Challenges in Applying Best Evidence to Physiotherapy Practice: Part 2 – Health and Clinical Reasoning Models to Facilitate Evidence-Based Practice

Abstract
Purpose: As the second of two papers addressing challenges in applying best evidence to physiotherapy practice (see volume 4 number 3), the purpose of this paper is to explore health and clinical reasoning models that can facilitate evidence-based practice. Summary of Key Points: The challenge and importance of using skilled clinical reasoning in applying research evidence and managing patients that fall outside the available evidence are discussed. The importance of a holistic understanding of health and illness is emphasised and three models of health and disability are considered and the concept of “hypothesis categories” is proposed to assist therapists to transfer these conceptual models to actual decision making in practice. Next, research supporting therapists’ use of “Clinical Reasoning Strategies” is reviewed distinguishing between diagnostic reasoning and narrative reasoning. Lastly, the organisational behaviour management practice of benchmarking is proposed as an important strategy to further facilitate application of research evidence in practice behaviour. Conclusion: A key challenge facing the profession is how best to assist clinicians’ application of research findings to practice and how to optimise experience-based evidence when research evidence is either poor or missing. To practice in a truly holistic patient-centred, evidence-based way clinicians need good conceptual understandings of health, pain and disability and equally good critical and reflective reasoning and management skills.