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Thrust joint manipulation utilization by U.S. physical therapists.

Emilio J Puentedura1, Rebecca Slaughter1, Sean Reilly1

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Summary
This summary is machine-generated.

Physical therapists report less comfort and utilization of thrust joint manipulation (TJM) for the cervical spine compared to the thoracic and lumbar regions. This highlights a clinical practice variability that warrants further investigation and potential intervention.

Keywords:
Thrust joint manipulationmanipulationmanual therapymobilizationsurvey

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Area of Science:

  • Orthopedic Physical Therapy
  • Spinal Manipulation Techniques
  • Clinical Practice Patterns

Background:

  • Thrust joint manipulation (TJM) to the cervical spine is less frequently taught in physical therapy programs compared to the thoracic and lumbar spines.
  • Existing literature suggests a potential disparity in TJM education and application across different spinal regions.

Purpose of the Study:

  • To assess physical therapists' current utilization of TJM across the cervical, thoracic, and lumbar spine.
  • To determine physical therapists' comfort levels and perceived safety and efficacy of TJM in these distinct spinal regions.
  • To identify factors influencing TJM use and comfort, particularly concerning the cervical spine.

Main Methods:

  • An online survey was developed and refined using a Delphi panel of 15 expert orthopedic physical therapists.
  • The survey was distributed to licensed physical therapists across the U.S.A. from October 2014 to June 2015.
  • A total of 1000 completed surveys were analyzed to capture data on TJM utilization and comfort.

Main Results:

  • A majority of physical therapists perceived TJM as safe and effective for the lumbar (90.5%) and thoracic (91.1%) spines, but a smaller percentage (68.9%) felt the same for the cervical spine.
  • Respondents reported less likelihood of performing and less comfort with TJM in the cervical spine compared to the thoracic and lumbar regions, often performing additional screening for the cervical spine.
  • Factors such as being male, practicing in an orthopedic spine setting, awareness of manipulation clinical prediction rules, and holding manual therapy certification were associated with increased TJM use and comfort across all spinal regions.

Conclusions:

  • Physical therapists perceive TJM for the cervical spine as less safe and efficacious than for the lumbar and thoracic spines.
  • There is a notable discrepancy in the utilization and comfort levels of TJM across different spinal regions among physical therapists.
  • These findings underscore variability in clinical practice regarding TJM, presenting an opportunity to address and potentially standardize its application.