Stratified Care Models

Abstract

Clinical reasoning skill is an important factor influencing the effectiveness of manual therapy. The frameworks of the clinical reasoning skills are grouped into the medical model and signs and symptoms model. In the medical model, the establishment of a pathoanatomical diagnosis is required for prognosis and/or making decisions about treatment strategies. Conversely, in the signs and symptoms model, the establishment of the pathoanatomical diagnosis is not necessary, and the decision making of management strategies is performed and revised based on pattern recognition and/or hypothesis-deduced reasoning of the clinical signs and symptoms. It is important to enhance the clinical reasoning skills in the signs and symptoms model in pregraduate and postgraduate education in physical therapy in Japan. This paper briefly presents a stratified care model, which will be useful for improving the clinical reasoning skills based on pattern recognition and/or hypothesis-deduced reasoning, briefly introduces the Keele STarT Back screening tool, and discusses the research agenda in the stratified care model.