, Integration and Application of the
Scientific Method, Evidence-Based
Practice, and Clinical Reasoning
Independent Study
Course 31.2.1
Sean P. Riley, PT, DPT, ScD
Sacred Heart University
Fairfield, CT
, Integration and Application of the
Scientific Method, Evidence-Based
Practice, and Clinical Reasoning
Guy G. Simoneau, PT, PhD, FAPTA—Editor
Gordon Riddle, PT, DPT, ATC, OCS, SCS, CSCS—Associate Editor
Cover Illustration by Joseph Kinstler
Dear Colleagues,
I am pleased to welcome you to Integration and Application of the Scientific Method, Evidence-Based Practice, and Clinical Reasoning by
Sean P. Riley, PT, DPT, ScD. This is the first monograph in the Academy of Orthopaedic Physical Therapy Independent Study Course
series 31.2, Current Concepts of Orthopaedic Physical Therapy, 5th Edition. In this edition, the material is presented both as a narrated
PowerPoint, consisting of 7 sections, and a matching written outline.
Sean P. Riley is an Assistant Professor in the Physical Therapy program at Sacred Heart University in Fairfield, CT, USA. He graduated
from the University of Connecticut Physical Therapy Program in 2004 and completed his Doctorate in Physical Therapy at Simmons
College in 2006. He obtained his Doctor of Science from Texas Tech University Health Science Center in 2013. Sean became board
certified in Orthopaedics through the American Board of Physical Therapy Specialties in 2007. He completed his certification in Or-
thopaedic and Manual Therapy (COMT) in the Extremities in 2012 through the International Academy of Orthopaedic Medicine-US.
He completed his Fellowship in Manual Therapy from Regis University in 2018. Sean has 16 published manuscripts in peer-reviewed
journals since 2014 and has presented his research at the national level each of the last 7 years. He has reviewed articles for The Journal of
Manual and Manipulative Therapy, Musculoskeletal Science and Practice, and Physiotherapy Theory and Practices within the previous year.
Sean is also an Associate Editor for The Journal of Manual and Manipulative Therapy. He is part of the team revising the Clinical Practice
Guideline for Adhesive Capsulitis. Sean serves as a research committee member for the American Academy of Orthopedic Manual Phys-
ical Therapists. He has served as a grant reviewer, poster presentation judge, and abstract mentor for research submissions.
In the monograph, Dr. Riley integrates concepts related to the scientific method, evidence-based-practice, and clinical reasoning to guide
the reader on how to apply this knowledge in clinical practice. The author first discusses the process of clinical reasoning along with com-
mon errors in reasoning – a section every clinician will be able to relate to. This section is followed by a discussion of what evidence-based
practice is and what it is not, along with the process to formulate a meaningful question relevant to patient care. This section ends by
providing the reader a list of on-line resources for evidence-based practice, several with “pre-processed” information. Finally, the author
provides a theoretical model of clinical reasoning based on the type of pain perceived by the patient (pain mechanism), a systematic pro-
cess of symptom modification (the origin of the pain), and an understanding of the mechanical input associated with pain generation.
Considerations for interpretation of the quality of diagnostic, prognostic, and intervention type research is also presented.
Clinical reasoning based on current evidence is key to optimal clinical decision-making and outcomes in clinical practice. The author has
provided an excellent background for readers to gain an increased appreciation for clinical reasoning. I would like to extend my sincere
gratitude to Dr. Riley for sharing his expertise on a topic so challenging to master.
Sincerely,
'i ~
Sincerely,
Guy Simoneau, PT, PhD, FAPTA
Editor
2920 East Avenue South, Suite 200 | La Crosse, WI 54601 | Office 608-788-3982 | Toll Free 800-444-3982 | Fax 608-788-3965
, TABLE OF CONTENTS
ACRONYM LIST................................................................................................................................................................................................................4
SECTION 1 ..........................................................................................................................................................................................................................5
SECTION 2 .......................................................................................................................................................................................................................10
SECTION 3 .......................................................................................................................................................................................................................15
SECTION 4 .......................................................................................................................................................................................................................20
SECTION 5 .......................................................................................................................................................................................................................31
SECTION 6 .......................................................................................................................................................................................................................43
SECTION 7 .......................................................................................................................................................................................................................48
Academy of Orthopaedic Physical Therapy, APTA.
For personal use only. No other uses without permission. 3
© 2021 Academy of Orthopaedic Physical Therapy, APTA, Inc. All rights reserved.
