Thrust joint manipulation curricula in first-professional physical therapy education: 2012 update.

Thrust Joint Manipulation Curricula in First-Professional Physical Therapy Education: 2012 Update Research Report J. Timothy Noteboom,1 Christian Little,1 William Boissonnault,2 1

School of Physical Therapy, Rueckert-Hartman College for Health Professions, Regis University, Denver, CO

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Physical Therapy Program, Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin, Madison, WI This study was approved by the Institutional Review Board at Regis University. This study was funded by a grant from the American Academy of Orthopaedic Manual Physical Therapy. The authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article. Address for correspondence: Tim Noteboom, PT, PhD School of Physical Therapy Regis University 3333 Regis Blvd, G-4 Denver, CO 80221 Email [email protected]

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Study Design: Descriptive online observational survey.

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Objectives: To identify the extent of thrust joint manipulation (TJM) integration into first-professional physical therapy program curricula.

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Background: The most recent TJM curricula survey was published in 2004 with a wide variation in faculty responses noted. Since that time faculty resources have been developed and TJM language in the Normative Model of Physical Therapy Professional Education from the Commission on Accreditation has been updated leaving the current status of TJM education in curricula unknown.

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Methods: Faculty from 205 accredited Physical Therapy programs were invited to participate in an anonymous 35 item electronic survey during the summer of 2012.

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Results: 72% of programs responded to the survey with 99% of programs teaching TJM and 97% of faculty believing TJM is an entry-level skill. Cervical spine TJM is still being taught at a lower rate than techniques for other body regions. Faculty deemed 77% and 91% of students respectively at or above entry-level competency for implementing TJM in their clinical practice upon graduation. Most respondents indicated increased utilization of TJM during clinical affiliations (78%) and lab hours (78%) would be beneficial to the student’s knowledge/application of TJM.

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Conclusion: TJM utilization and faculty perceptions in first-professional physical therapy programs in the United States have evolved over the past decade. With TJM content more fully integrated into educational curricula, programs can now look to refine teaching strategies that enhance learning outcomes.

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KEY WORDS: curriculum, manual therapy, survey, thrust manipulation

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Joint mobilization/manipulation techniques include high velocity, small amplitude

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therapeutic movements, termed thrust joint manipulation (TJM).2 Although physical therapists

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receive TJM training through many venues,5 the American Physical Therapy Association

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(APTA) Manipulation Education Manual states training should begin in first-professional

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physical therapy programs.19 This premise is supported by language found in the Normative

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Model of Physical Therapist Professional Education, Version 2004 (Normative Model)1 and the

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Commission on Accreditation in Physical Therapy Education (CAPTE) Evaluative Criteria,

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language that went into effect in 2006.10

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The last study to describe TJM curricula in first-professional physical therapy programs3

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was published prior to the publications of the Manipulation Education Manual19 and the current

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Normative Model, and to the adoption of the current mobilization/manipulation language found

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in the CAPTE Evaluative Criteria.10 Boissonnault et al3 surveyed physical therapy programs in

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2002, investigating: 1) whether TJM was being taught, and if so how was the content integrated

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into the curriculum, 2) for which body regions were techniques being taught, 3) the qualifications

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and experiences of faculty responsible for teaching the material, 4) the textbooks and other

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resources utilized by faculty, and 5) how student knowledge and skills were being assessed. The

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2004 survey results suggested that widely varying models and opinions existed regarding TJM

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curricula and first-professional physical therapy education.

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Considering the existing TJM language found in the current versions of the Normative

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Model1 and of the CAPTE Evaluative Criteria,10 one would assume most if not all of physical

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therapy programs are including TJM content in their curricula. Despite this, the language found

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in these 2 documents is very general, providing no specific curricula guidance as to what

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specifically should be taught and how students should be assessed. Therefore, questions exist 3

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regarding the current status of TJM education including for which body regions are techniques

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being taught, how the content is being integrated in the curriculum, what are the current

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qualifications and experiences of faculty teaching TJM, what resources are being utilized by

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faculty, and how student knowledge and skills are being assessed.


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The purpose of this study was to survey physical therapist professional degree programs

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in the United States regarding current status of TJM curricula. The results provide a more current

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benchmark for faculty involved in teaching TJM content, and may identify existing barriers or

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obstacles to effectively integrating the content into the curriculum. These noted barriers would

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provide guidance to the educational community as to the need for updated or expanded curricular

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resources.

