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Spinal Evaluation TechniquesA Survey Of Entry-Level Physical Therapy      Curricula In The United States  Allan Besselink,...
Introduction• Importance of diagnosis and the establishment  of treatment criteria defined by:  – American Physical Therap...
Purpose• Establish current trends in spinal evaluation  curriculum content in entry-level physical  therapy educational pr...
Methods And Research Design• Survey consisting of questions regarding -  – 1. Authors or references cited in the developme...
Survey Results• Survey sent to 148 accredited entry-level  physical therapy educational programs in the  United States• Re...
Faculty Profile• Gender: 57.0 % male, 38.7 % female• PT Educational Level  – Bachelors          45.2 %  – Masters         ...
Faculty Profile• 38.6 % have post-graduate certifications  –   OCS                     28.0 %  –   Manual Therapy         ...
Spinal Evaluation Curriculum:                Content•   McKenzie     95.7 %   •   Butler     51.6 %•   Maitland     93.6 %...
Spinal Evaluation Curriculum:              Content• References that critically examine the current  status of spinal evalu...
Spinal Evaluation Curriculum:            Techniques• > 95 % of all programs   • Postural Asymmetry  teach the following   ...
Spinal Evaluation Curriculum:            Techniques• > 90 % of all programs   • Palpation  teach the following      • Repe...
Spinal Evaluation Curriculum:            Techniques• Others:         • Non-Organic Tests                    (69 %)        ...
Relative Importance To Curriculum• What is the relative importance of each  technique to the overall scope of the spinal  ...
RI Score              As                   ym                                    0                                    1   ...
% Of Respondents               As                 ym                       m                                    0%        ...
Relative Importance And                                       Faculty Certification                               100% Res...
% Respondents Scoring 7 - 10               As                  y   m                                    0                 ...
Inter-Rater Reliability Of Spinal      Evaluation Techniques• Significant difficulties when reviewing the  current literat...
Conclusions And Future Research• Current trends in entry-level physical therapy  spinal evaluation curriculum have been  d...
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Spinal Evaluation Techniques: 1997 McKenzie Institute International conference

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Spinal Evaluation Techniques: 1997 McKenzie Institute International conference

  1. 1. Spinal Evaluation TechniquesA Survey Of Entry-Level Physical Therapy Curricula In The United States Allan Besselink, P.T., Cert.MDT Lecturer, Southwest Texas State University San Marcos, TX Staff PT, Columbia/St. David’s Spine Center Austin, TX
  2. 2. Introduction• Importance of diagnosis and the establishment of treatment criteria defined by: – American Physical Therapy Association “Guide To Physical Therapist Practice, Volume I” (1995) – Commission On Accreditation In Physical Therapy Education (1997)
  3. 3. 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
  4. 4. 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
  5. 5. Survey Results• Survey sent to 148 accredited entry-level physical therapy educational programs in the United States• Return rate of 62.8 % (n = 93) – 25 Bachelors programs (26.9 %) – 68 Masters programs (73.1 %)
  6. 6. Faculty Profile• Gender: 57.0 % male, 38.7 % female• PT Educational Level – Bachelors 45.2 % – Masters 45.2 %• Highest Educational Level Attained – Masters 63.4 % – Doctorate 33.3 % – 54.8 % have terminal degree in physical therapy
  7. 7. Faculty Profile• 38.6 % have post-graduate certifications – OCS 28.0 % – Manual Therapy 8.6 % – Paris 7.5 % – McKenzie 5.4 %• 79.6 % are currently active in spine care – 8.57 clinical hours per week (median = 6.0)• 9.54 years clinical experience in spine care
  8. 8. Spinal Evaluation Curriculum: Content• McKenzie 95.7 % • Butler 51.6 %• Maitland 93.6 % • Waddell 50.5 %• Cyriax 91.4 % • Grieve 44.1 %• Kaltenborn 75.3 % • Evjenth 26.9 %• Paris 72.0 % • Janda 25.8 %• Kendall 67.7 % • Mulligan 21.5 %• Saunders 64.5 % • Greenman 17.2 %• Travell 60.2 % • Stoddard 12.9 %
  9. 9. Spinal Evaluation Curriculum: Content• References that critically examine the current status of spinal evaluation and treatment: – Spitzer et al 1987 (QTF) 1.1 % – Bigos et al 1994 (AHCPR) 2.1 %
  10. 10. Spinal Evaluation Curriculum: Techniques• > 95 % of all programs • Postural Asymmetry teach the following • Neurological Testing spinal evaluation • Flexibility techniques: • Provocative Testing Sacroiliac/Spine • Neural Tension • ROM
  11. 11. Spinal Evaluation Curriculum: Techniques• > 90 % of all programs • Palpation teach the following • Repeated Movement spinal evaluation • Passive Intervertebral techniques: Joint Motion • Manual Muscle Tests • Pain Patterns/Behavior
  12. 12. Spinal Evaluation Curriculum: Techniques• Others: • Non-Organic Tests (69 %) • Isokinetic Testing (9 %)
  13. 13. Relative Importance To Curriculum• 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”
  14. 14. RI Score As ym 0 1 2 3 4 5 6 7 8 9 10 m et ry Ne ur Pa o lp at io Fl n ex ib ilit y R O Pr M ov .S pi ne PI VM R ep ea te d Pa inTechniques Pr ov .S Te I ns io n No MM n- T O rg an Is ic ok in et ic Mean Mode Median Relative Importance Of Techniques
  15. 15. % Of Respondents As ym m 0% 20% 40% 60% 80% 100% et ry N e Pa uro lp a Fl tion ex ib ilit y R Pr O ov M .S pi ne P R IVM ep ea te d PaTechniques Pr in ov Te .SI ns io n N on MM -O T rg a Is nic ok in et ic 10 Relative Importance Of Techniques 7 to 9 4 to 6 0 to 3
  16. 16. Relative Importance And Faculty Certification 100% Respondents Scoring 7 - 10 80 OCS 60 ManTher Paris 40 McKenzie Sample 20 0 Pain Flexibility Repeated Non-Organic
  17. 17. % Respondents Scoring 7 - 10 As y m 0 20 40 60 80 100 m et r Ne y Pa u r lp o a F l t io ex n ib ilit y P r RO ov M .S pi ne Re PIV pe M at ed PaTechniques Pr in ov Te .SI ns io No n n - MM O rg T Is an ok ic in et ic Relative Importance And Degree Masters Bachelors
  18. 18. Inter-Rater Reliability Of Spinal Evaluation Techniques• Significant difficulties when reviewing the current literature secondary to: – lack of published studies on any given technique – lack of standardized protocols for any given technique – variations in statistical analysis
  19. 19. Conclusions And Future Research• Current trends in entry-level physical therapy spinal evaluation curriculum have been defined• Statistical comparison to data on the inter- rater reliability of each technique• Other nationalities (Canada, Australia)• Other health care professions utilizing similar physical examination procedures

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