing hypotheses; used by novices or experts facing unfamiliar problems.

Narrative Reasoning

A process of enquiry involving collaborative discourse to understand the patient’s problem, perspective, and the context of that problem.

Nociceptive Pain

Pain arising from actual or threatened tissue damage due to the activation of nociceptors (mechanical, chemical, or thermal).

Neuropathic Pain

Pain caused by a lesion or disease of the somatosensory nervous system, which can be central (e.g., stroke, Parkinsons) or peripheral (e.g., nerve root compression).

Nociplastic Pain

Pain resulting from altered nociception despite no clear evidence of actual or threatened tissue damage or a lesion of the somatosensory system.

Inflammatory Symptom Mechanism

A symptom mechanism suggestive of prolonged morning pain/stiffness, pain that may be constant or worse at night, and a positive response to anti-inflammatory medication.

Mechanical Symptom Mechanism

A symptom mechanism characterized by a predictable response to mechanical loading, such as specific movements and postures.

Acute Inflammatory Phase

The first stage of the healing process occurring from $0-72\text{ hours}$.

Proliferation Phase

The second stage of the healing process occurring from $72\text{ hours}$ to $6\text{ weeks}$.

Remodelling and Maturation Phase

The final stage of the healing process occurring from $6\text{ weeks}$ to several months.

Yellow Flags

Maladaptive psycho-social factors that act as potential barriers to recovery.

Red Flags

Indicators of conditions that may require medical evaluation and management.

Peripheral Processes

Processes including inflammation and mechanical dysfunction that overlap with central processing.

Central Processes

Processes including dorsal horn changes and maladaptive processing.

Hypothesis Framework (Jones 2013)

A clinical framework categorized into hypotheses on the nature of the health condition, relevant clinical features, and management of the health condition.

Contributing Factors

Factors that may lead to the development or maintenance of a condition, such as co-morbidities, posture, genetics, ergonomics, and psychosocial factors.

Prognosis

The likely outcome and timeframe of treatment, influenced by the nature of the disorder, pain mechanisms, patient expectations, and yellow flags.