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mcap56 -> Re: Should manipulation be taught in Entry Level Physical Therapy Programs? (May 8, 2004 7:27:00 AM)
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I think this is a good debate and one that needs further attention. I have a few points;
1. When discussing the merits of manipulation I don't think we can begin by saying there is definitely solid research behind it. There isn't. When the evdience is reviewed by manipulators, they emerge convinced of the merits. When it is reviewed by expert task forces and researchers, the conclusions are far different. So far, most of the evidence I have seen (and admittedly, I haven't seen it all) seems to point to short term benefits only.
2. Students in PT programs have limited time for hands on techniques. They should master mobilization first. If there is time and expertise, then I don't see much wrong with teaching manipulation. McKenzie has just dropped manipulation from part D because it was felt there wasn't enough time.
3. In terms of the safety debate. I beleive it has been overblown. Manipulation is safe if done on the appropriate patients. However, you can't necessarily compare the safety of mobilizaiton and manipulation because there are differnt perceptions. If a relatively new PT increases a patients pain with manipulation (without negligence, poor technique, etc.), the patients concern and potential complaints, lawsuits etc are more likely to occur, even if nothing was done wrong. Manipulation may be every bit as safe as mobilizaton but there are different perceptions by patients, referral sources, etc.
4. I find it funny that we keep debating manipulation when the evidence is becoming overwhelming that psychosocial factors have a lot more to do with outcome in recurrent and chronic cases (these are the patients we really need to treat). The way the therapist talks to a patient, what they say, medicalization of the patient and attitude probably go much further in determinintg outcome than choosing the right manual technique. YET.....how many PTs can tell you what a yellow flag is? How many can explain the biopsychosocial model?
5. I have not taught manipulation in my classes yet but I don't think it's wrong. On the merits however, it may be overkill. There are far more important things that are not getting taught. Perhaps that is what we should be worried about.
mcap
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