Orthopaedic Manual Physical Therapists Research Articles

Are YouTube videos claiming to describe lumbar spinal manipulation techniques adequate?

ABSTRACT Background and objective YouTube has become a digital visual library in almost all fields of life, including medicine. Healthcare professionals and students frequently use YouTube to gain new skills and knowledge; however, the content of these videos has not been scientifically evaluated. Therefore, this study aimed to determine the descriptive adequacy and quality of YouTube videos on lumbar spine manipulation techniques (LSMTs) prepared by different healthcare professionals. Methods The first 50 most relevant videos retrieved on searching YouTube for the keyword ‘lumbar spinal manipulation techniques’ were included in the study. The video metrics (total duration, number of views, time since upload, number of comments, number of likes, and number of dislikes) that could be accessed from video descriptions were recorded. However the videos were scored according to manipulation definition criteria proposed by the American Academy of Orthopedic Manual Physical Therapists (AAOMPT manipulation description score – AAOMPT-MDS) and benchmark criteria for quality of digital content by the Journal of American Medical Association’s (JAMA). The video metrics, AAOMPT-MDS and JAMA scores of the videos prepared by medical doctors, chiropractors, osteopaths, and physiotherapists were compared. Results Video metrics of groups were similar. The mean AAOMPT-MDS of the videos was 2.40 ± 1.57 out of 6.00 (higher score was better), and the mean JAMA score was 2.14 ± 1.05 out of 4.00 (higher score was better). Videos created by all professional groups had statistically comparable AAOMPT-MDS and JAMA scores (p > 0.05). Conclusion Although YouTube videos on LSMTs offer valuable information for professionals and students, creators should follow the proposed recommendations when producing these videos to ensure quality content and systematic presentation.

Author Response to Shear et al.

We thank the colleagues who provided meaningful comments to our manuscript.1 A Delphi investigation aims to gather expert opinions, frame future studies, and guide clinical practice in research areas where there is sparse quality literature available.2 Because children can present with orthopedic/musculoskeletal and/or neurological impairments, physical therapists credentialed in those treatment skill sets would be most capable of identifying effective treatment techniques. Therefore, we recruited physical therapists who were board-certified clinical specialists in pediatric physical therapy, were certified in neuro-developmental treatment (C/NDT), or had manual therapy credentials (Fellow of the American Academy of Orthopaedic Manual Physical Therapists [FAAOMPT]) to participate in our Delphi study. Although these credentials are not specific to craniosacral therapy (CST) and visceral manipulation, the Round 1 respondents identified CST and visceral manipulation as manual techniques that could be utilized to treat children. Although we cannot ascertain that the respondents in Rounds 2 and 3 had advanced training (continuing education) in CST or visceral manipulation, no respondent indicated being certified in those specific techniques.

Perception of massage application among clinicians and parents in spastic cerebral palsy: Qualitative study.

To explore the perceptions about traditional massage and its modified techniques among clinicians and families of the patients with spastic cerebral palsy. The qualitative, cross-sectional study was conducted from November 2019 to August 2020 in Sialkot, Pakistan, after approval from the ethics review committee of Riphah College of Rehabilitation Sciences, Islamabad, and comprised neuro paediatricians and paediatricians in Group A, parents of children with spastic cerebral palsy aged 8-15 years in Group B, and musculoskeletal physiotherapists and orthopaedic manual physical therapists in Group C. The professionals in groups A and C had a minimum of 5-year paediatric experience in government and teaching hospitals. Data was collected using a semi-structured pilot-tested questionnaire. Qualitative approach and thematic code analysis was used to analyse the collected data. Of the 26 subjects, 10(38.5%) were in Group A, 8(30.7%) in Group B and 8(30.7%) in Group C. Overall, there were 16(61.4%) males and 10(38.5%) females. Among the professionals, experience ranged 5-38 years in Group A, and 5-9 years in Group C. The identified themes were reforms in recommendations, and application of massage techniques, with the participants overwhelmingly favouring termination markers to prevent increase in hypertonicity in spastic cerebral palsy. Termination markers of massage should be considered in interventions to improve outcomes in children with spastic cerebral palsy.

