An empirical, pragmatic approach applying reflection in interaction approach to manual therapy treatments

Abstract

The majority of literature on decision processes within physiotherapy relates to what can be referred to as "reasoning that results in action"-cognitive processes that determine initial treatment and its modification after reassessment. Particularly expert clinicians also use "reasoning in interaction" including ongoing, interactive processes that occur during the application of treatments. The theory behind the approach discussed in this article can be stated as: If the extent of a deficit (pain or limitation of passive movement) is related to the extent of a patient's limitations (impairments or functional limitations), then 1) a change in the deficit would be expected to be accompanied by a change in the patient's limitations and 2) the relative magnitude of a change in the deficit would be expected to correspond with the relative magnitude of change in the patient's limitations. When applied to manual therapy interventions, the theory suggests that rather than all parameters of a treatment technique being predetermined , therapists continually adjust their treatment in real time. Adjustments are made in real-time to maximise improvement and are informed by patient response (typically changes in pain or range or stiffness of (passive) movement). Implications for other areas of practice and teaching are discussed.

Localised manual therapy treatment has a preferential effect on the kinematics of the targeted motion segment

“…Localised manual therapy was performed with the intention of increasing the mobility of the selected location. Non-thrust techniques using accessory and/or physiological movements were selected by the therapist and applied according to an empirical reflection-in-interaction approach (Tuttle & Hazle, 2019). Briefly the mobility of the symptomatic location was assessed in both accessory and physiological movements.…”

“…As a result, changes in segmental mobility can be expected to correspond with changes in AROM. A reflectionin-interaction approach has been proposed (Tuttle & Hazle, 2019) where rather than SMT treatments being pre-determined from a priori findings (such as patterns in a patient's history and physical assessments), SMT treatments can be informed in real time by changes in factors considered to be related to patient symptoms (such as segmental stiffness, pain, or muscle tone).…”

Developing fluency in a language of tactile communication

“…It could be useful for the patient to have a sense of those responses to gain some control over them. I'm feeling increased movement and their protective response decreasing and that by adjusting the direction, force, rhythm, etc., I can increase the rate of improvement (12).…”

Completeness of the description of manipulation and mobilisation techniques in randomized controlled trials in neck pain; A review using the TiDieR checklist

“…Tailoring and modifications are expected because each treatment is tailored to the individual patient, although these items were not always reported as such (n ¼ 37,3%). As Tuttle et al stated (Tuttle and Hazle, 2019) that applying parameters of techniques are no longer predetermined but are continuously adjusted due to the feedback of the patients and the adjustment of the therapist to the responses of the individual patient. Furthermore, the perception of the patient as well of the therapist on the performed intervention is of influence on the tailoring of the intervention.…”