Severity, Irritability, Nature, Stage, and Stability (SINSS): A clinical perspective

ABSTRACT

Clinical reasoning errors in health-care can be mitigated with the use of systematic strategies and tools. One of these strategies is the SINSS construct, an acronym for Severity, Irritability, Nature, Stage, and Stability. The construct of SINSS appears in several textbooks and peer-reviewed articles. However, it has been inconsistently defined and applied in clinical practice. In this clinical perspective, the terms of the SINSS construct are defined in detail and their application to clinical practice is discussed. Current research showing the application of SINSS as a whole in clinical practice and educational settings is also presented. Recommendations for future application of SINSS are provided to advance the study of clinical reasoning and help minimize diagnostic, prognostic, and interventional clinical errors. The systematic use of SINSS allows the clinician to gain a thorough understanding of the patient’s condition and symptoms, which can lead to a well-tolerated and appropriately tailored physical examination and intervention. Additionally, the proper use of this construct can result in more optimal patient outcomes, as well as provide a structure for the mentor and learner in helping uncover errors in the learner’s clinical reasoning process.

KEYWORDS:

• Physical examination
• intervention
• vigor
• extent

Key points

1. Clinical reasoning requires clinicians to be able to integrate experience, knowledge, and ability to monitor cognitive processes efficiently and effectively.

2. Utilizing systematic tools and strategies, like the SINSS construct, can help learners move more rapidly from the beginning to more advanced stages of learning and performance.

3. The SINSS construct provides structure for the mentor and learner in helping uncover errors in the learner’s clinical reasoning process.

4. The SINSS construct allows the clinician to gain a thorough understanding of the patient’s condition and symptoms, which can lead to a well-tolerated and appropriately tailored physical examination and intervention.

5. Understanding and implementing the SINSS construct in orthopedic clinical settings may reduce diagnostic, prognostic, and interventional clinical reasoning errors and result in more effective and efficient patient outcomes.

Disclosure of Interest

The authors report no conflict of interest.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

There was no funding for this clinical perspective

Notes on contributors

Evan J. Petersen

Evan J. Petersen, PT, DSc, OCS, FAAOMPT is an Associate Professor at the University of the Incarnate Word, School of Physical Therapy where he teaches Patient/Client Management and Clinical Reasoning. Prior to his appointment at UIW, he was the Graduate Program Director of the Army-Baylor University Doctoral Fellowship in Orthopaedic Manual Physical Therapy. He has been a licensed physical therapist since 1999 and has practiced in outpatient orthopedic clinics in the United States, Egypt, Germany, and Afghanistan. He is a board-certified clinical specialist in Orthopaedics and a fellow in the American Academy of Orthopaedic Manual Physical Therapists.

Stephanie M. Thurmond, PT, DPT, ScD, COMT, CFMT is an Associate Professor at the Bowling Green State University School of Physical Therapy. As the Program Director, she is working to develop a new Doctor of Physical Therapy program at BGSU. She entered the field of academia in 2013 after spending the first part of her career as a clinician in the outpatient orthopedic setting. She received her Doctor of Physical Therapy from Hardin-Simmons University in 2002 and her Doctor of Science from Texas Tech Health Sciences Center in 2011.

Gail M. Jensen, PT, PhD, FAPTA, FNAP is Dean of the Graduate School and College of Professional Studies, Vice Provost for Learning and Assessment, and Professor of Physical Therapy at Creighton University. She is known nationally and internationally for scholarly contributions in expert practice, clinical reasoning, professional ethics, and interprofessional education. Dr. Jensen is author of coauthor of more than 85 publication in peer-reviewed journals and has coauthored 12 books, including the fourth edition of Clinical Reasoning in the Health Professions (Higgs, Jensen, Loftus, Christensen) and in 2020, Clinical Reasoning and Decision Making in Physical Therapy. She serves on a number of editorial boards and most recently became an associate editor for The Clinical Teacher. Dr. Jensen received her PhD in educational evaluation with a minor in sociology from Stanford University. She holds a master’s degree in physical therapy from Stanford University and a bachelor’s degree from the University of Minnesota.