Critical Skills for Manual Therapy Competency in Physical Therapy

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:

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

1. Boissonnault W, Bryan JM, Fox KJ. Therapist Professional Degree Programs. JOSPT. 2004;34(4):171-182.
2. 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.
3. 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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