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METHODS

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Participants

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An email that included a link to the survey was sent to the Program Director of each

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United States physical therapy programs (n = 205 at the time of the data collection) recognized

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by CAPTE as accredited or candidate. The email extended an invitation to participate in the

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online survey and included the request to forward the email to the primary faculty member

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responsible for teaching manual therapy curricular content. To ensure responder anonymity there

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was no specific question asking who completed the survey.

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Administration of the Survey

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The Institutional Review Board at Regis University reviewed and approved the study

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protocol. The electronic survey was largely adopted from the paper survey used by Boissonnault

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et al3 in 2004, although several new questions/modifications were added (APPENDIX). A

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preliminary version of the survey was reviewed by 3 current faculty for question clarity and their

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feedback was incorporated into the final draft. The survey was designed and distributed using

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Survey Monkey (SurveyMonkey.com) web-based service. The introduction described the study’s

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purpose, emphasized that results would be reported in the aggregate, assured anonymity of

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individual responses, and stated that participation in the study was voluntary. Survey requests

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were sent to each of 205 professional degree programs during summer 2012. Two weeks after

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the initial survey distribution, a follow-up e-mail was sent to each of the programs requesting

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they please complete the survey if it had not already been submitted. Three weeks after the initial

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request, 1 final attempt was made to contact non-respondents via email and by telephone. The

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survey software was able to identify which invitee responded or did not respond, while allowing

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the data to remain anonymous.

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Data Analysis

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Data from the online survey were exported into statistical analysis software (SPSS, v 18).

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Descriptive statistics were calculated for each of the variables to determine the demographics of

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the entry-level physical therapy programs and of the participating faculty member, as well as the

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current status of TJM curricula.

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RESULTS

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One hundred and forty-seven (72%) programs responded to our survey with 99% of the

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responders stating that TJM was included in their curriculums (TABLE 1). The one program not

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currently teaching TJM had plans to implement the content area into their curriculum. Nearly all

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respondents (99%) had programs offering the Doctorate of Physical Therapy (DPT) as the first-

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professional degree. The programs varied in the length of time that TJM had been part of the

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curriculum, with 31% of programs having taught TJM for less than 5 years, 47% having taught

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TJM for 6 to 10 years, and 21% having taught TJM for more than 10 years. The length of time

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programs have been teaching TJM indicated that 46% of programs implemented TJM into the

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curriculum within the last 6 to 10 years, however we are uncertain as to how many of these

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programs were newly accredited programs. Sixty-two per cent of respondents were from

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programs accredited since 2006 when the current CAPTE manipulation/mobilization language

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was put in place.

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Faculty Demographics

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Demographics data for faculty responsible for teaching TJM indicated that 62% were

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men. Fifty-five per cent of the faculty had received their first-professional degree at the

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Bachelor’s level, and most had some form of terminal doctoral degree. The average number of

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years of academic teaching and clinical experience was 12.2 and 19.7 years, respectively.

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Ninety-eight per cent reported having some post-professional training in TJM, with 68%

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completing continuing education courses, 38% completing a manual therapy certification, and

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34% completing a formal residency/fellowship in orthopedics/manual therapy. Sixty-eight per

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cent of the programs had at least 1 faculty teaching TJM who were orthopedic certified

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specialists and most faculty (51%) identified themselves as “well qualified” with only 2%

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identifying themselves as “minimally qualified.” Faculty were aware of the APTA-related

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documents guiding the inclusion of TJM into curricula, ranging from 83% who had prior

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experience using the Guide to Physical Therapist Practice1 to 70% who had experience with the

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APTA Manipulation Education Manual.19 Ninety-seven per cent of faculty replied that TJM is

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an entry-level skill.

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Thrust Joint Manipulation Curricula


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Ninety-seven per cent of the responders indicated that TJM was integrated within a

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clinical science course with 14% integrating TJM in multiple courses across the musculoskeletal

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curriculum and/or in an elective course. Twelve per cent (n = 18) indicated teaching content in a

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separate elective course, but only 2% reported that the elective course was the only exposure to

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TJM training for students. Respondents indicated the most frequently utilized method for

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teaching TJM theory and techniques included laboratory/practical experiences, followed by

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patient assessment, classroom/lecture, and video instruction/demonstration. Over half of

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programs indicated that multimedia (55%) and articles (57%) are very valuable in teaching TJM,

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and textbooks were noted as somewhat valuable by 50% of the respondents.

