Diagnostic reasoning in osteopathy – a qualitative study

The clinical reasoning processes which result in the formation of a diagnosis, are fundamental for safe, effective and efficient clinical practice and are central to professional autonomy and accountability. While research has identified the diagnostic reasoning approaches taken by a range of healthcare professions, there is limited understanding of how osteopaths formulate diagnoses in clinical practice. The aim of this research was to explore the diagnostic reasoning of experienced osteopaths in the UK. A qualitative constructivist grounded theory approach was taken in this study, which was situated in the interpretive research paradigm. A total of seventeen face-to-face semi-structured interviews were conducted with twelve experienced osteopaths. Participants were purposefully and theoretically sampled to take part in this study. Data collection methods involved semi-structured interviews with participants and observation and video-recording of clinical appointments, which were followed by video-prompted reflective interviews. The constant comparative method of analysis was used to code and analyse data. The findings suggest that when formulating a diagnosis practitioners adopted two diagnostic reasoning approaches, namely hypothetico-deductive reasoning and pattern recognition. In this study, there was interplay of these reasoning approaches as a result of the perceived level of complexity and degree of familiarity of the patient presentation. Experienced osteopaths adopted diagnostic reasoning approaches which are akin to other healthcare professions including medicine and physiotherapy. Metacognitive and reflexivity skills were central for safe and effective diagnostic reasoning. Further work is required to explore the transferability of these findings with practitioners of different levels of clinical experience and who work in different clinical settings.