The association between advanced orthopedic certification and confidence and engagement in prescription opioid medication misuse management practices: a cross-sectional study

ABSTRACT In the United States, attaining the orthopedic certified specialist (OCS) credential or the orthopedic subspecialty credential of Fellow of the American Academy of Orthopedic Manual Physical Therapists (FAAOMPT), may lead to a higher level of orthopedic practice. It is unknown whether attaining these credentials influences physical therapist confidence in and frequency of engagement in prescription opioid medication misuse (POMM) management practices. A national cross-sectional web-based survey of PTs identified whether respondents had an OCS or FAAOMPT credential. Self-report confidence in POMM-related management practices and the frequency of engaging in these practices were assessed. Logistic regression evaluated association between credential status and confidence in, and frequency of, engagement in POMM-related management practices. The analysis included 402 respondents with a mean age of 41.0 (SD = 11.2) and 203 (50.4%) females. There were 91 (22.6%) PTs with a FAAOMPT credential, 143 (35.6%) with an OCS but with no FAAOMPT credential and 168 (41.8%) had neither credential. Compared to those with an OCS credential, FAAOMPTs reported greater confidence in, and greater frequency of engagement in, POMM-related management practices (p< .05). Compared to those without an OCS or FAAOMPT credential and compared to those with an FAAOMPT credential, those with an OCS did not report greater confidence or greater engagement in any POMM-related management practice (p≥ .05). Obtain the FAAOMPT credential may increase PTs’ confidence in some POMM-related management practices. Research is needed to determine why FAAOMPTs report greater confidence and engagement in POMM-related management practices.

The healthcare buffet: preferences in the clinical decision-making process for patients with musculoskeletal pain

ABSTRACT The preferences a person has for care are associated with outcomes for patients presenting with musculoskeletal pain conditions. These include preferences for differing levels of involvement in the decision-making process, preferences for the provider attributes, and preferences for particular interventions. In this paper, we discuss these various forms of preference, as well as how they influence clinical care within shared decision-making frameworks. We also present a conceptual framing for how patient preferences can be incorporated in clinical decision-making by orthopedic manual physical therapists. Finally, research implications for interpreting findings from clinical studies are discussed.

Knowledge, Attitude, and Practice of Orthopedic Manual Physical Therapists Toward Lifestyle Screening and Education: A Descriptive Study.

Lifestyle-focused rehabilitation plans need to become part of the standard system of care for the treatment of chronic diseases. To achieve this goal, the KAP of rehabilitation professionals toward lifestyle medicine needs to be understood. This study investigated the niche of orthopedic manual physical therapy and is purposed as a foundational model for continued research. A survey instrument was designed to investigate the KAP of orthopedic manual physical therapists toward lifestyle screening and education. There were 155 participants of which 58.1-72.3% reported frequently talking to their patients about lifestyle topics, while 78.1-80.6% felt highly confident and competent while doing so. Additionally, 92.9-94.8% thought that lifestyle screening and education was important and that physical therapists should be doing it. Participants discussed exercise most frequently with their patients (96.1%) and alcohol the least (12.9%). Participants with advanced degrees (ie, PhD or DSc) had significantly higher Practice (MΔ= -3.755, P = .001) and Knowledge (MΔ= -4.14904, P = .020) ratings than those with entry-level physical therapy degrees. There was strong acceptance of lifestyle screening and education in orthopedic manual physical therapy with an emphasis on exercise. This study provides a foundational basis for continued research.

Examination procedures and interventions for the hip in the management of low back pain: a survey of physical therapists

ObjectivesThe main research aims were to investigate whether physical therapists are examining the hip(s) in individuals with a primary complaint of low back pain (LBP) and if so, the interventions being provided that target the hip(s). MethodsAn anonymous electronic survey was distributed to the membership of the American Physical Therapy Association Orthopaedic and Sports Sections, as well as that of the American Academy of Orthopaedic Manual Physical Therapists. Participant demographics and survey responses were analyzed using descriptive statistics. Associations between variables were examined using chi-square analysis. ResultsThe estimated response rate was 18.4% (n=1163, mean age 40.5±11.4 years). The majority of respondents (91%, n=1059) reported they always or most of the time examined the hip(s) in individuals with LBP. The most common examination items utilized were hip strength testing (94%, n=948), passive range of motion (91%, n=921) and muscle flexibility testing (90%, n=906). The most common interventions included hip strengthening (94%, n=866) and hip flexibility exercises (90%, n=814). Respondents enrolled in or having completed a post-professional fellowship were more likely to utilize hip joint manual therapy techniques (x2=25.3, p=<0.001) and less likely to prescribe hip flexibility exercises (x2=7.9, p=0.005) or use electrophysical modalities (x2=4.3, p=0.039). ConclusionsPhysical therapists commonly examine and provide interventions directed at the hip(s) for individuals with LBP. Post-professional fellowship training appears to influence the intervention selection of the physical therapist, with an increase in usage of hip joint manual therapy and a decrease in hip muscle flexibility and modality usage.

