Student Perception of Applying Joint Manipulation Skills During Physical Therapist Clinical Education: Identification of Barriers

Abstract

Introduction/Review of Literature. A 2004 survey of physical therapist education programs indicated that out of 116 responding programs, 44% were including thrust joint manipulation (TIM) in their curriculums. CAPTE accreditation includes instruction of TJM during physical therapist professional education. TJM has been shown to be effective in certain patient populations and adoption of TJM by graduating students is likely dependent on both didactic and clinical education. The purpose of this study was to identify and describe potential student-perceived barriers to learning and practicing TJM. Subjects and Methods. Students targeted from all professional PT education programs in their final year of graduation and within 3 months following graduation were asked to complete a survey that was sent to program directors to distribute to students. Results. 460 subjects responded from 38 states (all US regions). The median age was 26 and 73% were female. Results indicated a level of didactic education in TIM (95%), but a lesser percentage of opportunities to utilize techniques clinically. When asked about their experience during outpatient orthopedic-based clinical education, 54% of the student respondents indicated that they perceived that their clinical instructors (CIs) were not completely comfortable with students performing TJM. When students did not utilize TIM, despite clinical indication, they cited lack of confidence (55%), personal skill level (48%), and not feeling academically prepared to utilize techniques (26%) as some of the reasons. Discussion and Conclusion. This survey suggests an increase in the number of professional physical therapist education programs teaching TJM. However, the students surveyed perceived barriers to practicing TJM during clinical experiences, which may limit their use of these techniques during their clinical practice. While TIM instruction in academic programs appears to be increasing, full adoption clinically requires practice. Enhanced CI education may increase the opportunity for student TJM practice during internships and may result in adoption of TJM practice after graduation. Key Words: Clinical education, Student learning, Teaching methods, Orthopedics/musculoskeletal, Professional development. INTRODUCTION/REVIEW OF LITERATURE Application of published evidence into clinical practice is an expectation as the profession of physical therapy evolves and grows. In particular, as practitioners with doctoral degrees, physical therapists are increasingly expected to integrate current best evidence into clinical practice. Sackett1 states that an essential tenet of evidence-based practice (EBP) is integrating individual clinical expertise with the best available external clinical evidence from systematic research.?71 Using the Levels of Evidence from the Oxford Centre for Evidence-Based Medicine,2 thrust joint manipulation (TIM) is an intervention that has a growing body of high-level evidence supporting its use.3'5 TIM is included in The Commission on Accreditation of Physical Therapy Education's (CAPTE) evaluative criteria for physical therapy programs, indicating that it is now considered an entry-level skill for physical therapist (PT) education program graduates.6 TIM has traditionally been included in the broad category of manual therapy, and specifically mobilization/manipulation, defined in the American Physical Therapy Association's (APTA) Guide to Physical Therapist Practice7 as ... comprising a continuum of skilled passive movements to the joints and/or related soft tissues that are applied at varying speeds and amplitudes, including a small-amplitude/ high-velocity therapeutic movement.1*80 For the purposes of this research, the term thrust joint manipulation is defined as a high velocity/low amplitude therapeutic movement directed at a joint. TIM has been a component of physical therapy practice since its inception8'9 and has been reported to be effective for numerous musculoskeletal conditions. …