Background

There is considerable overlap between pain referral patterns from the lumbar disc, lumbar facets, the sacroiliac joint (SIJ), and the hip. Additionally, sciatic like symptoms may originate from the lumbar spine or secondary to extra-spinal sources such as deep gluteal syndrome (GPS). Given that there are several overlapping potential anatomic sources of symptoms that may be synchronous in patients who have low back pain (LBP), it may not be realistic that a linear deductive approach can be used to establish a diagnosis and direct treatment in this group of patients.

Objective

The objective of this theoretical clinical reasoning model is to provide a framework to help clinicians integrate linear and non-linear clinical reasoning approaches to minimize clinical reasoning errors related to logically fallacious thinking and cognitive biases.

Methods

This masterclass proposes a hypothesis-driven and probabilistic approach that uses clinical reasoning for managing LBP that seeks to eliminate the challenges related to using any single diagnostic paradigm.

Conclusions

This model integrates the why (mechanism of primary symptoms), where (location of the primary driver of symptoms), and how (impact of mechanical input and how it may or may not modulate the patient's primary complaint). The integration of these components individually, in serial, or simultaneously may help to develop clinical reasoning through reflection on and in action. A better understanding of what these concepts are and how they are related through the proposed model may help to improve the clinical conversation, academic application of clinical reasoning, and clinical outcomes.

中文翻译：

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用于评估和治疗腰痛患者的临床推理模型的原因、地点和方式

背景

腰椎间盘、腰椎小关节、骶髂关节 (SIJ) 和髋部的疼痛转诊模式之间存在相当大的重叠。此外，类似坐骨神经痛的症状可能起源于腰椎或继发于椎外源，例如深臀综合征 (GPS)。鉴于在腰痛 (LBP) 患者中可能存在多个重叠的潜在解剖学症状来源，因此在这组患者中使用线性演绎法来建立诊断和直接治疗可能是不现实的。耐心。

客观的

该理论临床推理模型的目标是提供一个框架，帮助临床医生整合线性和非线性临床推理方法，以最大限度地减少与逻辑错误思维和认知偏差相关的临床推理错误。

方法

该大师班提出了一种假设驱动和概率方法，该方法使用临床推理来管理 LBP，旨在消除与使用任何单一诊断范式相关的挑战。

结论

该模型整合了原因（主要症状的机制）、位置（症状主要驱动因素的位置）和方式（机械输入的影响以及它如何调节或不调节患者的主诉）。将这些组件单独、连续或同时集成可能有助于通过反思和行动来发展临床推理。通过提出的模型更好地理解这些概念是什么以及它们如何相关可能有助于改善临床对话、临床推理的学术应用和临床结果。