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TABLE 2 provides a summary of faculty responses indicating the total number of hours

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of TJM education in the following settings/methods: classroom, laboratory, patient assessment,

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and video instruction/cases. A total of 57% of respondents feel they have sufficient time to teach

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TJM while 42% feel that more time is needed. Nearly all (97%) respondents who indicated that

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they would like more time to teach TJM indicated that “not enough time in curriculum” was the

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limiting factor. Respondents were also asked to identify the percentage of TJM curricular hours

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dedicated to each body region (TABLE 3). Of the body regions, the cervical spine received the

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least amount of emphasis, with 35% of programs not currently teaching cervical manipulation. In

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contrast, the greatest percentage of time is devoted to teaching lumbar spine TJM with 99% of

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programs including this content in their curriculum.

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All respondents reported assessing student TJM competence in some manner.

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Technique skill checks (87%) and written examinations (86%) were most frequently utilized by

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programs. Nearly 50% of respondents reported using practical examinations (combination of

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psychomotor skill performance and clinical decision-making) to assess competency. Ninety-one

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per cent of respondents indicated students were competent at, or above entry-level expectations.

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DISCUSSION

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Since the 2004 study by Boissonnault et al,3 the physical therapy profession has more

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clearly defined TJM terminology, optimal TJM instruction and integration into the curricula,4

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and expectations for student TJM competence.4,13,24,25 Accordingly, our survey results indicate

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that TJM curricula in physical therapy programs has evolved and these results provide a more

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current benchmark for TJM curricula. The results highlight areas marked by increased

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consistency between programs compared to 10 years ago, but also illustrate areas of remaining

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inconsistencies. As expected considering the current Normative Model1 and CAPTE Evaluative Criteria10

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language, 99% of programs in the United States have integrated TJM into their curriculum, with

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the only program not currently teaching TJM planning to integrate this content into their

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curriculum in the near future. The gradual shift to a DPT degree, from only 27 (23%) programs

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offering a DPT at the time of the previous survey3 to 145 (97%) programs for this survey may

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also have played a role as a number of respondents in the previous survey indicated planning to

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include TJM in their curriculum as they transition to the DPT degree.

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Nearly all (97%) of our 147 respondents believe that TJM is an entry level skill, a

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considerable increase compared to a decade ago when only 47% of faculty shared that belief.

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This significant shift could be attributed to multiple factors, including a recent increase in peer-

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reviewed publications reporting positive outcomes when using TJM. 6,8,9,11,12,14,16,18,20,21,23,26

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Many of these studies incorporated clinical prediction rules that may have facilitated the

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transition from research findings to clinical practice.7,8,14,23 In addition, published reports on

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student use of and performance with manipulation13,24,25 provided helpful examples that students

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could perform these interventions at an earlier stage of training than previously expected.

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Finally, the mass distribution of the Manipulation Education Manual19 a decade ago, may have

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provided faculty with limited previous experience in using or teaching manual therapy

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interventions the knowledge and skills necessary to incorporate TJM into program curricula. The

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goal of this document was to promote evidenced-based instruction in TJM. Physical therapy

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program directors and faculty teaching TJM were provided with sample instructional and

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evaluative materials, comprehensive instructional resource list, and recommendations for

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academic and clinical faculty qualifications. Around the time the Manipulation Education

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Manual was distributed, a number of academic and clinical faculty seminars were offered to

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further develop faculty preparedness to teach TJM.

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TJM Curricula

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Since 2004, some aspects of TJM curricula have changed and others have not. The

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number of programs integrating TJM as part of a required clinical science course increased from

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61.9% to 94%. This change may reflect a growing understanding of how TJM as an intervention

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can be integrated into physical therapist clinical practice. In addition, our results provide the first

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description of time spent covering TJM content. While the average number of hours programs

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devoted to teaching TJM was 50 hours, a large amount of variation among programs was noted

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(FIGURE). Twenty-four programs reported teaching TJM in a 1-10 hour timeframe, whereas 17

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programs reporting using over 100 hours to teach this content with most of the programs

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somewhere between these ranges. At least a portion of this variability may be due to the

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relationship between TJM to the broader area of mobilization/manipulation. It is possible that

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some respondents included time spent teaching foundational course content such as anatomy and

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biomechanics into the hours estimation, while others used a more strict interpretation based on

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actual time covering TJM content specifically. Respondents indicated that the majority of time

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spent teaching TJM theory and techniques within the curriculum occurred utilizing laboratory

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sessions, followed by patient assessment, classroom/lecture, and video instruction/demonstration

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(TABLE 2).

