HVT-Technik +++ Manuelle Therapie +++ Manipulation +++ Wirbelsäule +++ Risikofaktoren
Evidence for physiotherapist delivery of effective procedures
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| Duncan Reid in Amsterdam |
AT A GLANCE
Duncan Reid, Timothy Flynn, Wayne Hing, Chris McCarthy and Pieter Westerhuis were speakers at the focused symposium regarding spinal manipulation on WCPT-congress in Amsterdam. Tanja Bossmann asked Duncan Reid, Associate Professor and Head of School of Rehabilitation and Occupation Studies, Faculty of Health and Environmental Science at Auckland University of Technology for the main issues discussed at the symposium.
Among others the symposium focuses on the evidence for the use of spinal manipulation. Could you please summarise the discussed results?
Professor Tim Flynn presented information on the current evidence for Spinal Manual Therapy (SMT). The Royal College of General Practice (2003) recommends that in the case of acute and subacute back pain manipulation provides short term improvements in pain, activity levels and patient satisfaction than other treatments it has been compared to (1). With respect to chronic low back there are significant short term benefits from manipulation but not in the long term (2). In the lumbar spine the development of clinical prediction rules has helped to define who will do well with high velocity thrust (HVT) in the acute setting. The main patient characteristics are: no pain into the leg, pain less than 16 days duration, minimal scores on the Fear Avoidance Belief Questionnaire (FABQ), internal hip rotation greater than 35 degrees and local stiffness on palpation of the lumbar spine (3). The type of HVT delivered also was of interest in that the classical side lying technique was more effective than a more general HVT position or mobilisation. The cavitation is also not required for success (4).
Teaching safe practice of spinal manipulation is a challenge. Could you please highlight the trends in undergraduate and postgraduate curricula?
Pieter Westerhuis, a clinician and teacher with the Swiss manual therapy programme discussed the following characteristics to improve safe practice in the delivery of cervical spine manipulation (CSM). He felt there were three main areas that required attention. Firstly having an evidence informed knowledge base, knowing when to do CSM, and when not to do it. Secondly have sufficient clinical experience, and thirdly having good manual skill so you know ...
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