Spinal Evaluation Techniques: 2000 McKenzie Institute North American Conference

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Spinal Evaluation Techniques: 2000 McKenzie Institute North American Conference

  1. 1. 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
  2. 2. Educational Process• Curriculum content (what) – validity – reliability – relevance• Perception of importance of content (why)• Clinical reasoning (how)
  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 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
  6. 6. Curriculum - Content• Maitland • Travell• Butler • Paris• Kaltenborn • Evjenth• Saunders • McKenzie• Janda • Cyriax• Grieve • Stoddard• Waddell • Mulligan• Kendall • Greenman
  7. 7. 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
  8. 8. 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%
  9. 9. 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
  10. 10. 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-
  11. 11. 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-
  12. 12. Curriculum - TechniquesOther Total US INTMMT 12 11+ 11Non-Organic 13 13 13Isokinetic 14 14 14
  13. 13. 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”
  14. 14. Relative Importance by Rank• International • United States – Neurological – Asymmetry – ROM/Mobility – Neurological – Palpation – Palpation – PIVM – Flexibility – ROM/Mobility
  15. 15. Relative Importance by Mode• International • United States – Palpation – Palpation – ROM/Mobility – Asymmetry – Provocative Spine – Repeated – PIVM Movements – Neurological – PIVM – Neural Tension – Neurological – Pain Patterns
  16. 16. 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)
  17. 17. Spinal Evaluation Curriculum • Degree Program • Content • Techniques – “eclectic teaching” approach • Relative Importance – faculty certification
  18. 18. 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
  19. 19. Treatment Preferences• Foster et al - Spine 1999 – treatment preferences in Britain and Ireland – “The Big 2” • 58.9% utilize Maitland • 46.6% utilize McKenzie
  20. 20. 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?
  21. 21. Acknowledgements• Iain Muir (Canada)• Richard Dale (Canada)• Harry Papagoras (Australia)• Mark Laslett (New Zealand)• Malcolm Robinson (United Kingdom)
  22. 22. 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

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