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While the per cent of TJM curricula proportionally spent on each body region (eg,

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cervical spine compared to lumbar spine compared to lower extremity) has not greatly changed

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since 2004, the number of programs teaching TJM content across multiple body regions has

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increased significantly (TABLE 3). For example the number of programs not including lumbar

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spine TJM curricula has dropped from 14% to 1%, and for the lower extremity the numbers have

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dropped from 39% to 13%. Although the number of programs excluding cervical techniques has

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decreased from 47% of programs responding in 20043 compared to 36% of our respondents, both

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studies found cervical spine TJM was taught at a lower rate than other spinal regions. This may

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reflect the relative increased risk for injury associated with cervical TJM compared to techniques

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applied to other body regions, and the comparative lesser amount of research supporting the use

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of cervical TJM.23

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How do programs assess student competency?


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The current survey indicates that programs assess competency in TJM through 1 or a

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combination of the following means, written examination (86% of programs), psychomotor skill

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assessment (87%), and practical examinations (50%), which incorporate psychomotor skill

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performance and clinical decision-making. This compares to respondents from 20043 where

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practical examinations (skill checks) were reported by only 34%, and some programs reported

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not assessing students (4%). There may be several reasons for this change, including a greater

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percentage of the faculty teaching TJM being core faculty (98% versus 87% in 20043) who may

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have a better perspective on curricular assessment, the more clearly established student TJM

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competencies upon graduation,19 and the general evolution of the student assessment process

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within DPT curricula.

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Ninety-one per cent of respondents indicated students were at or above entry level

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expectations for implementing TJM upon graduation, compared to 77% of respondents in 2004.3

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This indicates an improvement in how prepared physical therapy graduates are in

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knowledge/application of TJM. Faculty in both surveys believed that increase utilization of TJM

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during clinical affiliations and increase in lab hours would provide the greatest additional

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benefits to TJM education. Other studies24,25 have shown that clinical instructor perceptions

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influence student’s knowledge/application of TJM, so when students learn

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knowledge/application of TJM in their curriculum the carryover into clinical rotations is of equal

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importance. Interestingly, in 2004 only 10% of faculty felt that having a board-certified specialist

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teaching the course was of benefit to the student’s knowledge/application of TJM,3 in contrast to

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37% of respondents in the current study. Although it is not certain that having a greater

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percentage of faculty teaching TJM who are board certified specialists translates into better

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educational outcomes, it is understandable that educational programs value faculty who have

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content expertise and specialty practice designation for the content that they teach.

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Barriers to TJM Curricular Implementation

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Several barriers to implementing TJM into curricula were reported in 2004,3 with the

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belief that TJM was not an entry-level skill, and lack of time, qualified faculty, and evidence

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being the most frequently cited. Comparatively, in the current survey, respondents noted very

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few barriers to implementation. The one area of consistency between the 2 surveys was potential

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time constraints. Although 57% of our respondents stated they have sufficient time to teach TJM,

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97% of respondents stated they would like more time to teach the content area.

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Limitations

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Seventy-two per cent of all United States physical therapy programs responded to our

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survey, which falls well-within the 60-80% response rate considered excellent for survey

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research.22 If we extrapolate our data to all physical therapist programs in the United States and

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construct a 100% confidence interval by including the 46 programs that did not respond to our

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survey, the potential number of programs not teaching TJM could range from 1 to 47.

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Considering the CAPTE and Normative Model of Physical Therapy Education TJM language,

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we believe it can be assumed that most/all of the programs who did not respond are teaching

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TJM to some degree. The question remains about the extent to which TJM is taught within and

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across programs. It may be that programs having a very small emphasis on this material chose

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not to respond to the survey. Regardless, the results illustrate considerable variation in the

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number of hours allotted for TJM curricula, time spent on various body regions, and how

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students are being assessed. Our survey did not provide details explaining this variation. In

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addition, results from all surveys have issues of recall bias, which impacts the quality of the data.

