Peyton's four-step approach is more effective than the 'See one, do one' approach in skills laboratories aimed at developing physiotherapy student competence in C1-C2 passive mobilisation.

Special attention should be paid to prevention during manual skills training, since inexperience exposes manual therapist to a higher risk of developing thumb pain.

The use of expensive devices to measure ACROM in adults with nonspecific neck pain does not seem to improve the reliability of the assessment. Side bending had a lower level of intrarater reliability.

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BackgroundEconomic impact of neck pain shows an increasing trend. In order to limit the costs of spine disorders management, it is important to assess clinical efficacy and the cost-worthiness of new technological devices, recently introduced in physical therapist's clinical practiceObjectivesThis systematic review compares, in patients with non-specific neck pain, the reliability of measures of Active Cervical Range of Motion (ACROM) detected with technological devices with those assessed with low cost, common-use devices. As secondary outcomes, it was investigated if ACROM reliability depends on the plane on which the measured movement is performedMethodsThe literature search was carried out in Medline, Scopus, Embase, The Cochrane Library, CINHAL, PEDro and grey literature until August 2016. Inclusion criteria were: reliability design, population of adults with nonspecific neck pain, examiners of any level of experience, measures repeated at least twice and statistics indexes on reliability. Exclusion criteria were: other study designs, asymptomatic population or mixed population, single or none ACROM measure, inadequate statistics. The risk of bias was assessed by QAREL. It was considered inexpensive a device that costs at maximum 500 euros. A Univariate, and a Multivariate Analysis, were performed by using the Linear Mixed-Effect ModelResultsSearching the databases yielded 35,151 records. Nine studies met all eligibility criteria. The QAREL mean score of the selected studies was 3.7 out of 11. No significant effect of the type of device (inexpensive versus expensive) on ICC was observed for intra-rater (ICC=0.93vs0.91 p-value>0.99) and inter-rater reliability (ICC=0.80vs0.87 p-value>0.99) [Table 1]. The plane of movement did not affect inter-rater reliability (p-value=0.11) while significantly influenced the intra-rater reliability (p-value=0.0001) assessed with low-cost devices. Intra-rater reliability significantly decreases (p-value=0.0129) in frontal plane movements (side bending) compared with movement on the sagittal plane (flexion-extension).Table 1.Comparison of intra and inter-rater reliability between tool typesCharacteristicsICC Descriptive statisticsMixed effect model Mean (SD)β (95% CI)p-value Intra-rater reliability Tool Type0.99  Expensive0.91 (0.07)0  Inexpensive0.93 (0.02)0.01 (-0.04 : 0.06) Direction0.56  Flexion & Extension0.91 (0.07)0  Rotation0.95 (0.02)0.03 (-0.01 : 0.07)  Side Bending0.92 (0.01)0.01 (-0.02 : 0.04) Agerho =0.290.00 (-0.01 : 0.01)0.79Inter-rater reliability Tool Type0.99  Expensive0.87 (0.09)0  Inexpensive0.80 (0.12)0.03 (-0.15 : 0.21) Direction0.06  Flexion & Extension0.82 (0.09)0  Rotation0.86 (0.11)0.04 (-0.02 : 0.11)  Side Bending0.77 (0.13)-0.04 (-0.10 : 0.01) Agerho =0.580.01 (-0.01 : 0.03)0.43ConclusionsThe use of expensive devices to measure ACROM in adults with nonspecific neck pain does not seem to improve the reliability of the assessment. The assessment of side bending showed the lowest level of inter-raters reliability. Since the quality of the analysed stu...

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Intra-rater reliability of 3D PIVMs was superior to inter-rater reliability in patients with nonspecific neck pain. The most repeatable evaluation parameter was pain. However overall poor reliability suggests avoiding the use of these techniques alone to examine patients and measure their outcome. Further studies are needed to investigate PIVMs reliability in combination with other assessment procedure in symptomatic patients.