Clinical Specialization and Adherence to Evidence-Based Practice Guidelines for Low Back Pain Management: A Survey of US Physical Therapists.

Study Design Electronic cross-sectional survey. Background The American Physical Therapy Association (APTA) evidence-based practice guideline for low back pain (LBP) elaborated on strategies to manage nonspecific LBP in routine physical therapy practice. This guideline described LBP associated with mobility deficit, leg pain and a directional preference, coordination impairment (lumbar instability), and fear-avoidance behavior. Objectives To assess American physical therapists' adherence to the clinical practice guidelines (CPGs) for LBP of the Orthopaedic Section of the APTA, and to compare adherence among physical therapists with different qualifications. Methods The investigators contacted 1861 members of the Orthopaedic Section of the APTA and 1000 members of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). Participants made treatment choices for 4 clinical vignettes: LBP with mobility deficit, coordination impairment, leg pain (directional preference), or fear-avoidance behavior. The investigator used logistic regression analyses to compare guideline adherence among physical therapists with the following qualifications: orthopaedic clinical specialists (PTOs), Fellows of the AAOMPT (PTFs), PTOs and PTFs (PTFOs), and physical therapists without clinical specialization but with a musculoskeletal interest (PTMSs). Results A total of 410 physical therapists completed all sections of the survey (142 PTOs, 110 PTFOs, 74 PTFs, and 84 PTMSs). Adherence to the APTA's CPG was highest for LBP associated with leg pain and a directional preference (72.2%), followed by LBP with mobility deficit (57.1%), LBP with coordination impairment (46.1%), and fear-avoidance behavior (29.5%). Physical therapists who were PTFOs adhered better to the CPG for LBP than did PTMSs for all 4 patient vignettes. Orthopaedic clinical specialists adhered better to the CPG for LBP for the vignettes of mobility deficit and of LBP with fear-avoidance behavior than did PTMSs. Conclusion Physical therapists who were PTFOs and PTOs adhered better to the CPG than did PTMSs. Based on our preliminary results, further education on the CPG for LBP management is needed, particularly for managing LBP with coordination impairment and with fear-avoidance behavior. J Orthop Sports Phys Ther 2017;47(5):347-358. Epub 3 Mar 2017. doi:10.2519/jospt.2017.6561.

Third Annual Geneva R. Johnson Forum on Innovations in Physical Therapy Education: Formation of a Doctoring Professional: Are We Shying Away From Education that Really Matters in the Lives of Our Graduates?

