A simulated passive intervertebral motion task: observations of performance in a cross-sectional study

Face validity of a simulated low back pain clinical case in physical therapy training

Introduction: The use of clinical cases in simulated environments allows for a more realistic approach to the simulated health condition, which results in a more effective training experience for students, as they are immersed in situations they may encounter in their professional practice. Objective: To determine the face validity of a low back pain clinical case as a clinical simulation tool in the training of physical therapy students. Materials and methods: Study conducted to determine the face validity of a low back pain clinical case presented to physical therapy students. The case has 9 items, which were evaluated by 5 expert raters. Agreement between raters regarding the pertinence, relevance, coherence, clarity, and sufficiency of the case was established using the Fleiss’ Kappa coefficient. Results: Fleiss’ Kappa for the simulated case was 0.67 (substantial agreement), and for items 1, 2, 4, and 9 was 0.97, 1.0, 0.89, and 1.0, respectively (almost perfect agreement). Furthermore, the percentage of case comprehensibility (9 items) was 95.2. Conclusion: The face validity of the low back pain clinical case was confirmed, so its use in clinical simulation practices in the physical therapy programs offered by the Universidad de La Sabana and Universidad de Boyacá in Colombia is valid.

Spinal PA movements behave 'as if' there are limitations of local segmental mobility and are large enough to be perceivable by manual palpation: A synthesis of the literature

BACKGROUND

Posterio-anterior (PA) movements are one type of passive intervertebral movement used to assess and treat perceived deficits in localized segmental mobility.

OBJECTIVES

To describe: 1) The specific effects that reductions in segmental mobility would be expected to have on PA movements; 2) How differences in PA movements in clinical situations compare to what would be expected with reduced segmental mobility; and 3) Whether such differences in PA movements are likely to be perceivable by manual palpation.

METHODS

Multiple modelling studies and in vivo measurements of PA movements are described.

RESULTS

The findings indicate the differences in PA movements present in clinical conditions corresponds with the differences that would be expected with decreased segmental mobility. The differences both predicted from the modelling and found in clinical conditions were greatest at low levels of force. Additionally, the differences are large enough that individuals with training are likely to be capable of 1) consistently producing controlled movements with sufficiently small magnitudes of force to assess the movements, and 2) detecting the differences in stiffness expected from modelling and found in clinical situations.

CONCLUSIONS

Implications for clinical practice and teaching include the need to attend to the stiffness of PA movements at lower levels of force than those typically described. The authors recommend a three tiered approach to assessment of PA movements which may assist in both clinical practice and teaching manual therapy skills.