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Identifying Directional Preference: A Scoping Review and Thematic Analysis of Variability and Application in
Joshua A Kidd1, Joseph M Lorenzetti1, Kenneth W Kirby1
1Department of Physical Therapy, Bellin College, Green Bay, WI 54311, United States.
Physical Therapy
|July 17, 2025
Summary
Definitions of directional preference in musculoskeletal research vary widely, hindering consistent application. A standardized definition, potentially based on symptom response to movement, is needed for better research and clinical practice.
Area of Science:
- Musculoskeletal research
- Clinical practice guidelines
- Healthcare research methodology
Background:
- Directional preference is a key concept in musculoskeletal care.
- Inconsistent definitions complicate research interpretation and clinical application.
- A clear, standardized definition is needed for improved research synthesis and clinical translation.
Purpose of the Study:
- To identify and describe the varying definitions and operational criteria for directional preference in musculoskeletal research.
- To evaluate expert consensus on essential components of a directional preference definition.
Main Methods:
- A comprehensive scoping review of 6 electronic databases was conducted.
- 149 studies involving adults with musculoskeletal conditions were included.
- Thematic analysis of definitions and expert consultations were performed.
Main Results:
- 111 unique definitions of directional preference were identified across 149 studies.
- 22% of studies failed to define directional preference, and 15% conflated it with centralization.
- Expert consultation revealed variability, with "response to repeated and/or sustained movements" being the most prioritized criterion, yet no consensus was reached.
Conclusions:
- Substantial inconsistency exists in defining and operationalizing directional preference in musculoskeletal literature.
- This inconsistency impairs research synthesis and clinical translation.
- Symptom change in response to movement may form the basis for a standardized definition, requiring further research.