INTRODUCTIONDr Geneva R. Johnson (Figure 1) continues to influence physical therapy education as an inspirational participant in the Third Annual Geneva R. Johnson Innovations in Physical Therapy Education Forum (GRJ Forum). Dr Johnson is recognized for her longstanding leadership and mentorship, having contributed to the advancement of physical therapy education, practice, and research for over 60 years. The GRJ Forum started in 2014 through the collaborative efforts of the Academic Council of Academic Physical Therapy (ACAPT) and the Physical Therapy Learning Institute (PTLI).3,12 Once again it was the keynote for the 2016 Education Leadership Conference (ELC) held in Phoenix, Arizona. As expected, the Forum continues to foster creative ideas for positive change to promote excellence in physical therapist education, a hallmark of Dr Johnson's legacy.As in previous years, the Forum set the stage for energy, enthusiasm, and excitement for conference participants as discussions evolved to explore new opportunities to promote excellence in education. The GRJ Forum design is like no other in our profession. Key to its success is provocative speakers who share personal perspectives, immediately followed by active engagement all participants. As Tschoepe shared in her recognition to Dr Johnson and the introduction of the Forum, many remember what has become known as "Dr Johnson's 3 Ps of strong leadership skills": passion, persistence, and perseverance. Illustrations of these, as well as other essential personal leadership skills, were explored throughout the Forum by many speakers at ELC 2016.THE GRJ FORUM: ORGANIZATION AND STRUCTUREThe GRJ Forum is designed to:* Create a safe environment for key stakeholders in physical therapy education to discuss the infinite possibilities of the future, rather than solving problems of the past.* Encourage vision, innovation, creativity, and provocative new ideas that can positively influence the future of physical therapy education.* Challenge educators to proactively advance physical therapy education to prepare graduates to meet projected societal and professional needs rather than merely react to external pressures.3The 2016 GRJ Forum featured Dr Emma Stokes, an international visionary leader and current World Confederation for Physical Therapy (WCPT) president, who energized the over-800 conference participants and set the stage for ongoing conversation and idea development throughout the conference. Her keynote was followed by 3 Ignite Talks from active leaders in physical therapy education in the United States - Dr Michael Majsak, Dr Bob Rowe, and Dr Chris Sebelski. Collectively, they shared individual perspectives of what each believed to be critical to foster graduate success in physical therapist practice that is entrepreneurial in spirit, illustrates personal ownership and accountability, and offers a unique value to the health care team to facilitate optimal, efficient, and effective individual-centered health promotion and management. Discussion by over 200 participants followed these speakers, and they more thoroughly explored the 13 themes presented, and discussed "how might we" or "wouldn't it be great if..." Participants had options to discuss 2 different themes, and table facilitators shared 3 possible highlights that might illustrate innovation and educational change to include education that really matters to better prepare physical therapist graduates for success in their future professional careersTHIRD ANNUAL GRJ FORUM HIGHLIGHTSKeynote Address - Walk With the DreamersEmma Stokes, PT, PhD, is deputy head of the Department of Physiotherapy and a fellow of Trinity College in Dublin, Ireland. She teaches in the university's entry to practice and PhD programs in Dublin and Singapore. Her research focuses on matters related to professional practice; particularly, leadership in the profession. She has received numerous awards and professional recognitions for her contributions to the physiotherapy profession and has been a board member of the World Confederation for Physical Therapy (WCPT) since 2007. …

The effectiveness of functional massage on pain and range of motion measurements in patients with orthopedic impairments of the extremities

Objectives: Functional Massage (FM) is a therapeutic technique that incorporates joint motion with massage to treat musculotendinous pain and impairments. The purpose of this study was to determine the effectiveness of FM to decrease pain and improve range of motion (ROM) in patients.Methods: A test re-test design was utilized to identify the effects of FM as measured by the numeric pain rating scale (NPRS) and ROM. Twenty patients were treated by one of three participating orthopedic manual physical therapists (OMPT) and data was collected for five sessions.Results: One hundred and five data points collected from the twenty patients included: shoulder (55), knee (40), and ankle (10). The average change in NPRS (1.68) was statistically significant but not clinically significant (change ≥2). The majority of the FM treatments resulted in a positive NPRS change 82/105(78.1%). The average change in ROM (7.08°) was statistically (P 4°).Conclusions: FM resulted in st...

The status of temporomandibular and cervical spine education in credentialed orthopedic manual physical therapy fellowship programs: a comparison of didactic and clinical education exposure

Objective:The purpose of this investigation was to establish a baseline of physical therapist education on temporomandibular disorders (TMD)-related topics during credentialed orthopedic manual physical therapy fellowship training and compare it to cervical spine disorders education.Method:An online survey was distributed electronically to each fellowship program credentialed by the American Physical Therapy Association (APTA) and recognized by the Academy of Orthopedic Manual Physical Therapists (AAOMPT). Data were analyzed to compare overall exposure to TMD educational content, including a direct comparison of TMD and cervical spine disorders education.Results:The response rate was 79%. Thirteen programs (87%) reported providing both didactic and clinical training on both TMD and cervical spine disorders. Didactic education for cervical spine disorders ranged from 16–20 hours to over 25 hours, whereas TMD hours ranged from 0 to 6–10 hours. Clinical education for cervical spine disorders ranged from 11–15 hours to over 25 hours, whereas TMD hours ranged from 0 to 6–10 hours. The number of hours of exposure during didactic training and the number of patients exposed to during clinical training were significantly different when comparing TMD to cervical spine disorders exposure (P<0·0001).Discussion:The data indicate a lack of uniformity between credentialed fellowship programs in orthopedic manual physical therapy with respect to the extent to which programs expose trainees to evaluation and management of TMD. There is consistency in that all programs provided more training on cervical spine disorders than TMD. Despite a high level of clinical specialization, fellows-in-training receive minimal TMD education.

