3 ways Mark Jones’ Masterclass transformed my clinical reasoning

Clinical reasoning can come in all shapes and sizes, with physios putting their own individual spin on what is ultimately the same end goal – to effectively analyse the information we gather and use it to make decisions which achieve the best possible outcome for our patients (that’s the aim anyway!). Through our careers, we are likely to come across numerous tools and strategies that can guide and change our practice, ensuring that our clinical judgments are both informed and effective. I recently had the pleasure of watching clinical reasoning genius Mark Jones’ Masterclass, and below I’ve listed three things I’ve changed about my clinical practice as a result:

If you’d like an in-depth understanding of expert physio Mark Jones’ clinical reasoning strategies, watch his full Masterclass HERE.

1 – Hypothesis categories

I’m always on the lookout for ways to categorise the information I’ve gathered, to make it easier to understand and cut out all the extra noise that can hinder an effective decision making process. This is why I have adopted Mark Jones’ hypothesis categories in my clinical reasoning, they are:

• Activity and participation capability/restriction
• Psychosocial components
• Problem classification/diagnosis
• Impairments in body function or structure
• Contributing factors to development and maintenance of the problem
• Precautions and contraindications to physical examination and treatment
• Management or treatment selection and progression
• Prognosis

Not only do I use these categories as a tool to help me reflect and make sense of the information I have gathered in a session, I also use them as a framework to help guide my subjective and objective examinations, so I can take a more systematic approach to ensuring I am completing a thorough exam every time.

Watch Mark explain the activity and participation capability/restriction category in the below snippet taken from his Masterclass:

2 – I use the research-backed criteria for neuropathic pain

The International Association for the Study of Pain (IASP) has criteria for diagnosis of neuropathic pain (1). I didn’t know this until watching Mark’s Masterclass, but I now use these as a checklist when in a relevant assessment setting. As Mark explains, neuropathic pain refers to pain caused by a damage or disease of the somatosensory nervous system – it therefore must have a sensory element. For example, radicular pain in absence of radiculopathy is not neuropathic pain, while radiculopathy is considered neuropathic. So for those of you who don’t already know the IASP requirements for neuropathic pain, here they are:

Requirements for POSSIBLE neuropathic pain

• History with clinical presentation suggestive of neural lesion or disease (e.g. surgery, trauma)
• Neuropathic characteristics such as numbness/tingling/burning
• Symptom behaviour such as spontaneous, or with aggravating or easing factors logically associated with potential stress to nerve tissue
• Relationship between spine and limb symptoms
• Neuro-anatomically plausible pain distribution

Requirements of PROBABLE neuropathic pain

• Pain associated with sensory signs (typically negative signs such as decreased or absent sensation) in same neuro-anatomically plausible distribution
• Positive sensory signs (e.g. tactile allodynia) if in neuro-anatomically plausible distribution OR,
• Absence of cutaneous sensory signs with presence of confirmed diagnostic test

Requirements of DEFINITE neuropathic pain

• All of the above criteria, PLUS
• Objective diagnostic test confirming lesion or disease of somatosensory nervous system

Mark also outlines the classification of findings in somatosensory testing between a potential loss or a potential gain. See him explain these classifications in the below video taken from his Masterclass:

3 – I use general principles for treatment progression

There’s no doubt that being a physio is challenging, you’re constantly required to make decisions (hopefully in collaboration with your patients!) which will ultimately dictate a patient’s progress and outcome, and often under time and resource constraints! This is why we are always looking for a recipe, something that can cut through that noise and help us to make sound, reasonable decisions. This can be particularly true of decisions about treatment – when to progress your treatment or when to change it altogether. That’s why I’ll have Mark Jones’ simple treatment progression principles in the back of my mind from now on.

I’ll share them with you, but first of all, once we have identified an “asterisk sign” from the subjective and objective exams, we want to make sure we are re-assessing them at regular time-points (start of each appointment, end of objective exam, prior to treatment, post-treatment, end of each appointment) to measure changes over time with different input. If you’re already doing this then that’s a great first step – now use these principles:

• If there IS improvement in the asterisk signs underpinning the treatment then PROGRESS the treatment
• If there’s NO change in the asterisks sign that you’re targeting, then you may need to consider PROGRESSING the treatment and re-assessing (before discarding it)
• If there IS improvement in the asterisk you’re targeting, but NO change in other system asterisks, then ADD treatment to the next most significant impairment you have identified
• If there’s NO improvement in the asterisk (despite having progressed treatment), then it’s time to CHANGE treatment
• If the asterisk you’re targeting is worsened by treatment, then you will need to MODIFY/REGRESS treatment

Mark stresses that while there are no set guidelines in clinical reasoning, it can be useful to have these general principles to guide you when making decisions in-session or over a number of sessions.

Wrapping up

Clinical reasoning is a multifaceted skill that allows physios to tailor their approach to each patient’s unique needs. By continuously refining our methods and incorporating new strategies, we can ensure our clinical judgments are both informed and effective. As we navigate our careers, tools like hypothesis categories, research-backed diagnostic criteria, and structured treatment progression principles can significantly enhance our practice.

Remember, clinical reasoning is an ongoing journey of learning and adaptation. Keep exploring, questioning, and refining your approach to become the best physio you can be. For an in-depth look at these strategies, don’t miss Mark Jones’ Masterclass – watch it HERE.