Diagnostic Hypothesis

Introduction

Diagnostics is one of the cornerstones of physiotherapy, in fact of medical and paramedical practice in general, and it constitutes the starting point for any possible treatment strategy. A diagnosis rarely provides complete certainty, and especially in primary care, making a diagnosis and determining variables that can be treated is difficult. During the course of the first consultation the physiotherapist will develop one hypothesis, or several, about possible diagnoses. Subsequently, this hypothesis (or hypotheses) will be tested. During such a first consultation, a patient will usually provide a history, indicating the symptoms they are experiencing and a request for help. Frequently, a physical examination is conducted after

Initiating the diagnostic hypothesis

The diagnostic hypothesis (or hypotheses) can be made in a reasonably early stage of the consultation (initiation stage). It may well be that the diagnostic hypothesis is made based on something that is noticeable as soon as the patient enters the room. For example, the patient may be leaning to one side or walk in with a foot drop. This is called a ‘spot’ diagnosis, and it is made on the basis of clinical expertise which leads to an initial diagnosis through pattern recognition.

It may also be that the patient comes in and indicates the complaint: ‘I think my tennis elbow is back’. This is called diagnosis by means of self-labelling. An initial diagnosis like that is often based on the patient’s previous experience and may well be incorrect, but research in the general practitioner’s practice shows that such a diagnosis is very often correct [Gupta et al.,

These criteria are often history items, like: the patients have been suffering from neck pain for over three months. In addition, selection criteria can also consist of variables from the physical examination, like: the patients also tested positive on the ‘upper limb tension test’. The more valid a set of selection criteria is, the more certainty there will be that only suitable patients will be included in a scientific study. This is why it is advisable to determine the validity and the reproducibility of diagnostics (selection criteria) first, before studying the effectiveness of treatment. The question if someone has neck pain that has persisted for over a week is reasonably or quite valid and reproducible, but for the ‘upper limb tension test’ there is still some uncertainty in that