Spurious Identification of Patient Problems

The intent of this letter is to illustrate why the routine application of clinical diagnostic tests often results in identifying patient problems that do not exist. Two data-gathering strategies used frequently by physical therapists are the exhaustive approach and the hypothetico-deductive method.1,2 In order to illustrate these two strategies and their potential impact, the following scenario is presented: A 12-year-old male basketball player with anterior knee pain (patient SS) is referred to you for assessment and treatment. The lad tells you he has had intermittent anterior knee discomfort for the past 6 weeks, and there is no history of an injury in either the immediate or distant past. His discomfort increases with running, jumping, kneeling, kicking objects, and going up and down stairs. The knee does not lock, nor does it give way. He tells you the discomfort subsides with rest. A 12-year-old male basketball player with anterior knee pain (patient SS) is referred to you for assessment and treatment. The lad tells you he has had intermittent anterior knee discomfort for the past 6 weeks, and there is no history of an injury in either the immediate or distant past. His discomfort increases with running, jumping, kneeling, kicking objects, and going up and down stairs. The knee does not lock, nor does it give way. He tells you the discomfort subsides with rest.