A survey of physical therapists’ clinical practice patterns and adherence to clinical guidelines in the management of patients with whiplash associated disorders (WAD)

Objectives:To explore the clinical practice of physical therapists and examine adherence to clinical guidelines for treating patients with whiplash associated disorders (WAD).Methods:A cross-sectional electronic survey was sent to 1484 licensed physical therapists from the Orthopedic Section of the American Physical Therapy Association and the American Academy of Orthopedic Manual Physical Therapists. The survey included demographic data and two clinical vignettes describing patients with acute and chronic WAD. The chi-square test was used to analyze responses.Results:There were 291(19·6%) responses to the survey. Of those, 237 (81·4%) provided data for vignette 1 and 204 (70·1%) for vignette 2. One hundred and eighty (76·6%) respondents reported familiarity with evidence-based or clinical practice guidelines for treating patients with WAD. Of those, 71·5% (n = 128) indicated that they followed them more than 50% of the time. Therapists with an advanced certification were more likely to be familiar with clinical guidelines than those who were not certified (P<0·01). Responses indicated overall adherence to guidelines; however, there was a low utilization of quantitative sensory assessment, screening for psychological distress and some outcome measures. Significant differences in clinical practice (P<0·01) were found between therapists who were and were not familiar with guidelines and those with and without an advanced certification.Discussion:Advanced certification and knowledge of guidelines appeared to play a role in the clinical practice of physical therapists treating patients with WAD. Further research is needed to explore factors affecting knowledge translation from research to clinical practice and to evaluate the outcomes of patients with WAD when clinical guidelines are applied in practice.

Residency Education in Every Town: Is It Just So Simple?

Kornelia Kulig, PT, PhD, FAPTA, FAAOMPT(Hon), is a physical therapist, educator, and scholar whose work focuses on exploring the mechanisms behind the causes and presentations of and interventions for recurrent pain of seemingly musculoskeletal origin such as low back pain and tendinopathies. Currently Professor in the Division of Biokinesiology and Physical Therapy, University of Southern California, Dr Kulig also serves as Co-Director of the Division's Musculoskeletal Biomechanics Research Laboratory. Previous posts include Associate Professor at Oakland University and Director of the Orthopedic Physical Therapy Residency Program. Dr Kulig earned a PhD in Biomechanics and an MS in Physical Therapy and Physical Education from the Academy of Physical Education, Wroclaw, Poland; a BS in Physical Therapy from Oakland University, Rochester, Michigan; and was a postdoctoral fellow in Biomechanics at the Biomechanics Laboratory, University of Iowa, Iowa City. Dr Kulig's research explores tissue morphology, biomechanics, physiology, and pathology in relation to degenerative processes in connective tissues and accompanying muscle activation and movement strategies, signs, symptoms, and loss of function. A sought-after lecturer, she has presented at the Annual International Conference on Foot Biomechanics and Orthotic Therapy, The Hong Kong Polytechnic University, Annual Conference of PTAROC (Taiwan), Nordic OMT Conference, University of Potsdam, and the American Physical Therapy Association, among many others. Dr Kulig is an active and contributing member of the American Physical Therapy Association, where she has served on the Board of Directors of the Orthopaedic Section. In addition, she is a member of the American and International Societies of Biomechanics and the American College of Sports Medicine, as well as a Founding Member of the American Academy of Orthopedic Manual Physical Therapists. Thank you, Mr Maley, for introducing me (Fig. 1). Each year, with this lecture, we honor your father's life, and it is a privilege for me to do …

