Spinal Evaluation Techniques

A 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

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)

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 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 %)

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

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

Spinal Evaluation Curriculum:

Content• McKenzie 95.7 %

• Maitland 93.6 %

• Cyriax 91.4 %

• Kaltenborn 75.3 %

• Paris 72.0 %

• Kendall 67.7 %

• Saunders 64.5 %

• Travell 60.2 %

• Butler 51.6 %

• Waddell 50.5 %

• Grieve 44.1 %

• Evjenth 26.9 %

• Janda 25.8 %

• Mulligan 21.5 %

• Greenman 17.2 %

• Stoddard 12.9 %

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 %

Spinal Evaluation Curriculum:

Techniques

• > 95 % of all programs

teach the following

spinal evaluation

techniques:

• Postural Asymmetry

• Neurological Testing

• Flexibility

• Provocative Testing

Sacroiliac/Spine

• Neural Tension

• ROM

Spinal Evaluation Curriculum:

Techniques• > 90 % of all programs

teach the following

spinal evaluation

techniques:

• Palpation

• Repeated Movement

• Passive Intervertebral

Joint Motion

• Manual Muscle Tests

• Pain Patterns/Behavior

Spinal Evaluation Curriculum:

Techniques• Others: • Non-Organic Tests

(69 %)

• Isokinetic Testing

(9 %)

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”

Relative Importance Of Techniques

0

1

2

3

4

5

6

7

8

9

10

Asy

mm

etry

Neu

roP

alpa

tion

Flexi

bilit

y

RO

MP

rov.

Spi

ne

PIV

MR

epea

ted

Pai

nP

rov.

SI

Tensi

on

MM

TN

on-O

rgan

icIs

okin

etic

Techniques

RI S

core

MeanMedianMode

Relative Importance Of Techniques

0%

20%

40%

60%

80%

100%

Asym

met

ryN

euro

Palpa

tion

Flexib

ility

RO

MPro

v.Spi

nePIV

MR

epea

ted

Pain

Prov.

SITe

nsio

nM

MT

Non

-Org

anic

Isok

inet

ic

Techniques

% O

f R

esp

on

den

ts

0 to 3

4 to 6

7 to 9

10

Relative Importance And

Faculty Certification

0

20

40

60

80

100

Pain Flexibility Repeated Non-Organic

% R

esp

on

den

ts S

corin

g 7

- 1

0

OCS

ManTher

Paris

McKenzie

Sample

Relative Importance And Degree

0

20

40

60

80

100

Asym

met

ryNeu

roPal

patio

nFle

xibilit

yRO

MPro

v.Spin

ePIV

MRep

eate

dPai

nPro

v.SI

Tensio

nM

MT

Non-O

rgan

icIs

okin

etic

Techniques

% R

esp

on

de

nts

Sco

rin

g 7

- 1

0

Bachelors

Masters

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

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