The Influence of Experience and Specialty Certifications on Clinical Outcomes for Patients With Low Back Pain Treated Within a Standardized Physical Therapy Management Program

Abstract

Study Design: Secondary analysis of a randomized trial. Objectives: To examine the influence of experience and specialty certification on outcomes for patients with low back pain receiving a standardized manipulation or stabilization exercise intervention program. Background: Little research has examined the impact of therapist-related factors on the outcomes of clinical care for patients with low back pain. It is assumed that therapists with more clinical experience or specialty certification will achieve better clinical outcomes; however, few studies have examined this hypothesis. Methods and Measures: One hundred thirty-one participants in a randomized trial were included (70 randomized to receive manipulation, 61 stabilization). All subjects completed an Oswestry Disability Questionnaire at baseline, and after 1 and 4 weeks of treatment. Therapists were categorized based on total years of experience, years of experience with manual therapy, and specialty certification status. Two-way repeated-measures analyses of covariance were performed within each intervention group to examine the effects of the therapist characteristics on outcomes. Hierarchical linear regression models were used to examine the relative effects of therapist characteristics and intervention on clinical outcomes. Results: Thirteen therapists participated (average 6.0 years of experience [standard deviation, 4.0], 4 (30.8%) with specialty certification). A significant interaction between time and specialty certification status (P = .04) was detected for subjects receiving the manipulation intervention. No significant interactions were detected in the stabilization group. The regression models found that the intervention group significantly contributed to explaining clinical outcomes, but that therapist characteristics did not. Professions, Mail Code G-9, 3333 Regis Blvd, Denver, CO 80221-1099. E-mail: jwhitman@regis.edu Conclusions: With the standardized protocol utilized in this study, it appears that the therapist-related factors of increased experience and specialty certification status do not result in an improvement in patients' disability associated with low back pain.

Subgrouping Patients With Low Back Pain: Evolution of a Classification Approach to Physical Therapy

“…It also appears that the intervention strategies proposed by the classification system can be applied effectively by physical therapists regardless of clinical experience. Whitman et al 124 found no difference in outcomes associated with therapists' years of experience in a group of patients with LBP who received manipulation or stabilization exercise interventions.…”

A Primer on Selected Aspects of Evidence-Based Practice Relating to Questions of Treatment, Part 2: Interpreting Results, Application to Clinical Practice, and Self-Evaluation

“…Despite these findings, one cannot infer that patients cared for by expert clinicians will achieve superior outcomes when compared to the outcomes of patients treated by novice clinicians. 71,85 In fact, it has been demonstrated that expert clinicians are often resistant to changing their practice behaviors even when their treatment approaches have been disproven. 5 Hence, while clinical expertise is important, it is insufficient to assure optimal outcomes.…”

“…17,36,85 While some clinicians are quick to adopt change, many others are unfortunately resistant to change and rely predominantly on their clinical experience rather than incorporating evidence into their practice. 9 Although the volume and quality of emerging evidence in many areas of physical therapist practice is mounting rapidly, we acknowledge that there are still many areas where evidence is sparse and inconclusive.…”

“…Reliance on clinical experience without including knowledge and application of evidence to clinical care is inconsistent with the principles of EBP. 16,85 Therefore, seeking and incorporating the best available evidence should be an integral part of the clinical decision-making process.…”

A Model for Standardizing Manipulation Terminology in Physical Therapy Practice

“…For example, multiple theories exist to explain mechanisms of action and indications for techniques [32][33][34][35][36] . Issues also surround the effi cacy of techniques 37,38 , qualifi cations for performing manipulations 39 , and the lack of consistent defi nitions regarding manual therapy and manipulation in general 6,18-20, . These issues are very important, and debate on these topics should and will continue.…”