Peter A. Huijbregts

Too soon and too young, on Saturday, November 6, 2010, Dr. Peter Huijbregts died of a heart attack while asleep at home in Victoria, BC. Peter was born and grew up in Reusel, a small town in the Netherlands. In addition to earning a 4-year baccalaureate diploma in physical therapy at the Hogeschool Eindhoven, the Netherlands (1990), he completed a Master of Science in Manual Therapy at the Free University of Brussels, Belgium (1994); a Master of Health Science in Physical Therapy at the University of Indianapolis (1997); and a Doctor of Physical Therapy at the University of St. Augustine for Health Sciences in Florida (2001). He was board certified in orthopaedic physical therapy by the American Board of Physical Therapy Specialties and held postgraduate certificates in strength and conditioning, manual therapy, functional capacity evaluation, clinical education, and intramuscular stimulation. He also attained Fellowship status in the American Academy of Orthopaedic Manual Physical Therapists and the Canadian Academy of Manipulative Therapy. Peter taught in both entry-level and postgraduate education programs. He served as adjunct professor at Grand Valley State University in Allendale, Michigan (2000), and at Pacific University in Forest Grove, Oregon (2001). Beginning in 2002, Peter held an appointment as assistant professor at the University of St. Augustine for Health Sciences, where he taught and developed online courses in the areas of orthopaedic basic science, spinal instability, and statistics and research methodology. In 2008, he was appointed as an advisory faculty member to the North American Institute of Orthopaedic Manual Therapy. Beginning in 1990, Peter worked in a variety of clinical settings, with an emphasis on orthopaedic manual physical therapy. His last place of employment was Shelbourne Physiotherapy Clinic in Victoria, where he worked as a physiotherapy consultant with a special interest in assessment and management of patients with chronic spinal pain syndromes, shoulder pain, headache, and dizziness. Peter’s writings include 60 scientific publications and textbook chapters on topics related to various areas in manual physical therapy, produced between 1990 and 2010. His editorials were of great interest to colleagues in the field of manual physical therapy and showed a clear vision of the future. After serving as editor-in-chief of the Journal of Manual and Manipulative Therapy from late 2004 to the end of 2007, Peter continued to function as its consulting editor; he was a sought-after peer reviewer for several international journals. Beginning in 2006, Peter worked as consulting editor for Jones and Bartlett Publishers and editor of its Current Topics in Physical Therapy and Rehabilitation Medicine series. Among his many interests were jazz and classical music, science fiction, weight training, and judo. He loved his family in the Netherlands. Since Peter lived in the United States and Canada, his Dutch family often missed important events in his life. Besides his many international contacts, Peter stayed in touch with his Dutch and Belgian colleagues. He contributed regularly to the Dutch Manual Therapy Journal, which will shortly publish one of his last articles. The news of his death was devastating to his colleagues in the Netherlands, Belgium, and throughout the world. He was liked and respected by all who knew him. Peter will be missed as an enthusiastic, persistent, intelligent, and friendly colleague. I remember him with respect and friendship. I have lost one of my best students, whom I considered a good personal friend. After his busy and fulfilling life and career, I hope that Peter will rest in peace. Peter is survived by his wife, Rap, and their two young children, Arun and Annika. I hope that his memory will be a comfort to them.

Manual Physical Therapy: We Speak Gibberish

In December of 2006, the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) convened a task force to create a framework for standardizing manual physical therapy procedures. The impetus came from many years of frustration with our ability to precisely communicate to each other, as well as to stakeholders outside our profession. To this end, a contribution titled "A Model for Standardizing Manipulation Terminology In Physical Therapy Practice" is published in this issue of the Journal.

