Spinal Evaluation Techniques: 2000 McKenzie Institute North American Conference
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Transcript of Spinal Evaluation Techniques: 2000 McKenzie Institute North American Conference
Spinal Evaluation Techniques
A Survey Of Entry-Level Physical Therapy
Curricula In The United States, Canada, Australia,
New Zealand, And The United Kingdom
Allan Besselink, P.T., Dip.MDT
Austin, TX
Jeffrey Witten, MSPTSan Antonio, TX
Educational Process
• Curriculum content (what)
– validity
– reliability
– relevance
• Perception of importance of content (why)
• Clinical reasoning (how)
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 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
Curriculum - Content
• Maitland
• Butler
• Kaltenborn
• Saunders
• Janda
• Grieve
• Waddell
• Kendall
• Travell
• Paris
• Evjenth
• McKenzie
• Cyriax
• Stoddard
• Mulligan
• Greenman
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
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%
Curriculum - Techniques
• Palpation
• Postural Asymmetry
• ROM/Mobility
• Flexibility
• Manual Muscle Tests
• Isokinetic Testing
• Repeated Movement
• Provocative Testing
Sacroiliac Joint/Spine
• Passive Intervertebral
Joint Motion
• Non-Organic Tests
• Neurological Testing
• Neural Tension
• Pain Patterns/Behavior
Curriculum - Techniques
>95% of programs Total US INT
Asymmetry 1 1 1
Neurological 1 1 1
Neural Tension 3 6 1
Flexibility 4 4 8--
PIVM 4 8- 1
Palpation 6 8- 5
ROM/Mobility 6 7 6-
Curriculum - Techniques
>90% of programs Total US INT
Rep. Movement 8 8 6
Prov. Sacroiliac 9 3+ 11-
Prov. Spine 9 4+ 10-
Pain Patterns 11 12 8-
Curriculum - Techniques
Other Total US INT
MMT 12 11+ 11
Non-Organic 13 13 13
Isokinetic 14 14 14
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”
Relative Importance by Rank
• International
– Neurological
– ROM/Mobility
– Palpation
– PIVM
• United States
– Asymmetry
– Neurological
– Palpation
– Flexibility
– ROM/Mobility
Relative Importance by Mode
• International
– Palpation
– ROM/Mobility
– Provocative Spine
– PIVM
– Neurological
– Neural Tension
– Pain Patterns
• United States
– Palpation
– Asymmetry
– Repeated
Movements
– PIVM
– Neurological
Faculty Profile
International United States
Gender M/F 20.7/55.2 57.0/38.7
Certification 38.0 38.6
Active 79.3 79.6
Hours 0-25 (3) 0-35 (10)
Years 0-35 (10) 0-25 (10)
Spinal Evaluation Curriculum
• Degree Program
• Content
• Techniques
– “eclectic teaching” approach
• Relative Importance
– faculty certification
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
Treatment Preferences
• Foster et al - Spine 1999
– treatment preferences in Britain and Ireland
– “The Big 2”
• 58.9% utilize Maitland
• 46.6% utilize McKenzie
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?
Acknowledgements
• Iain Muir (Canada)
• Richard Dale (Canada)
• Harry Papagoras (Australia)
• Mark Laslett (New Zealand)
• Malcolm Robinson (United Kingdom)
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