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

Evan J. Petersen, Stephanie M. Thurmond, Gail M. Jensen

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)297-309
Number of pages13
JournalJournal of Manual and Manipulative Therapy
Issue number5
StatePublished - 2021

All Science Journal Classification (ASJC) codes

  • Physical Therapy, Sports Therapy and Rehabilitation


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