Training Primary Care Physicians to Give Limited Manual Therapy For Low Back Pain

Curtis, P.; Carey, Timothy S.; Evans, Paul; Rowane, Michael P.; Garrett, Joanne M.; Jackman, Anne

doi:10.1097/00007632-200011150-00018

Cited by 35 publications

(44 citation statements)

References 19 publications

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“…Our strategy included 5 contact hours. This is more than the 2-hour program of Cherkin et al, 42 but less than the 18-hour program of Curtis et al 41 A 192-hour program for physical therapists, which was given over a period of 12 months, improved outcomes in patients with chronic low back pain. 43 Although it may be expected that a more intense strategy automatically improves the results, this may not necessarily be true.…”

Section: Limitationsmentioning

confidence: 95%

“…In contrast, educating a professional did not seem sufficient to improve patient outcomes. 40 Curtis et al 41 concluded that the lack of results may be related to the failure of some participants to undertake the required sequence of maneuvers. Only 43% of the patients who underwent manual therapy actually received the complete planned sequence of maneuvers, which could be related to a lack of skills among the care providers.…”

Section: Limitationsmentioning

confidence: 99%

“…40,41 It may be possible that the intensity of our active strategy (eg, number of contact hours, number of sessions or frequency of sessions) was insufficient to result in improved patient outcomes. Our strategy included 5 contact hours.…”

Section: Limitationsmentioning

confidence: 99%

See 2 more Smart Citations

Implementation of Clinical Guidelines on Physical Therapy for Patients With Low Back Pain: Randomized Trial Comparing Patient Outcomes After a Standard and Active Implementation Strategy

Bekkering¹,

Tulder²,

et al. 2005

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Background and Purpose. An active strategy was developed for the implementation of the clinical guidelines on physical therapy for patients with low back pain. The effect of this strategy on patients' physical functioning, coping strategy, and beliefs regarding their low back pain was studied. Subjects. One hundred thirteen primary care physical therapists treated a total of 500 patients. Methods. The physical therapists were randomly assigned to 1 of 2 groups. The control group received the guidelines by mail (standard passive method of dissemination). The intervention group, in contrast, received an additional active training strategy consisting of 2 sessions with education, group discussion, role playing, feedback, and reminders. Patients with low back pain, treated by the participating therapists, completed questionnaires on physical functioning, pain, sick leave, coping, and beliefs. Results. Physical functioning and pain in the 2 groups improved substantially in the first 12 weeks. Multilevel longitudinal analysis showed no differences between the 2 groups on any outcome measure during follow-up. Discussion and Conclusion. The authors found no additional benefit to applying an active strategy to implement the physical therapy guidelines for patients with low back pain. Active implementation strategies are not recommended if patient outcomes are to be improved.

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Section: Limitationsmentioning

confidence: 95%

Section: Limitationsmentioning

confidence: 99%

See 1 more Smart Citation

Implementation of Clinical Guidelines on Physical Therapy for Patients With Low Back Pain: Randomized Trial Comparing Patient Outcomes After a Standard and Active Implementation Strategy

Bekkering¹,

Tulder²,

et al. 2005

View full text Add to dashboard Cite

show abstract

“…Figure 1 However, the remaining 59 measures of recovery were not used in more than one study. The majority of studies used one measure of recovery, however six studies measured recovery in two ways [8,13,20,34,35,60,83], one study used three measures [19,68] and one study had four different measures of recovery [44]. Of the 66 different measures reported, recovery was determined by a defined cut-off value on an established measurement instrument on 36 occasions.…”

Section: Data Extractionmentioning

confidence: 99%

How is recovery from low back pain measured? A systematic review of the literature

et al. 2010

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“…Visual instructional formats incorporate observation to facilitate psychomotor skill acquisition 10 , while kinesthetic instruction uses the learner's sensory system by physically moving the learner through the task 11 . Finally, movement context appears to influence psychomotor skill acquisition 12 . The intrinsic factors include 1) attention, 2) memory, 3) motivation, and 4) psychomotor learning stage 13 .…”

mentioning

confidence: 99%

Intrinsic and Extrinsic Factors Important to Manual Therapy Competency Development: A Delphi Investigation

Sizer

Sawyer²,

Felstehausen³

et al. 2008

Journal of Manual & Manipulative Therapy

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A learner's development of orthopaedic manual physical therapy (OMPT) psychomotor skills may be influenced by selected intrinsic and extrinsic factors. The purposes of this study were to identify the factors that influence learners' development of manual physical therapy competencies and to define each factor as intrinsic or extrinsic. A 3-round Delphi method survey and a retrospective review of the data were used to develop composite scores and rankings. Eighty manual physical therapy educators participated in the 3 rounds. Thirty-six factor descriptor statements associated with manual physical therapy competency were established and further categorized as intrinsic (19 total), extrinsic (10 total), or conceptual outliers (7 total). Cognitive Processing ranked as the most important factor influencing manual physical therapy competency development. Adaptation ranked second, followed by Science Knowledge. This study is the first to establish manual physical therapy educational factors associated with attainment of competency. The majority of the factors distill into the theory of extrinsic and intrinsic factors identified by Schmidt and Lee. The outcomes of this study identify the factors to which OMPT educators should give particular attention when developing and executing the learning experiences for their learners. Keywords:Competency-Based Education, Curriculum, Delphi Technique, Factors, Motor Learning, Musculoskeletal Manipulations, Psychomotor Performance. S pecific manual and/or movement-based competencies are emphasized by physical therapy educators during learners' development of psychomotor skills. Psychomotor skill acquisition is a product of psychomotor learning, which is a set of processes associated with practice or experience leading to relatively permanent changes in the capability for responding to stimuli 1 . As a consequence of psychomotor learning, individuals gain greater movement efficiency, develop more complex movement control strategies, optimize movement behaviors, and develop movement expertise 2 . Schmidt and Lee identified five extrinsic and four intrinsic factors that influence psychomotor learning factors are 1) practice, 2) feedback, 3) task classification, 4) instruction format, and 5) movement context. Factors such as practice, which involves cognitive processing 3,4 , accentuate learned abilities through the processing of sensory information 5 . The use of quantitative feedback and concurrent feedback in manual physical therapy learning has provided both favorable [6][7][8] and unfavorable results 9 . Visual instructional formats incorporate observation to facilitate psychomotor skill acquisition 10 , while kinesthetic instruction uses the learner's sensory system by physically moving the learner through the task 11 . Finally, movement context appears to influence psychomotor skill acquisition 12 . The intrinsic factors include 1) attention, 2) memory, 3) motivation, and 4) psychomotor learning stage 13 . These factors are less tangible and more difficult to measure t...

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Training Primary Care Physicians to Give Limited Manual Therapy For Low Back Pain

Cited by 35 publications

References 19 publications

Implementation of Clinical Guidelines on Physical Therapy for Patients With Low Back Pain: Randomized Trial Comparing Patient Outcomes After a Standard and Active Implementation Strategy

Implementation of Clinical Guidelines on Physical Therapy for Patients With Low Back Pain: Randomized Trial Comparing Patient Outcomes After a Standard and Active Implementation Strategy

How is recovery from low back pain measured? A systematic review of the literature

Intrinsic and Extrinsic Factors Important to Manual Therapy Competency Development: A Delphi Investigation

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