Why do you need a physio diagnosis?





Diagnosis is the identification of the nature and cause of a certain phenomenon, an experience to determine “cause and effect.” It is a brief conclusion about the pathological condition, existing disease, injuries, or the cause of death of a person under investigation. It forms the most important part of any consultation along with treatment. Diagnosis and classification in Physical Therapy are complementary to the diagnosis made by other healthcare practitioners. The role of a practitioner of Physical Therapy has changed from a mere technician following prescriptive orders to an independent health-care professional with sound scientific knowledge and evidence-based practice.


The aim of Physical Therapy Diagnosis (PTD) or Functional Diagnosis (FD) is to diagnose movement system impairments to guide intervention for health optimisation such that the disability can be minimised. The objective is clearly focused in the expertise of identifying clusters of movement system dysfunction and classifying them rather than diseases. Treatment effectiveness and prognosis are further mapped for a particular classification of movement system impairment using function as an outcome. This not only increases effectiveness of practice but also contributes to health care and research.


The process of clinical reasoning is by which a therapist interacts with a patient, collecting information, generating and testing hypotheses, and determining optimal diagnosis and treatment based on the information obtained. It has been defined as “an inferential process used by practitioners to collect and evaluate data and to make judgments about the diagnosis and management of patient problems".


Clinical reasoning is “the sum of the thinking and decision-making processes associated with clinical practice”. During this process, the therapist analyses multiple variables contributing to the patient’s limited physical capacity (the ability to execute a task or action in a standard environment) and performance (what the patient can do in his or her own current environment). The key elements of the process include generation of hypotheses of factors assumed to underlie the limitations of physical capacity and performance and postulation of the magnitude of those factors. The therapist interacts with the patient and other persons involved in the patient's care (family, other health care professionals) and guides the patient in finding meaningful goals and health management strategies. All decisions and actions need to be made in line with professional ethics and community expectations.


Clinical Reasoning is integral to physiotherapy practice. The most common form of clinical reasoning within the physiotherapy profession is hypothetico-deductive reasoning. Within hypothetico-deductive reasoning, the clinician gains initial clues in regards to the patient's problem (from the subjective assessment), which forms the initial hypotheses in the therapist's mind. Further data is collected in the objective assessment, which may confirm or negate the hypotheses. Continual hypothesis generation may occur during management and reassessment.


Clinical reasoning consists of the following five dimensions

• cognition

• a discipline-specific knowledge base

• metacognition, which means the individual’s awareness of his/her way of thinking

• the role of the patient in the decision-making process

• contextual interaction


Reflection after the initial assessment and also after the subsequent sessions will help the therapist to recognise patterns and their clinical reasoning process will improve.


This approach is a content-specific process requiring rules and knowledge related to the text and context. The types vary according to different clinical cases or problems. It involves comparing, testing and analysing the case to determine what will be next in protocol and this keeps on going in cycle till a desired result is achieved.


Despite the desire of the physiotherapist to find logical connections between signs and symptoms that lead to specific functional diagnoses, this is not always readily achieved. In such instances, failure to get the pieces that will solve the puzzle may prove troubling and discomforting. Physiotherapists are certified to give referrals to GP’s, X-ray scans, MRIs etc. to gain a better understanding of your condition that presents.



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