Is Manual Physical Therapy Distinct From Physical Therapy Clinical Practice?

Abstract

To the Editor: We were both surprised and disappointed to learn of the categorical deletion of research involving the use of manual physical therapy from the Philadelphia Panel Evidence-Based Clinical Practice Guidelines. Manual physical therapy is actively practiced in the majority of clinics in the United States and Canada, is part of the Guide to Physical Therapist Practice ,1 is included in the normative model of physical therapist education curriculum, and is a large part of mainstream physical therapist practice. Therefore, it is perplexing that the authors of the Philadelphia Panel reported “one RCT was excluded because manual therapy was used as the comparison intervention.”2(p1681) This statement is notably ambiguous. The exclusion could be due to a categorical bias against manually applied physical therapy. Alternatively, the authors could have been concerned about the inability to separate the effects of passive movement imparted by the treating therapist from the effects of active and passive movement performed by the patient. The first possible explanation is the least acceptable, as bias is no more appropriate in systematic review research than in original research. The second possible explanation is academic hairsplitting that is more likely to foster debate than better patient care. Although attempts to isolate individual effects are desirable in basic research, applied clinical research questions are often better answered by studying realistic clinical treatment regimens. Most of our practice remains undefined thanks to a slavish adherence to the reductionist approach. Physical therapist researchers have labored in vain to tease out the effects …