Clinical
reasoning has been described as “a process in which the therapist, interacting
with the patient, structures meaning, goals & health management strategies
based on clinical data, client choices, professional judgment & knowledge ”
(Higgs and Jones 2000, Edwards et al 2004). While the most comprehensive means
of developing and implementing clinical reasoning in practice is the use of
hypothetic-deductive approach and diagnostic sieves, as physiotherapists gain
experience and skills, they are able to use clinical pattern recognition to aid
their clinical reasoning and decision making.
Clinical
pattern recognition have developed a guideline based orthopedic rehabilitation
app which aims to help students and clinicians hone their clinical reasoning
skills regarding examination, differential diagnosis, movement faults,
treatments and exercises for low back pain, as per the description on the
developer’s page. The app is currently available for low back/ lumbar region
only, but hip, knee, neck, shoulder are under development and are expected to
be released in a phased manner over the next few months. In this article, I
have reviewed the lumbar region clinical pattern recognition app for
development of clinical reasoning skills related to low back pain.
Description
of App
The app is presented is a well organized
interface with sections for clinical pattern recognition, clinical practice
guidelines, physical examination, manual therapy and therapeutic exercises.
Each of these sections then provides further comprehensive information about
the pain patterns.
Clinical Pattern recognition section identifies
8 major hypotheses related to back pain presentation (centralised pain, lumbar
disc pathology, lumbar facet syndrome, lumbar instability, lumbar muscle
strain, SI joint sprain, sciatica and spinal stenosis. It also has a separate
sub-section on red flags. For each of these hypotheses, prevalence, clinical
findings (divided into acute, sub-acute and chronic), physical examination,
interventions and use of outcome measures are presented.
This section is pretty comprehensive with
clinical findings focusing on aspects of subjective presentation, reported
findings and examination findings, physical examination including the key
findings and assessment tests, movement faults, associated impairments and
differential diagnosis related to the specific pain pattern. Clinical reasoning
for each pattern is discussed through use of audio-visual aids. Each test/
movement is also defined in further detail through text and demonstrated
through the use of videos.
The intervention section within each pain
pattern provides interventions specific to that pain pattern for e.g. there is
no manual therapy or modalities section for interventions related to
centralised pain. But the therapeutic exercises are further divided into
mobility, motor coordination and functional movement exercises. Again each of
these exercises is described in detail through textual information and
demonstrated through videos. Each of the technique for assessment and
management interventions is also supplemented by provision of related
references which can be used for further reading. The references are also liked
to their relevant abstracts on Pubmed database.
While the first clinical pattern
recognition provides details of assessment, differential diagnosis, examination
and interventions related to a specific pain pattern, subsequent sections
provide a comprehensive directory of evaluation and management approaches. For
e.g. the general manual therapy section contains description and demonstration
videos for over 40 manual therapy techniques which are useful in evaluation and
management of patients presenting with low back pain.
Features
The app has a pleasing, user friendly interface,
professionally edited and pleasing videos with adequate description and
demonstration of techniques, along with textual description. The interface of
the app feels very intuitive. It is easy to navigate and make use of the
various options available. The different sections can be navigated and results
clearly displayed. The app can be useful for students as well as practising
clinicians looking to refresh their clinical skills as well as to develop
further skills and clinical reasoning.
However, there are certain other features
which can be quite useful, but seem to be missing from the app. One most
important example is the use of a search feature. As discussed above, the
general sections related to examination, manual therapy and exercises are
pretty comprehensive, so searching for a specific technique and its description
can be a bit cumbersome by trying to scroll through several sections/ names to
find what we are looking for. I have seen several apps which utilise the voice
to search feature of iOS to allow clinicians to search for relevant information
on the go. Another useful feature can be integration of bookmarking, which will
allow the users to save specific information or their favourites in a separate
folder and access it as needed.
Summary
Price
– $9.99
Availability – iOS (iPhone and iPad)
Pro’s
–
•Wealth of information
•Easy to use interface
•Evidence based clinical practice
guidelines
Con’s
–
•No means of organizing information
•Lack of an Android version
Written
by Devdeep Ahuja
