Diagnostic reasoning in musculoskeletal healthcare: a scoping review

The clinician's inability to define the underlying processes of musculoskeletal disorders is a challenge for individual-tailored therapy facilitation within a holistic context. An overview of clinical reasoning dimensions contributing to the clinician's diagnostic reasoning might help visualize the current focus during history taking.

To (1) identify and explore the use of reasoning dimensions, and (2) summarize diagnostic reasoning tools in musculoskeletal disorders.

Scoping review.

From inception to March 2025 three databases (Medline, Web of Science, SCOPUS) were searched for relevant studies. Based on the International Classification of Functioning, Disability and Health and Jones, Jensen and Edwards' hypothesis categories (2008), the representation of reasoning dimensions was analysed and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews.

From 9659 abstracts, 65 studies across different health professions were included, the majority (n = 44) published after 2015. Reasoning dimensions were pragmatically categorized, in order of frequency, into environmental and personal factors (n = 55), risk stratification (n = 50), structures and tissue mechanisms (n = 48), and pain mechanisms (n = 35). Twenty-three distinct diagnostic reasoning tools were identified, incorporating various combinations of at least two reasoning dimensions with environmental and personal factors the most, and pain mechanisms the least commonly addressed reasoning dimension.

This review informs researchers and clinicians working with patients suffering from musculoskeletal disorders about the representation of both reasoning dimensions and diagnostic reasoning tools. Future research should prioritize the development of a valid and reliable diagnostic reasoning tool involving the simultaneous consideration of multiple dimensions.