Critical Skills for Manual Therapy Competency in Physical Therapy
Created by Kip Stromberg, SPT, LAT, ATC, CSCS
Background
At the beginning of my third year in PT school, I discussed a potential capstone project with Dr. Mike McMorris regarding critical skills in manual therapy competency for physical therapists and physical therapy students. Throughout my education, manual therapy/high-velocity low-amplitude (HVLA) joint thrusts has always been an interest of mine and something that I hope to be proficient in. Currently, in physical therapy education programs, there is a lot of variability in the amount of manual therapy to which students are exposed.1 With that training, I was interested to find out what the expert consensus was on critical skills needed to perform manual therapy and what the evidence said about each of those skills.
Overview
In a 2007 Delphi study, performed by Sizer et al2, they looked into obtaining consensus among manual therapy educators regarding stand-alone skills that are essential for competent application of manual therapy. They found eight skill sets that were associated with orthopedic manual therapy proficiency. The skill sets include: manual joint assessment, proficiency of fine sensorimotor characteristics, manual patient management, bilateral hand-eye coordination, manual gross characteristics of the upper extremity, manual gross characteristics of the lower extremity, control of self and patient movement, and discriminate touch. A heterogeneous group of orthopedic manual therapy (OMT) educators came to a consensus in selecting these skills.
In further narrowing down these critical skills, Sizer et al2 found three dominant themes into which the eight skills fit. These themes include: controlled practice methods, repetition and body control, and expertise and discriminate touch. Because of our goal, as a profession, for competent application of manual therapy, it is important to educate current entry-level students (and current clinicians) on the importance of these eight critical skills.
Capstone Products
For my capstone, I first created an evidence table (Capstone Evidence_Stromberg) which was used to look at the quality of evidence of each of the main areas of manual therapy. I used quality assessment tools, including the AMSTAR, PEDro Scale, and Downs and Black, to find the articles of the greatest quality. Then, using the evidence, I created a presentation that was given to the first-year physical therapy students at the University of North Carolina at Chapel Hill as part of their musculoskeletal evaluation course. This presentation had a lecture (Capstone Presentation_Stromberg) and a lab portion (Capstone Lab Instructions_Stromberg) which focused on the current evidence and aimed to show how it can be practically applied to patient care in physical therapy.
If you would like to see the presentation with the videos you can email me at kip_stromberg@med.unc.edu and I can send you a copy.
Evaluation
To improve the presentation, I got feedback from my committee members and used the text “Teaching and Learning in Physical Therapy” by Margaret Plack and Maryanne Driscoll3 to make the PowerPoint more applicable for my audience. The text helped me to look for ways to simplify the material and really focus my research on the message that I want to portray to the audience. There were a few parts of my presentation that were very wordy and used more difficult language to understand. The text (and my committee members) also helped me to look for material that I could get rid of that wasn’t needed and focus on the essential product. They helped me take a step back and look at the big picture.
The book did a great job of helping me to make sure that my presentation is helpful for people of all different learning styles and include motivational hooks that would attempt to capture each learner’s attention. My committee members also gave some great feedback in the format of my presentation to make it a more polished product.
To assess my presentation skills and the quality/clarity of the presentation, a survey was sent out to the first year class (n=30) after the presentation and here are the results:
How clear was the presentation of information?
|
Extremely Clear
24% |
Very Clear
71% |
Somewhat clear
5% |
Not so clear
0% |
How knowledgeable was the presenter?
|
Extremely Knowledgeable
48% |
Very Knowledgeable
48% |
Moderately Knowledgeable
4% |
Slightly Knowledgeable
0% |
How well did the presenter answer questions?
|
Extremely Well
43% |
Very Well
57% |
Somewhat well
0% |
Not so well
0% |
How engaging was the speaker at the event?
|
Extremely Engaging
38% |
Very Engaging
52% |
Somewhat engaging
5% |
Not so engaging
5% |
Overall, how would you rate the event?
|
Excellent
43% |
Very Good
48% |
Good
9% |
Fair
0% |
From the survey, I was also able to gather some strengths and weaknesses of the presentation. The participants, for the most part, really enjoyed the lab component and liked how applicable the research is to what they are currently learning. They also thought there could have been improvement which mostly included the need for more examples of clinical application.
Self-Assessment
Throughout the capstone process I have learned many important things. I realized how intensive the process can be of assessing literature and preparing a presentation. I have learned how to better use quality assessment tools when looking at research articles and use those to find the highest quality literature. I have also learned the importance of catering presentations to your audience and making sure that your take-home-message is delivered. I feel like the products I developed can help physical therapists (and physical therapy students) to understand the important skills required to best perform manual therapy. I received some great feedback and know that I could continue to improve in portraying clinical applications. If I were to do the project again, I would make sure to clearly state how the studies and concepts are relevant to clinical practice. Just as with manual therapy, I know with practice my presentation skills will continue to improve.
Acknowledgments
I would like to thank my advisor, Dr. Mike Gross (PT, PhD, FAPTA), for all of his assistance with this project. He was always willing to give feedback and answered my many questions. I also want to thank my committee members, Dr. Mike McMorris (PT, DPT, OCS) and Dr. Jon Hacke (PT, DPT, MA, OCS), who also were a great help throughout this whole process. Dr. McMorris was one of the key players in helping me throughout the process. I want to thank him for meeting with me on multiple occasions in-person and allowing me to present as part of his course. Dr. Hacke was also so helpful in giving me feedback on my evidence table and in polishing up my presentation. All three of these professors have been a great help with my capstone and I have thoroughly enjoyed working with them throughout my physical therapy education. I would also like to thank the rest of the UNC PT family for all their help along the way.