Scientific Method, Evidence-Based
Practice, and Clinical Reasoning
Independent Study
Course 31.2.1
Sean P. Riley, PT, DPT, ScD
Sacred Heart University
Fairfield, CT
, Integration and Application of the
Scientific Method, Evidence-Based
Practice, and Clinical Reasoning
Guy G. Simoneau, PT, PhD, FAPTA—Editor
Gordon Riddle, PT, DPT, ATC, OCS, SCS, CSCS—Associate Editor
Cover Illustration by Joseph Kinstler
Dear Colleagues,
I am pleased to welcome you to Integration and Application of the Scientific Method, Evidence-Based Practice, and Clinical Reasoning by
Sean P. Riley, PT, DPT, ScD. This is the first monograph in the Academy of Orthopaedic Physical Therapy Independent Study Course
series 31.2, Current Concepts of Orthopaedic Physical Therapy, 5th Edition. In this edition, the material is presented both as a narrated
PowerPoint, consisting of 7 sections, and a matching written outline.
Sean P. Riley is an Assistant Professor in the Physical Therapy program at Sacred Heart University in Fairfield, CT, USA. He graduated
from the University of Connecticut Physical Therapy Program in 2004 and completed his Doctorate in Physical Therapy at Simmons
College in 2006. He obtained his Doctor of Science from Texas Tech University Health Science Center in 2013. Sean became board
certified in Orthopaedics through the American Board of Physical Therapy Specialties in 2007. He completed his certification in Or-
thopaedic and Manual Therapy (COMT) in the Extremities in 2012 through the International Academy of Orthopaedic Medicine-US.
He completed his Fellowship in Manual Therapy from Regis University in 2018. Sean has 16 published manuscripts in peer-reviewed
journals since 2014 and has presented his research at the national level each of the last 7 years. He has reviewed articles for The Journal of
Manual and Manipulative Therapy, Musculoskeletal Science and Practice, and Physiotherapy Theory and Practices within the previous year.
Sean is also an Associate Editor for The Journal of Manual and Manipulative Therapy. He is part of the team revising the Clinical Practice
Guideline for Adhesive Capsulitis. Sean serves as a research committee member for the American Academy of Orthopedic Manual Phys-
ical Therapists. He has served as a grant reviewer, poster presentation judge, and abstract mentor for research submissions.
In the monograph, Dr. Riley integrates concepts related to the scientific method, evidence-based-practice, and clinical reasoning to guide
the reader on how to apply this knowledge in clinical practice. The author first discusses the process of clinical reasoning along with com-
mon errors in reasoning – a section every clinician will be able to relate to. This section is followed by a discussion of what evidence-based
practice is and what it is not, along with the process to formulate a meaningful question relevant to patient care. This section ends by
providing the reader a list of on-line resources for evidence-based practice, several with “pre-processed” information. Finally, the author
provides a theoretical model of clinical reasoning based on the type of pain perceived by the patient (pain mechanism), a systematic pro-
cess of symptom modification (the origin of the pain), and an understanding of the mechanical input associated with pain generation.
Considerations for interpretation of the quality of diagnostic, prognostic, and intervention type research is also presented.
Clinical reasoning based on current evidence is key to optimal clinical decision-making and outcomes in clinical practice. The author has
provided an excellent background for readers to gain an increased appreciation for clinical reasoning. I would like to extend my sincere
gratitude to Dr. Riley for sharing his expertise on a topic so challenging to master.
Sincerely,
'i ~
Sincerely,
Guy Simoneau, PT, PhD, FAPTA
Editor
2920 East Avenue South, Suite 200 | La Crosse, WI 54601 | Office 608-788-3982 | Toll Free 800-444-3982 | Fax 608-788-3965
, TABLE OF CONTENTS
ACRONYM LIST................................................................................................................................................................................................................4
SECTION 1 ..........................................................................................................................................................................................................................5
SECTION 2 .......................................................................................................................................................................................................................10
SECTION 3 .......................................................................................................................................................................................................................15
SECTION 4 .......................................................................................................................................................................................................................20
SECTION 5 .......................................................................................................................................................................................................................31
SECTION 6 .......................................................................................................................................................................................................................43
SECTION 7 .......................................................................................................................................................................................................................48
Academy of Orthopaedic Physical Therapy, APTA.
For personal use only. No other uses without permission. 3
© 2021 Academy of Orthopaedic Physical Therapy, APTA, Inc. All rights reserved.