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This is especially true for topics such as TJM that are now explicitly part of the education

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outcomes evaluated in the accreditation process, a social bias may have an effect of how faculty

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may respond to survey questions. Finally, this study’s inclusion of only United States programs

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does not allow for generalization to education programs in other countries.

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Future Studies

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Based on the stated limitations of this survey, future work should focus on studying areas

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of variability in TJM education. For example, a follow-up survey combined with a qualitative

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investigative approach may shed light as to what accounts for the wide variation. In addition,

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similar surveys performed in various countries could provide a better understanding of TJM

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education for the profession. Future study should also investigate the student’s clinical rotation

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experience with regards to student and clinical instructor perceptions and implementation of TJM

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in the clinic.

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Conclusion

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Physical therapy faculty survey respondents have provided an updated benchmark

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regarding TJM curricula in United States first-professional physical therapy programs. While our

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data suggest increased consistency and standardization has occurred in some areas since 2004,

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significant variation still exists in others. This suggests that further consensus amongst faculty

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regarding body region emphasis, method of assessing student competence, and continued faculty

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resource development is warranted. The next steps for educational programs may be to engage in

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curricular discussions around the desired learning outcomes for TJM education.

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Key Points

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Findings: Nearly all physical therapy education programs have integrated TJM into their

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curriculum, but with a wide range of content hours and emphasis on various body regions.

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Implications: Physical therapy education programs are producing graduates familiar with TJM,

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although there appears to be justification for further standardization of the educational outcomes

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in this area.

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Cautions: Survey data may contain recall bias that may account for some variability in the

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results. In addition, it is possible that the 28% of programs that did not respond to the survey may

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have different curricular content and percepts of TJM compared to those of the responding

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programs.

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References

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1. American Physical Therapy Association. A Normative Model of Physical Therapist

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professional Education: Version 2004. Alexandria, VA: American Physical Therapy

290

Association; 2004.

291

2. American Physical Therapy Association. Guide to Physical Therapy Practice. 2nd ed.

292

Phys Ther. 2001;81:9-746.

293

3. Boissonnault W, Bryan JM, Fox KJ. Joint manipulation curricula in physical therapist

294

professional degree programs. J Orthop Sports Phys Ther. 2004;34(4):171-181.

295

4. Boissonnault W, Bryan JM, Euhardy R, Backus P, Schultz. Understanding beliefs

296

associated with thrust joint manipulation and professional degree physical therapist

297

student training. J Manual Manipulative Ther. 2006;14(3):170-171.

298

5. Boissonnault W, Bryan JM. Thrust joint manipulation clinical education opportunities

299

for professional degree physical therapy students. J Orthop Sports Phys Ther.

300

2005;35(7):416-423.

301

6. Boyles RE, Flynn TW, Whitman JM. Manipulation following regional interscalene

302

anesthetic block for shoulder adhesive capsulitis: a case series. Man Ther

303

2005;10(2):164-71.

304

7. Childs JD, Fritz JM, Flynn TW, Irrgang JJ, Johnson KK, Majkowski GR, Delitto A.

305

A clinical prediction rule to identify patients with low back pain most likely to benefit

306

from spinal manipulation: A validation study. Ann Intern Med. 2004;141(12): 920–

307

928.

15

308

8. Cleland JA, Fritz JM, Kulig K, Davenport TE, Eberhart S, Magel J, Childs JD.

309

Comparison of the effectiveness of three manual physical therapy techniques in a

310

subgroup of patients with low back pain who satisfy a clinical prediction rule: a

311

randomized clinical trial. Spine. 2009;34(25):2720-9.


312

9. Cleland JA. Manual Physical Therapy and Exercise Versus Supervised Home

313

Exercise in the Management of Patients Status Post Inversion Ankle Sprain: A Multi-

314

Center Randomized Clinical Trial. J Orthop Sports Phys Ther. 2013;43(7):443-55.

315

10. Commission on Accreditation in Physical Therapy Education. Evaluative Criteria for

316

Accreditation of Education Programs for the Preparation of Physical Therapists.

317

Alexandria, VA: American Physical Therapy Association; 2006.

