COVID 19 and manual therapy: international lessons and perspectives on current and future clinical practice and education

BACKGROUND

The COVID-19 pandemic has altered clinical practice and education in manual therapy globally. Social distancing has limited in-person care and changed health-care provision. Education in manual therapy has moved to online platforms with in-person instruction restricted. The global impact on the clinical practice of manual therapy and education has to date not been explored.

METHODS

a questionnaire survey methodology was used. A sample of convenience of global leaders in manual therapy practice and education received an electronic link to two surveys: one on clinical practice and one on education. Contributors could complete one or both surveys.

RESULTS

Twenty-five surveys were received on clinical practice and 23 on education in manual therapy, representing the six major continents. Global themes in clinical practice demonstrated a sudden and dramatic shift away from patient contact, with limited modifications to manual therapy in patient care currently adopted. Themes in education were of a major shift to online learning, development of new modes of student instruction including video-based assessment and virtual case-based instruction.

CONCLUSION

The international perspectives provided demonstrate a major change in manual therapy practice and education globally. Various approaches have been taken in practice and education without a uniform approach being demonstrated.

[Orthopaedic manual therapy : definition, characteristics and update on the situation in Belgium]

Although orthopaedic manual therapy (OMT) has existed for decades, and although a recent Belgian Royal Decree, published in 2014, recognized it as a particular professional qualification in physiotherapy for the treatment of neuromusculoskeletal dysfunctions, OMT remains little known by patients, but also by healthcare professionals. Yet, this professional qualification, based on clinical reasoning, using highly specific treatments, guided by the best available scientific and clinical evidence and the specific biopsychosocial characteristics of each patient, is the subject of a growing number of scientific studies pointing out its effectiveness. This article summarizes the knowledge related to OMT (definition, history, characteristics, techniques, indications, access and reimbursement) and describes its situation in Belgium.

Quantification of Motion Palpation

CONTEXT

The palpation of motions is at the heart of the practice of foreign-trained osteopaths. When practicing osteopathic manual therapy (care provided by foreign-trained osteopaths) in the cranial field or osteopathic cranial manipulative medicine, the palpation of small motions (several tens of micrometers) is a key process. However, to the authors' knowledge, the smallest detectable motion has not been identified.

OBJECTIVE

To quantify motion detection capacity by passive palpation.

METHODS

Participants were instructed to hold a mechanical device containing a micrometric actuator between their hands and report when they felt motion while 6 series of 27 random motions were generated by the actuator. After each series, if a participant succeeded or failed to detect motion with a confidence level of greater than 98%, the motions in the next series were set to a smaller or larger magnitude, respectively. After 6 series, the individual motion detection capacity was recorded. Statistical significance was set at P=.02.

RESULTS

A total of 21 participants were selected, comprising 14 osteopaths and 7 nonosteopaths. The average performance of the sample was 148 μm. Thirteen participants (62%) perceived motions of 200 μm or less, and 7 participants (33%) detected motions of 50 μm or less with bare hands. Osteopathic training did not notably affect the performance. Osteopaths were twice as likely to claim detection of nonexisting motions than to miss existing ones, whereas nonosteopaths were equally subject to both types of errors.

CONCLUSION

The data show human passive palpatory sensitivity to be in the range of several tens of micrometers. This range is comparable to that reported for calvarial motion (10-50 μm).

[Exploration and practice of research-based teaching in the course of theory of Meridians and Acupoints for acupuncture and tuina specialty]

For the purpose of exploring the teaching reform model and method, also promoting the quality of talents in acupuncture and tuina field, the research-based teaching model is applied into the course of Theory of Meridians and Acupoints. This method includes two parts of teaching and learning. For teachers, they bring modern research focus and trend into teaching through questionnaire survey among students, aiming to integrate the education inside and outside class. For students, they are guided to resolve the opening, enlightening and scalable issues through consulting abundant resources of literature and database to achieve autonomous participation in the course of learning. By this teaching method, it is expected to train the student's ability of expanding their thinking, as well as discovering, analyzing and solving the problem.

An online community of practice to support evidence-based physiotherapy practice in manual therapy

INTRODUCTION

The purpose of this study was to explore how a community of practice promoted the creation and sharing of new knowledge in evidence-based manual therapy using Wenger's constructs of mutual engagement, joint enterprise, and shared repertoire as a theoretical framework.

METHODS

We used a qualitative approach to analyze the discussion board contributions of the 19 physiotherapists who participated in the 10-week online continuing education course in evidence-based practice (EBP) in manual therapy. The course was founded on community of practice, constructivism, social, and situated learning principles.

