Description of Physical Therapist Student Use of Manipulation During Clinical Internships

Abstract

Background and Purpose. While evidence shows that therapist students are introduced to manipulation within academic curriculum, little is known about its use during their final clinical internships. The purpose of this study was to identify student perceptions of clinical barriers and support for manipulation, student frequency and type of manipulation use, and factors guiding student decision-making in the selection of manipulation. Subjects. Two consecutive classes of Doctor of Physical Therapy program students represented an overall sample of 48 clinical survey responses. Methods. The survey was completed by students completing clinical internships in outpatient orthopedic clinical sites during their final clinical internships. The survey documented the students' perspective of their academic preparation, experience with manipulation in the clinical setting, and student reasoning regarding the use of manipulation as an intervention option. Results. Of 48 returned survey responses out of 70 surveys (69%), 24 (50%) indicated some use of manipulation. Spinal manipulation was used at a minimum level, and peripheral manipulation essentially was not used. When students were supervised by clinical instructors (CIs) who practiced manipulation, 74% indicated that the CIs used manipulation. Of the students who were supervised by a CI who did not practice manipulation, only 28% reported using manipulation during their internship; suggesting that students model the CIs' clinical practices. A variety of clinical factors influenced students' decision- making and frequency of manipulation use. Overall, 87% of participants agreed that they were academically prepared to perform manipulation in a clinical setting. Discussion and Conclusion. Results indicate minimal student use of manipulation during clinical internships. Students perceived that CI training and CI practice were factors involved in the student practice of manipulation. Patient diagnosis and population type also were influential. Future research should focus on manipulation opportunities during clinical internships for students from multiple programs and from the CI perspective. Key Words: Physical therapist education, Clinical internship, Manipulation, Decision-making. BACKGROUND AND PURPOSE In recent years, therapist education has progressed to a doctorate degree, preparing graduates for primary contact in neuromusculoskeletal health care. The transition to the doctoral level has allowed expanded curriculum in differential diagnosis and manual therapy, including manipulation. Manipulation is one part of a continuum of manual therapy techniques that has been associated with the therapy profession since its inception.1'3 Manipulation is defined as a high velocity, low-amplitude therapeutic movement within or at end range of motion (thrust joint manipulation). Ii4(p2) Doctorallevel education advocates for the use of interventions that are supported by evidence, including manipulation. In fact, the Manipulation Education Manual4 (MEM) from the American Physical Therapy Association (APTA) suggests that physical therapist students must be prepared with the knowledge and skills to practice manipulation if they are expected to practice in an evidence-based manner.4'p4' In the past, the foundation for evidencebased practice and increasing use of manipulation within the profession has mostly occurred in postprofessional education.4 Over time, the realm of manipulation education has shifted from the postprofessional sphere to the professional therapist education curricula. Almost 2 decades ago, only 17.5% of programs covered manipulation within professional education.5 Currently, nearly 75% of therapist professional education programs either include manipulation in their curriculum or have plans to do so.6 These numbers are expected to rise as nearly all professional therapist education programs have converted to doctorallevel education. …