Spinal Evaluation Techniques: 2000 McKenzie Institute North American Conference
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Spinal Evaluation Techniques: 2000 McKenzie Institute North American Conference

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Spinal Evaluation Techniques: 2000 McKenzie Institute North American Conference Spinal Evaluation Techniques: 2000 McKenzie Institute North American Conference Presentation Transcript

  • Spinal Evaluation Techniques A Survey Of Entry-Level Physical TherapyCurricula In The United States, Canada, Australia, New Zealand, And The United Kingdom Allan Besselink, P.T., Dip.MDT Austin, TX Jeffrey Witten, MSPT San Antonio, TX
  • Educational Process• Curriculum content (what) – validity – reliability – relevance• Perception of importance of content (why)• Clinical reasoning (how)
  • Purpose• Establish current trends in spinal evaluation curriculum content in entry-level physical therapy educational programs• Provide a foundation for further comparison with the literature on reliability and validity of spinal evaluation techniques
  • Methods And Research Design• Survey consisting of questions regarding - – 1. Authors or references cited in the development of the curriculum content – 2. Evaluation techniques taught in the curriculum – 3. Relative importance of each technique to the overall scope of the spinal evaluation curriculum
  • Survey Results• Survey sent to 195 entry-level physical therapy educational programs – 148 United States, 47 International• Return rate of 62.6 % (n = 122) – 93 United States, 29 International – 53 Bachelors (43.4 %) - 28 International – 69 Masters (56.6 %) - 68 United States
  • Curriculum - Content• Maitland • Travell• Butler • Paris• Kaltenborn • Evjenth• Saunders • McKenzie• Janda • Cyriax• Grieve • Stoddard• Waddell • Mulligan• Kendall • Greenman
  • Curriculum - Content• “The Big 2” – McKenzie 95.1% – Maitland 93.4%• United States – The Big 2, Cyriax, Kaltenborn, Paris, Kendall• International – The Big 2, Butler, Grieve, Cyriax, Janda
  • Curriculum - Content• References that critically examine the current status of spinal evaluation and treatment: – Spitzer et al 1987 (QTF) 5.7 % • United States 1.1% • International 20.7%
  • Curriculum - Techniques• Palpation • Provocative Testing• Postural Asymmetry Sacroiliac Joint/Spine• ROM/Mobility • Passive Intervertebral• Flexibility Joint Motion• Manual Muscle Tests • Non-Organic Tests• Isokinetic Testing • Neurological Testing• Repeated Movement • Neural Tension • Pain Patterns/Behavior
  • Curriculum - Techniques>95% of programs Total US INTAsymmetry 1 1 1Neurological 1 1 1Neural Tension 3 6 1Flexibility 4 4 8--PIVM 4 8- 1Palpation 6 8- 5ROM/Mobility 6 7 6-
  • Curriculum - Techniques>90% of programs Total US INTRep. Movement 8 8 6Prov. Sacroiliac 9 3+ 11-Prov. Spine 9 4+ 10-Pain Patterns 11 12 8-
  • Curriculum - TechniquesOther Total US INTMMT 12 11+ 11Non-Organic 13 13 13Isokinetic 14 14 14
  • Relative Importance• What is the relative importance of each technique to the overall scope of the spinal evaluation curriculum?• Prioritized ranking of 0 - 10 – 0 = “no priority/not taught” – 10 = “high priority/great deal of time spent on that particular technique”
  • Relative Importance by Rank• International • United States – Neurological – Asymmetry – ROM/Mobility – Neurological – Palpation – Palpation – PIVM – Flexibility – ROM/Mobility
  • Relative Importance by Mode• International • United States – Palpation – Palpation – ROM/Mobility – Asymmetry – Provocative Spine – Repeated – PIVM Movements – Neurological – PIVM – Neural Tension – Neurological – Pain Patterns
  • Faculty Profile International United StatesGender M/F 20.7/55.2 57.0/38.7Certification 38.0 38.6Active 79.3 79.6Hours 0-25 (3) 0-35 (10)Years 0-35 (10) 0-25 (10)
  • Spinal Evaluation Curriculum • Degree Program • Content • Techniques – “eclectic teaching” approach • Relative Importance – faculty certification
  • Treatment Preferences• Battie et al - Physical Therapy 1994 – 48% rated the McKenzie method as the “most useful” approach – 56.4% “poorly prepared at entry” to clinical practice
  • Treatment Preferences• Foster et al - Spine 1999 – treatment preferences in Britain and Ireland – “The Big 2” • 58.9% utilize Maitland • 46.6% utilize McKenzie
  • Conclusions• Current trends in entry-level physical therapy spinal evaluation curriculum• Consensus-based versus Evidence-based curricula• Are we preparing physical therapists for entry-level practice?
  • Acknowledgements• Iain Muir (Canada)• Richard Dale (Canada)• Harry Papagoras (Australia)• Mark Laslett (New Zealand)• Malcolm Robinson (United Kingdom)
  • Implications To MII• McKenzie is referenced but repeated movements are not perceived as important by instructors• McKenzie method is becoming well- supported as an assessment technique• Clinicians are poorly prepared at entry level• Clinicians eventually rate it as effective