318

11. Cross KM, Kuenze C, Grindstaff TL, Hertel J. Thoracic spine thrust manipulation

319

improves pain, range of motion, and self-reported function in patients with

320

mechanical neck pain: a systematic review. J Orthop Sports Phys Ther. 2011;41:633-

321

642.

322

12. Dunning JR, Cleland JA, Waldrop MA, et al. Upper cervical and upper thoracic thrust

323

manipulation versus nonthrust mobilization in patients with mechanical neck pain: a

324

multicenter randomized clinical trial. J Orthop Sports Phys Ther. 2012;42:5-18.

325

13. Flynn TW, Wainner RS, Fritz JM. Spinal manipulation in physical therapist

326

professional degree education: a model for teaching and integration into clinical

327

practice. J Orthop Sports Phys Ther. 2006;36(8):577-587.

328

14. Flynn TW, Fritz JM, Whitman JM, Wainner R, Magel J, Rendeiro D, Butler B,

329

Barber M, Allison S. A clinical prediction rule for classifying patients with low back

16

330

pain who demonstrate short-term improvement with spinal manipulation. Spine.

331

2002;27(24):2835-2843.


332

15. Franciscatto Stieven F, Esteves Ferreira G, Faria Silva M, Telles da Rosa LH. Thurst

333

manipulation versus non-thrust manipulation: a question that still needs to be

334

answered. Man Ther. 2013;18(6):15

335

16. Fritz JM, Whitman JM, Flynn TW, Wainner RS, Childs JD. Factors related to the

336

inability of individuals with low back pain to improve with a spinal manipulation.

337

Phys Ther. 2004;84(2):173-90.

338

17. Kramer CD, Koch WH, Fritz JM. Development and outcomes of a program to

339

translate the evidence for spinal manipulation into physical therapy practice. J Man

340

Manip Ther. 2013 Nov;21(4):177-86.

341

18. Learman KE, Showalter C, O’Halloran B, Cook CE. Thurst and nonthrust

342

manipulation for older adults with low back pain: an evaluation of pain and disability.

343

J Man Manip Ther. 2013;36(5):284-91.

344

19. Manipulation Education Committee of the APTA Manipulation Task Force.

345

Manipulation Education Manual for Physical Therapist Professional Degree

346

Programs. Alexandria, VA: American Physical Therapy Association; 2004.

347

20. Masaracchio M, Cleland JA, Hellman M, Hagins M. Short-term combined effects of

348

thoracic spine thrust manipulation and cervical spine nonthrust manipulation in

349

individuals with mechanical neck pain: a randomized clinical trial. J Orthop Sports

350

Phys Ther. 2013;43(3):118-27.

351

17

352

21. Mintken PE, Cleland JA, Carpenter KJ, Bieniek ML, Keirns M, Whitman JM. Some

353

factors predict successful short-term outcomes in individuals with shoulder pain

354

receiving cervicothoracic manipulation: a single-arm trial. Phys Ther. 2010

355

Jan;90(1):26-42.


356

22. Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice.

357

3rd edition. Upper Saddle River, NJ: Pearson Prentice Hall; 2008.

358

23. Puentedura EJ, Cleland JA, Landers MR, Mintken PE, Louw A, Fernandez-de-Las-

359

Penas C. Development of a clinical prediction rule to identify patients with neck pain

360

likely to benefit from thrust joint manipulation to the cervical spine. J Orthop Sports

361

Phys Ther. 2012;42(7):577-92

362

24. Sharma NK, Sabus CH. Description of physical therapist student use of manipulation

363

during clinical internships. J Phys Ther Educ. 2012;26(2):9-18

364

25. Struessel TS, Carpenter KJ, May JR, Weitzenkamp DA, Sampey E, Mintken PE.

365

Student perception of applying joint manipulation skills during physical therapist

366

clinical education: identification of barriers. J Phys Ther Educ. 2012;26(2):19-29.

367

26. Wright AA, Cook CE, Flynn TW, Baxter GD, Abbott JH. Predictors of Response to

368

Physical Therapy Intervention in Patients With Primary Hip Osteoarthritis. Phys

369

Ther. 2011;91(4):510–524.

