Physical Therapists Increase Use of Spinal Manipulation for Back Pain

Health care professionals such as doctors, nurses, and physical therapists often treat patients based on what they learned in school. Physical therapists (PTs) are trying to match evidence in research about what works for low back pain (LBP) with what PT students are taught in school. For example, spinal manipulation has been shown to help patients with acute low back pain. Physical therapists are taught these techniques but don't use them as often as they should. The authors say that a lack of understanding of the latest research findings may be why PTs aren't using manual therapy techniques with acute LBP patients. Including evidence-based treatment methods like spinal manipulation in PTs training may be the best way to increase its use. In this study the authors present one model for teaching and monitoring the use of thrust spinal manipulation. The model includes four basic steps:

Students are taught to identify patients who can most benefit from this method of treatment.

Students learn how to do the manipulation technique. Video and lab instruction are included.

Methods of testing the outcome are presented. The therapist must be able to show the treatment helps improve patient function.

Students give their instructors a demonstration of their skill and reasoning behind treatment chosen for each patient. By following 8 PT students treating 61 LBP patients, the authors showed a 58 per cent rate for the use of spinal manipulation. This rate decreased over time but remained higher than the average rate of 3.7 per cent for PTs who have already graduated. The authors conclude that including proven methods of treatment in student programs is a good way to increase use in the clinic. Improving quality of treatment and patient outcomes are two good goals.

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