WHAT IS IMPACTING CERVICAL MANUAL THERAPY PRACTICES?

Thomas L.¹, Allen M.², Shirley D.³, Rivett D.⁴

¹University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, Australia, ²4 Degrees, Brisbane, Australia, ³University of Sydney, Faculty of Health Sciences, Sydney, Australia, ⁴The University of Newcastle, Callaghan, Australia

Background: The Australian Physiotherapy Association 2006 VBI Guidelines are used by many of the member organisations of WCPT in treatment of the cervical spine. However these Guidelines are due for revision. The revised Guidelines need to reflect not only new research findings and the publication of IFOMPT Framework (2012) for assessing cervical arterial dysfunction but also contemporary experiences and viewpoints on manual therapy practice.

Purpose: To investigate experiences and viewpoints of manual therapists in Australia on the clinical utility and currency of the APA 2006 Guidelines, and to report on their recommendations for revision of the Guidelines.

Methods: Five Focus Groups were conducted in the larger Australian states. Qualitative data were collected from 41 Manual Therapists who were purposefully selected for their broad range of experience by coordinators of State Musculoskeletal Physiotherapy Australia Chapters.Participants included clinicians and academics, those recently graduated to those with over 30 year experience, and those with and without specialist musculoskeletal qualification. Focus Groups interviews ran for 1.5 to 2 hours and were conducted by an independent qualitative researcher and a subject expert. The five stage Framework Analysis approach was used to analyse and interpret the data.

Results: Four main themes emerged: (a) current influences on Manual Therapy practice, (b) familiarity with the Guidelines and their use in practice, (c) experience with specific components of the Guidelines, and (d) recommendations for the revised Guidelines including its application to techniques other than high velocity techniques and minimising adverse events. This paper will focus on the current influences on manual therapy practice consisting of positive professional influences, risk perceptions, medico-legal concerns, need for increased evidence, availability of other techniques, reduction in training, education and skills, and patient influences. A dominant positive professional influence was the way the Guidelines set standards for iconic physiotherapy manual therapy practices. Participants reported that medico-legal concerns and consequent negative media attention along with the difficulty quantifying the actual risk of adverse events subsequent to manipulative therapy had resulted in physiotherapists becoming more fearful and risk adverse. Participants reported decreasing use of high velocity techniques with more focus on gentle techniques and patient self-management. Many participants expressed concerns regarding the loss of manual therapy skills assessment and treatment training from both educational programs and in graduates.

Conclusion(s): Focus groups uncovered several influences on Manual Therapy practice, both barriers and facilitators, which need to be taken into account when revising the Guidelines. Advice to physical therapists at all levels of practice needs to more accurately reflect risks and benefits of manual therapy and provide a simple and clear research evidence-based approach to safe practice in the cervical spine. This will be important not only in training and education of students but also in maintaining a body of confident highly skilled practitioners.

Implications: Revised Guidelines need to address these influences and concerns and involve relevant organisational bodies in increasing skill levels. Such advice needs to be disseminated in a wide range of formats to reach clinicians at all levels of experience.

Funding acknowledgements: Australian Physiotherapy Association

Topic: Musculoskeletal: spine

Ethics approval: Ethical approval ws granted from the Medical Research Ethics CommitteeUniversity of Queensland, project no. 2015000367.

All authors, affiliations and abstracts have been published as submitted.