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TABLE 1. Summary of key survey outcomes.*

Outcomes

n (%)

Teaching TJM in curriculum

146 (99%)

Believe TJM is entry level skill TJM covered only as elective course

142 (97%) 3 (2%)

TJM taught by core faculty

142 (97%)

Faculty with orthopedic board specialty Abbreviation: TJM, thrust joint manipulation

100 (68%)

* The survey was returned by 147 of the 205 physical therapy programs queried, reflecting a 72% response rate. Data are the number (percentage) of programs based on the 147 respondents.

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TABLE 2. Amount of time teaching TJM using each instructional method*


Instructional Methods

Time (Hours)

Classroom/Lecture 10.5 +/- 14.1 (6) Lab 21.1 +/- 19.8 (15) Patient Assessment 13.3 +/- 21.2 (5) Video Instruction/Demo 8.6 +/- 21.4 (3) Abbreviation: TJM, thrust joint manipulation *Data are mean +/- SD (median)

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TABLE 3. Percentage of TJM curricular hours for each body region


Body Region

Percentage of Curriculum *

Cervical spine 9.9 +/- 9.8 Thoracic spine 25.5 +/- 10.7 Lumbar spine 28.1 +/- 12.6 Pelvis/Sacral 15.6 +/- 8.1 Upper Extremity 8.7 +/- 8.3 Lower Extremity 12.2 +/- 9.5 Abbreviation: TJM, thrust joint manipulation

Programs Not Teaching TJM (%)** 35 3 1 7 23 13

*Based on 100% of curricular hours for each program. Data are mean +/- SD. **The percentage of programs not including the body region in their curriculum.

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FIGURE. Data are the number of programs for each range of hours included in the curriculum to teach TJM. Abbreviation: TJM, thrust joint manipulation

22


Appendix

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The following questions where used in the non-demographics portion of the survey:


              



What professional/entry-level degree does your institution grant upon graduation? What is your entry-level accreditation status? How many students are enrolled in the most recent class? Do you believe joint manipulation is an entry-level education skill? How long has joint manipulation been integrated into your program’s curriculum? Are there any plans to initiate joint manipulation into your current curriculum? Is joint manipulation taught as an individual course? As an elective course? How many total hours does your curriculum spend teaching joint manipulation? For labs covering manipulation content what is your student:instructor ratio? Is it different than labs covering other content? What is the percentage of time teaching manipulation by body region? How do you assess student competency in joint manipulation? Please indicate how valuable each of the following resources are in teaching joint manipulation (eg, textbooks, multimedia, articles)? Who teaches the joint manipulation content? Do you feel that more or less time should be available for instruction specific to joint manipulation in your curriculum? How beneficial are each of the following items for increasing your students’ knowledge/application of joint manipulation (eg, lecture hours, specialist teaching content)? What credentials do you feel a faculty member should have to teach joint manipulation (eg, residency/fellowship training, OCS, certificate)

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Physical therapists drive thrust-manipulation research.

Safety of thrust joint manipulation in the thoracic spine: a systematic review.

Safety of thrust joint manipulation in the thoracic spine: a systematic review.

Does Talocrural Joint-Thrust Manipulation Improve Outcomes After Inversion Ankle Sprain?

Telehealth Education in Nursing Curricula.

Health and physical education: a joint effort.

To letter to the editor: 'Safety of thrust joint manipulation in the thoracic spine: a systematic review'.

Postoperative physical therapy in temporomandibular joint arthroplasty.

Experiential learning in physical therapy education.

Minority applicants to physical therapist education programs 2010-2012.

Physical therapy post-arthroscopic TMJ management (update).

Education: Integrating PTD Into Undergraduate Curricula.

Perspectives on pediatric physical therapy education.

Lower extremity thrust and non-thrust joint mobilization for patellofemoral pain syndrome: a case report.

Fibrolamellar carcinoma: 2012 update.

Education update.

Education update.

The current state of physical therapy pain curricula in the United States: a faculty survey.

Use of Simulation Learning Experiences in Physical Therapy Entry-to-Practice Curricula: A Systematic Review.

Example of part-time study in undergraduate physical therapy education.

Essential competencies in entry-level pediatric physical therapy education.

If Exercise is Medicine, Where is Exercise in Medicine? Review of U.S. Medical Education Curricula for Physical Activity-Related Content.

Research productivity grants: Physical Education, Physical Therapy, Speech Pathology, and Occupational Therapy.

Anterior knee pain: an update of physical therapy.