Physiotherapy Assessment and Clinical Reasoning
The assessment sequence
A defensible assessment moves from history to hypothesis to targeted examination. The subjective examination establishes the irritability, nature and behaviour of symptoms, the 24-hour pattern, and the aggravating and easing factors. Use the SINSS framework (severity, irritability, nature, stage, stability) to grade the condition. The objective examination then tests the hypothesis: observation, active and passive range, resisted testing, special tests, neurological screening, and functional tasks.
Clinical reasoning
Reasoning is hypothesis-driven and iterative. Distinguish the biomedical diagnosis from the physiotherapy diagnosis (the movement problem). Consider the biopsychosocial model: yellow flags such as fear-avoidance and catastrophising predict chronicity and shape communication. Use outcome measures with known psychometric properties (e.g., numeric pain rating scale, Oswestry Disability Index, Berg Balance Scale) and re-measure to demonstrate change.
Traps
Questions often reward the next step rather than the final diagnosis. If red flags are present, the correct answer is referral, not a special test. Another trap is choosing a special test with poor sensitivity as a stand-alone diagnostic. Remember that a positive test supports, but does not confirm, a hypothesis.
Rule of thumb
For any case, ask: what is the hypothesis, what finding would confirm or refute it, and is there anything that changes the plan (red flag, comorbidity, patient preference)? Document the reasoning, not just the findings.