RESULTS

The 1436 postings on 9 active discussion boards revealed that the community of practice was a social learning environment that supported strong participation and mutual engagement. Design features such as consistent facilitation, weekly guiding questions, and collaborative assignments promoted the creation and sharing of knowledge. Participants applied research evidence to the contexts in which they worked through reflective comparison of what they were reading to its applicability in their everyday practice. Participants' shared goals contributed to the common ground established in developing collective knowledge about different study designs, how to answer research questions, and the difficulties of conducting sound research.

DISCUSSION

An online longitudinal community of practice utilized as a continuing education approach to deliver an online course based on constructivist and social learning principles allowed geographically dispersed physiotherapists to be mutually engaged in a joint enterprise in evidence-based manual therapy. Advantages included opportunity for reflection, modeling, and collaboration. Future studies should examine the impact of participation on clinical practice.

Effectiveness of two forms of feedback on training of a joint mobilization skill by using a joint translation simulator

BACKGROUND AND PURPOSE

Joint mobilization is a complicated task to learn and to teach and is characterized by great intersubject variability. This study's purpose was to investigate whether quantitatively augmented feedback could enhance the learning of joint mobilization and, more specifically, to compare the effects of training with concurrent or terminal feedback by using a joint translation simulator (JTS).

SUBJECTS

Thirty-six undergraduate physical therapist students were randomly assigned to control (no feedback), concurrent feedback, and terminal feedback groups.

METHODS

The JTS was designed to simulate tissue resistance based on load-displacement relationships of glenohumeral joint specimens. Subjects applied specific mobilization grades of force on the JTS while quantitative feedback was given to the feedback groups either during a trial (ie, concurrent feedback) or after a trial (ie, terminal feedback). The skill acquisition phase lasted a total of 40 minutes, and a total of 75 repetitions were performed for each grade of each joint model. Pretest and no-feedback retention tests were conducted.

RESULTS

During acquisition and retention, both feedback groups performed more accurately than did the control group. No obviously superior performance was shown by the terminal feedback group compared with concurrent feedback group during retention testing.

DISCUSSION AND CONCLUSION

Subjects who trained with augmented feedback had less variability, and thus more consistency, than the control group subjects who received no feedback. Augmented feedback provides the student with a reference force and the status of his or her performance. The effectiveness of the JTS feedback compared with no feedback was clearly demonstrated. Skill acquisition in mobilization can be enhanced by either concurrent or terminal feedback.

The influence of a postgraduate clinical master's qualification in manual therapy on the careers of physiotherapists in the United Kingdom

Over the last decade there has been potential for manual therapists to extend their roles and develop their careers. In order to explore the career pathways of a group of postgraduate manual therapists and to identify the influence of Master's education on those careers, a postal questionnaire was sent to all graduates from a clinically based programme (response rate 62.3%, n=48, with representation from each year over a 10-year period). All the respondents were still working in physiotherapy and the majority had a clinical element to their role (83%). The new career framework, which seeks to enable therapists to progress their careers and retain a clinical work load is demonstrated within this sample, with 6.2% achieving Consultant Therapist roles, 14.4% in Extended Scope Practitioner posts and 16.6% working as Clinical Specialists. Positive contributions from Master's education were the status of the qualification, improved clinical skills and increased confidence. Negative factors were less clinical 'hands-on' within their roles, lack of time and an increase in management responsibilities. Findings suggest that Master's education has enabled the participants to take on the new roles that have resulted from a raft of political imperatives but further work could explore the issues around positive and negative drivers.

A survey of training and practice patterns of massage therapists in two US states

BACKGROUND

Despite the growing popularity of therapeutic massage in the US, little is known about the training or practice characteristics of massage therapists. The objective of this study was to describe these characteristics.

METHODS

As part of a study of random samples of complementary and alternative medicine (CAM) practitioners, we interviewed 226 massage therapists licensed in Connecticut and Washington state by telephone in 1998 and 1999 (85% of those contacted) and then asked a sample of them to record information on 20 consecutive visits to their practices (total of 2005 consecutive visits).

RESULTS

Most massage therapists were women (85%), white (95%), and had completed some continuing education training (79% in Connecticut and 52% in Washington). They treated a limited number of conditions, most commonly musculoskeletal (59% and 63%) (especially back, neck, and shoulder problems), wellness care (20% and 19%), and psychological complaints (9% and 6%) (especially anxiety and depression). Practitioners commonly used one or more assessment techniques (67% and 74%) and gave a massage emphasizing Swedish (81% and 77%), deep tissue (63% and 65%), and trigger/pressure point techniques (52% and 46%). Self-care recommendations, including increasing water intake, body awareness, and specific forms of movement, were made as part of more than 80% of visits. Although most patients self-referred to massage, more than one-quarter were receiving concomitant care for the same problem from a physician. Massage therapists rarely communicated with these physicians.

CONCLUSION

This study provides new information about licensed massage therapists that should be useful to physicians and other healthcare providers interested in learning about massage therapy in order to advise their patients about this popular CAM therapy.