Clinical Reasoning Assessment For Thinking Effectively (CRAFTE)

I. WHAT AREAS/STRUCTURES MUST BE CONSIDERED AS A POSSIBLE SOURCE(S) OF THE PATIENT’S

SYMPTOMS? Consider the following:
Joints & bony Muscles & Ligaments, MSK Pain NON-MSK
structures Tendons, Nerves and producing structures or
UNDER THE UNDER & IN other Soft structures conditions
AREA of the area of Tissues which may which must be
symptoms symptoms UNDER & IN REFER into examined or
the area of the area of ruled out
symptoms symptoms

INITIAL HYPOTHESES AFTER THE BODY CHART

Most Likely Hypothesis: Less Likely Hypothesis: Remote Hypotheses:
(2-3 Primary Hypotheses) (2-3 Secondary Hypotheses) (Include at least 1 non-MSK or hypothesis
requiring referral)
1. 1. 1.

2. 2. 2.

3. 3. 3.

II. INFLUENCE OF THE SYMPTOMS ON THE EXAM. Detailed by Area of Symptoms as Mapped on Body Chart
Pain Severity Irritability Nature (identify the primary mechanism Stage Stability Limit
Location behind the signs/symptoms) Exam?

Non Non Mechanical Nociceptive Acute, Subacute, Improving ↑ Yes

Min Min Inflammatory Nociceptive Chronic, Worsening ↓ No
Mod Mod Neurogenic Acute on Chronic, Not Changing
Max Max Central Subacute on Waxing
Autonomic Chronic &Waning
Affective
Which symptoms will Do you expect a
you try to reproduce comparable sign to
during the physical be EASY or HARD
exam? to reproduce?

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What is the anticipated vigor (limit) of your ROM exam?

Examine only to the
FIRST ONSET or change
in pain (P1), even if the
active limit has not been
achieved.
Rationale for this
vigor. Justify
your assessment
of severity &
irritability
Examine only to Examine to the Unlimited Other (Describe):
the end of active range end of PASSIVE examination using
or ACTIVE LIMIT, LIMIT with OVER SUSTAINED or
even if P1 has already PRESSURE sufficient COMBINED
been reproduced. to determine end feel. movements as needed.
Does the nature, diagnosis, or co-
morbidities warrant special
caution for exam or treatment?
Yes / No If yes, what?
(e.g. Trauma / Inflammation / Red Flags
/ Instability/ Pathological Process)

How is this activity limitation

What is the
affecting the patient’s
primary activity
participation in normal social
limitation?
roles?

REVISED HYPOTHESES AFTER THE PATIENT INTERVIEW

Most Likely Hypothesis: Less Likely Hypothesis: Remote Hypotheses:
(Primary Hypotheses) (Secondary Hypotheses) (Include at least 1 non-MSK or hypothesis
requiring referral)
1. 1. 1.

2. 2. 2.

Tool #1: What do you expect to be treating primarily?

What outcome MCID: (Circle one)
tool(s) is (are) MDC: * PAIN
most
appropriate? Tool #2: * JOINT RESTRICTION RESPECTING PAIN
MCID: * JOINT STABILITY
MDC:
* MOTOR CONTROL

Based on your Is a neurological examination necessary?

primary hypothesis, Circle which type(s).
what do you expect to * None *Central *Cranial
see in the physical
exam? List your *Peripheral *Segmental
predicted important
objective findings.
III. PLANNED PHYSICAL EXAM PROCEDURES for day/visit #1: Prioritize based on most likely hypotheses and SINSS. List
in order of performance. BE SPECIFIC.

IV. ASSESSMENT AFTER THE PHYSICAL EXAM:

Has there been a change in your assessment of SINSS? Is the
condition more or less irritable than originally thought? Did
your assessment of pain mechanisms change during the physical
exam?

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Is the patient an appropriate candidate for physical therapy

intervention? Do they require additional referral?
(Treat, Refer, or Treat & Refer). Indicate reason for referral
(imaging, lab work, etc.)? What? Why? Justify.
Most Important Baseline Subjective findings from the Patient Most Important Baseline Objective tests and measure findings
Interview: Put most important findings at top from the Physical Exam: Put most important findings at top
Aggravating activity Symptom Time to ease Movement or test Range Symptoms What limits it

Most Likely Hypothesis: Alternate Hypotheses:

Supporting Clinical Evidence: Supporting Clinical Evidence:

V. CONTEXTUAL FACTORS: Are there contributing factors that may affect prognosis? (check all that apply)
Occupational Environmental Societal Health and/or Other (describe)
Personality Wellness
and/or
motivational
List and describe how these factors may act as barriers to recovery:

List and describe how these factors may act as facilitators of recovery:

Describe how you will MANAGE any relevant contextual factors:

VI. PROGNOSIS:
What is the natural history of the disorder? How will it progress over the life span?

Likelihood of recurrence: MILD / MODERATE / HIGH

How will you attempt to prevent a recurrence of symptoms? How will you educate the patient to manage an exacerbation if it does
happen?

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Functional SMART goals:

Short Term (2 weeks):
1.
2.
Long Term (12 weeks):
1.
2.
3.
4.

VII. PLAN OF CARE

How many visits over what period of time do you expect to see this patient? What CPT codes do you anticipate using?

Rationale (What from the interview or Expected Response (What movement test
Initial interventions. BE SPECIFIC and
physical exam indicates this treatment is will you reassess to prove that your
include dosage.
important?) treatment was effective?)
1st

2nd

Assume good patient adherence and no red flags are present. At the next visit, what treatment will you choose if the patient is:
Better: Worse: The Same:

Treatment Progression: Describe how you plan to progress this patient over the next 4-6 weeks. BE SPECIFIC AND DETAILED
including all appropriate parameters. This may include the following: Physical Agents, Manual Therapies, Therapeutic Exercise,
Neuro Re-education, Motor Learning/Skill Acquisition Strategies, Activity Modification, & Home Education. *Be sure to include
principles of dosage and progression for manual therapy, therapeutic exercise, and motor learning/skill acquisition.