How should we teach lumbar manipulation? A consensus study

O’Donnell, Michael; Smith, Jo Armour; Abzug, A.; Kulig, Kornelia

doi:10.1016/j.math.2016.05.003

Cited by 9 publications

(12 citation statements)

References 42 publications

(55 reference statements)

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“…Through a Delphi process, O'Donnell et al investigated what educators and clinicians considered to be important characteristics of the patients and clinicians' positions before and during SMT. Results showed that patient comfort was identified as important, with a high level of agreement ( 32 ). In addition to this Delphi, Pasquier et al investigated associations between objective SMT biomechanical parameters and subjective assessments such as patient comfort perceived by patients, clinicians, and expert assessors ( 41 ).…”

Section: Discussionmentioning

confidence: 99%

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Factors Associated With Clinical Responses to Spinal Manipulation in Patients With Non-specific Thoracic Back Pain: A Prospective Cohort Study

et al. 2022

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Introduction: The management of musculoskeletal disorders is complex and requires a multidisciplinary approach. Manual therapies, such as spinal manipulative therapy (SMT), are often recommended as an adjunct treatment and appear to have demonstrable effects on pain and short-term disability in several spinal conditions. However, no definitive mechanism that can explain these effects has been identified. Identifying relevant prognostic factors is therefore recommended for people with back pain.Objective: The main purpose of this study was to identify short-term candidate prognostic factors for clinically significant responses in pain, disability and global perceived change (GPC) following a spinal manipulation treatment in patients with non-specific thoracic back pain.Methods: Patients seeking care for thoracic spine pain were invited to participate in the study. Pain levels were recorded at baseline, post-intervention, and 1 week after a single session of SMT. Disability levels were collected at baseline and at 1-week follow-up. GPC was collected post-intervention and at 1-week follow-up. Biomechanical parameters of SMT, expectations for improvement in pain and disability, kinesiophobia, anxiety levels as well as perceived comfort of spinal manipulative therapy were assessed.Analysis: Differences in baseline characteristics were compared between patients categorized as responders or non-responders based on their pain level, disability level, and GPC at each measurement time point. Binary logistic regression was calculated if the statistical significance level of group comparisons (responder vs. non-responders) was equal to, or <0.2 for candidate prognostic factors.Results: 107 patients (62 females and 45 males) were recruited. Mean peak force averaged 450.8 N with a mean thrust duration of 134.9 ms. Post-intervention, comfort was associated with pain responder status (p < 0.05) and GPC responder status (p < 0.05), while expectation of disability improvement was associated with GPC responder status (p < 0.05). At follow-up, comfort and expectation of pain improvement were associated with responder GPC status (p < 0.05). No association was found between responder pain, disability or GPC status and biomechanical parameters of SMT at any time point.Discussion: No specific dosage of SMT was associated with short-term clinical responses to treatment. However, expectations of improvement and patient comfort during SMT were associated with a positive response to treatment.

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Section: Discussionmentioning

confidence: 99%

“…Finally, the level of comfort during SMT was assessed following the intervention, using a 100-mm scale, a higher score indicating a very comfortable procedure and a lower score a very uncomfortable one. This criterion was identified by O'Donnell et al as an important patient characteristic regarding SMT performance ( 32 ).…”

Section: Methodsmentioning

confidence: 99%

Factors Associated With Clinical Responses to Spinal Manipulation in Patients With Non-specific Thoracic Back Pain: A Prospective Cohort Study

et al. 2022

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“…Therefore, it is vital that students have adequate practice time and appropriate feedback in the academic setting from educators with expertise in TJM, in order to successfully acquire and retain these motor skills. Consistency among educators, and use and development of best teaching methods and practices based on motor learning and educational theory play an important role in developing TJM skills [16,28,29,31,32]. It is important that academic programs provide students with a strong foundation in manual therapy skills and for clinical education experiences to provide students with opportunities for mentorship by clinical instructors with advanced manual therapy training in order to further develop their competency.…”

Section: Recommendationsmentioning

confidence: 99%

Use of thrust joint manipulation by student physical therapists in the United States during clinical education experiences