References
- Boissonnault W, Bryan JM, Fox KJ. Therapist Professional Degree Programs. JOSPT. 2004;34(4):171-182.
- Sizer PS, Felstehausen V, Sawyer S, Dornier L, Matthews P, Cook C. Eight critical skill sets required for manual therapy competency: A Delphi study and factor analysis of physical therapy educators of manual therapy. J Allied Health. 2007;36(1):30-40.
- Plack M, Driscoll M. Systematic Effective Instruction Keys to Designing Effective Presentations. In: Teaching and Learning in Physical Therapy From Classroom to Clinic. SLACK Incorporated; 2011:97-115.
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6 Responses to “Critical Skills for Manual Therapy Competency in Physical Therapy”
Kip Stromberg
Kristen,
Thank you for your kind words and feedback. It definitely was a great experience being able to present to the first year DPT students and get their feedback. This experience will definitely help me to improve my presentation skills. Again, thanks for taking the time to look at my capstone project.
Kip Stromberg
Melody,
Thanks for all the great feedback and taking the time to read about my capstone. You make a great point in that practicing on other students was a great resource for getting individual feedback. The authors of that article actually discussed how that is a great resource, but they also discuss how using a manikin could also decrease the risk of negative side effects. Also, in answer to your question, the research never really stated an exact number of repetitions that it would take to become proficient. The point that seemed to be repeated was with more repetitions came better proficiency. There definitely is more research that needs to be done to better understand the best training methods that lead to proficiency. Thanks again for your feedback and kind words.
Kip Stromberg
Lauren,
Thank you for your feedback and kind words. It was great having familiar faces in the crowd during my presentation. In answer to your questions, there wasn’t really any information on cost of the manikins. Basing off the cost of CPR manikins, they would be hundreds of dollars each (https://www.cpr-savers.com/Instructor-Packages_c_830.html). I did research on another one of the devices (dynadjust) which was only sold in classroom sets and was thousands of dollars (~$5000). These devices were only used as part of a scholastic program. So, this is a definite concern with these devices in that is the cost worth the benefit. To answer your other question, the research never really stated an exact number of repetitions that it would take to become proficient. The point that seemed to be repeated was with more repetitions came better proficiency. With further research, maybe we can better understand that question. Thanks again for the feedback!
Kristen Ignaszewski
Kip,
What a fantastic idea for a capstone topic! The evidence collected during our Evidence Based Practice II class certainly aided in the development of this project and it’s apparent just how much research went into the creation of this capstone material. That being said, you presented your capstone PowerPoint in an easy-to-follow manner that made the evidence portion seem less overwhelming. I am sure the first year DPT students really appreciated the material you provided on becoming a good manual therapist, and undoubtedly enjoyed the lab portion of the presentation to practice their skills. Great job on your capstone, you received some excellent feedback from the first years!
Melody Tran
Hi Kip,
I appreciate that you took the time to dive into the topic of manual therapy education as these questions have crossed my mind several times, particularly as it relates to the spinal manipulation legislation in North Carolina. Like others, I have wondered if a threshold can or has been identified to determine a clinician’s proficiency in manual therapy techniques, and if so, then how it has been quantified. I reviewed your evidence table and enjoyed the depth and clarity of the information presented. One interesting piece I read was that one study utilized manikins to provide feedback and was suggested as being more efficient for specific biomechanical parameters of spinal manipulation. Though a big proponent for efficiency, I wonder if the use of manikins for this training may have taken away from individual feedback and hands-on learning that occurs between students practicing together – as we progressed through our own manual therapy training, I believe the feedback and practice on 29 bodies was the most beneficial part in my learning. Also, as I alluded to earlier and as Lauren mentioned above, I wonder if there is any information related to a range of the number of repetitions needed to reach a standard level of proficiency. Overall, great project and perhaps you’ve found more areas of research that should be explored related to this topic. Nice work!
Lauren Kozar
Kip
I absolutely loved your capstone project! The evidence table was extremely well-organized, and it was a fantastic idea adding the column for key findings so that you did not have to repeatedly read through each article as you composed your project. That was a very time efficient change that you made to the evidence table we used in our Evidenced Based Practice II Course!
That being said, I was most impressed by your presentation! I can honestly say that it was one of the best presentations that someone in our class has ever delivered over the past three years. Not only was the material very well-organized, but you were able to keep the breakdown of material consistent throughout the three sections making it easy to follow. The incorporation of very creative videos and periodic questions also helped to keep the audience very engaged. You also did a fantastic job avoiding “wordy” slides by including the basic concepts and further expanding on this information during your presentation. The Musculoskeletal I students also expressed that they loved the lab component of the presentation. It was fun and competitive, yet very applicable to the topic.
I only have two questions from your presentations. As you said, “research has found that the instrumented manikin providing augmented feedback is certainly as valuable as standard training and even more efficient for specific biomechanical parameters of spinal manipulate;” however, (1) how much would it cost to integrate these devices into every doctorate physical therapy programs?and (2) how many repetitions would each student need to become proficient so that schools can determine the necessary student to manikin ratio?