Corkery

Hensley

Cesario

et al. 2020

Journal of Manual & Manipulative Therapy

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Introduction: Thrust joint manipulation (TJM) is used in physical therapy practice and taught in entry-level curricula in the United States (US); however, research regarding implementation by student physical therapists (SPT)s is scarce. Objectives: To explore the use of TJM in SPT clinical education and factors influencing implementation. Methods: In a cross-sectional exploratory study, accredited physical therapy (PT) programs in the US (n = 227) were invited to participate in an electronic survey. SPTs were queried about TJM use and their clinical instructor's (CI) credentials during their final musculoskeletal clinical experience.Results: Forty-five programs participated in the study, consisting of 2,147 SPTs. Of those, 414 (19.3%) responses were used for analysis and 69% reported using TJM. SPTs who utilized TJM were more likely to have a CI who used TJM (p < 0.001) and/or had advanced certification/ training in manual therapy (p < .001). A majority of students agreed or strongly agreed that their academic preparation provided them with clinical reasoning tools (84%) and psychomotor skills (69%) necessary to perform TJM. SPT use of TJM was facilitated by CI clinical practice, SPT competence in psychomotor skill, confidence in clinical reasoning, and practice setting. A main barrier to student use of TJM was CI lack of TJM use.

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“…척추교정실행은 다양한 부위에 적용이 가능하며 적용 부위에 따라 대상자의 자세로 달라진다. 그 중 옆으로 누운 골반의 척추교정적용은 힘을 효과적으로 전달하기 위해 초심자 물리치료사가 많은 훈련과 연습이 필요로 하는 복잡한 운동 기술이며 [16]. Triano와 Descarreaux [17], 요천추의 척추교정적용은 치료사의 자세변화가 작 은 흉추 적용에 비해 더욱 복잡한 다중 협응 운동이라 고 정의하였다.…”

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“…Triano와 Descarreaux [17], 요천추의 척추교정적용은 치료사의 자세변화가 작 은 흉추 적용에 비해 더욱 복잡한 다중 협응 운동이라 고 정의하였다. O'Donnell과 Smith [16]의 요천추 척추 교정에 대한 연구에 의하면 추력의 힘 발생을 위한 테 이블 높이가 중요하다는 것에 모든 임상의들이 동의한 다고 기술하였고, 테이블 높이에 관하여 시술자의 전상 장골극(anterior superior iliac spine)과 환자의 테이블과 비접촉면의 전상장골극 위치와 만나는 지점의 높이에서 척추교정이 이루어져야 한다는 주장이 있지만 이것은 일부 임상의의 의견이다 [16].…”

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Analysis of Biomechanical Characteristics of Therapist's Ground Reaction and Contact Hand Force and Time According to Table Height During Spinal Manipulation

Lee

2023

Phys Ther Rehabil Sci

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Objective: This study aimed to analyze the effects and characteristics of the height of the treatment table on the force and time of ground reaction (GR) and contact hand (CH) generated from the therapist's feet to generate thrust during spinal manipulation (SM). Design: A cross-sectional survey study Methods: Thirty-six healthy subjects were recruited. SM was performed on the ilium using a knee-high table, where the therapist felt it was easy to control the subject's posture and body shape and comfortable to generate force, as well as a relatively high thigh-high table. The force and time generated by the therapist's GR and CH were simultaneously measured through a force plate. Results: As a result, there was a significant difference in peak force and rundown force at the therapist's GR according to the table height (p＜0.05). In the therapist's CH, there was a significant difference between PreMin (preload minimum) force and peak force (p＜0.05), and there was a significant difference between the time from PreMin to peak and the time of the entire section (p＜0.05). Conclusions: As a result, the generation of increased CH force and faster thrust duration were confirmed by mobilizing the reduced GR force of the therapist to generate thrust than the relatively high table on the knee-high table.

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How should we teach lumbar manipulation? A consensus study

Abstract: This Delphi study successfully identified key characteristics of patient position and operator position and motion for effective delivery of side-lying lumbar spine manipulations.

Cited by 9 publications

References 42 publications

Factors Associated With Clinical Responses to Spinal Manipulation in Patients With Non-specific Thoracic Back Pain: A Prospective Cohort Study

Factors Associated With Clinical Responses to Spinal Manipulation in Patients With Non-specific Thoracic Back Pain: A Prospective Cohort Study

Use of thrust joint manipulation by student physical therapists in the United States during clinical education experiences

Analysis of Biomechanical Characteristics of Therapist's Ground Reaction and Contact Hand Force and Time According to Table Height During Spinal Manipulation

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