In the Best Interests of the Patient

Dr Paris has dual citizenship in the United States and New Zealand and has practiced physical therapy in the United States, Bermuda, and New Zealand. He founded the University of St Augustine, the nation's only proprietary school graduating doctorally prepared physical therapists. The University is active in Japan, Iceland, and Chile, helping to advance physical therapist practice in those nations by offering degrees and clinical certifications. Although Dr Paris may be most closely associated with his contributions in establishing manual therapy practices as an accepted essential component of physical therapist practice, he also has been a leader in physical therapist education, research, and professional service. He has lectured extensively and presented continuing education courses nationally and internationally. As an author or co-author, Dr Paris has actively promoted the concepts of manual therapy in text chapters, professional journal articles, guest editorials, and proceedings. He also has published textbooks, a film, and a PBS television series on back pain. He currently serves as co-editor of the Journal of Manual and Manipulative Therapy . Dr Paris was instrumental in establishing the Orthopaedic Section of APTA and the International Federation of Manipulative Therapists and has served as president of both organizations. He also was instrumental in establishing the American Academy of Orthopaedic Manual Physical Therapists. He has been a delegate to the APTA House of Delegates and has served on the APTA Board of Directors. Dr Paris was appointed to APTA's Task Force on Clinical Specialization and was an early proponent of recognizing physical therapist clinical specialists. Dr Paris has received ATPA's Chattanooga Research Award and was elected a Catherine Worthingham Fellow of APTA. In 1992, the Orthopaedic Section established the Paris Distinguished Service Award in his honor. He is an honorary fellow of the New Zealand Society of Physiotherapy and an honorary life …

Identifiers Suggestive of Clinical Cervical Spine Instability: A Delphi Study of Physical Therapists

Clinical cervical spine instability (CCSI) is controversial and difficult to diagnose. Within the literature, no clinical or diagnostic tests that yield valid and reliable results have been described to differentially diagnose this condition. The purpose of this study was to attempt to obtain consensus on symptoms and physical examination findings that are associated with CCSI. One hundred seventy-two physical therapists who were Orthopaedic Certified Specialists (OCS) or Fellows of the American Academy of Orthopaedic Manual Physical Therapists (FAAOMPT) participated in the survey. This study was a 3-round Delphi survey designed to obtain consensual symptoms and physical examination findings for CCSI. The symptoms that reached the highest consensus among respondents were "intolerance to prolonged static postures," "fatigue and inability to hold head up," "better with external support, including hands or collar," "frequent need for self-manipulation," "feeling of instability, shaking, or lack of control," "frequent episodes of acute attacks," and "sharp pain, possibly with sudden movements." The physical examination findings related to cervical instability that reached the highest consensus among respondents included "poor coordination/neuromuscular control, including poor recruitment and dissociation of cervical segments with movement," "abnormal joint play," "motion that is not smooth throughout range (of motion), including segmental hinging, pivoting, or fulcruming," and "aberrant movement." The Delphi method is useful in situations where clinical judgments are encountered but empirical evidence to provide evidence-based decision making does not exist. Findings of this study may provide beneficial clinical information, specifically when the identifiers are clustered together, because no set of clinical examination and symptom standards for CCSI currently exists. Diagnosis of CCSI is challenging; therefore, appropriate clinical reasoning is required for distinctive physical therapy assessment using pertinent symptoms and physical examination findings.

Subjective and objective descriptors of clinical lumbar spine instability: A Delphi study

Accurate ability to diagnose lumbar spine clinical instability is controversial for numerous reasons, including inaccuracy and limitations in capabilities of radiographic findings, poor reliability and validity of clinical special tests, and poor correlation between spinal motion and severity of symptoms. It has been suggested that common subjective and objective identifiers are specific to lumbar spine clinical instability. The purpose of this study was to determine if consensual, specific identifiers for subjective and objective lumbar spine clinical instability exist as determined by a Delphi survey instrument. One hundred and sixty eight physical therapists identified as Orthopaedic Clinical Specialists (OCS) or Fellows of the American Academy of Orthopaedic Manual Physical Therapists participated in three Delphi rounds designed to select specific identifiers for lumbar spine clinical instability. Round I consisted of open-ended questions designed to provide any relevant issues. Round II allowed the participants to rank the organized findings of Round I. Round III provided an opportunity to rescore the ranked variables after viewing other participant's results. The results suggest that those identifiers selected by the Delphi experts are synonymous with those represented in related spine instability literature and may be beneficial for use during clinical differential diagnosis.

Acceptance Speech—2002 John McM. Mennell Service Award

The following acceptance speech for the John McM. Mennell Service Award was presented at the 8th annual meeting of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) in Orlando, Florida, on October 4, 2002. Before all else is said, we want to thank the Academy, the Executive Board, and the membership for this great honor you are bestowing on us. When we reflected on the past recipients, it was hard for us to imagine that we were joining such an esteemed list: Jane Wolthers, Helene Fearon, Steve McDavitt, and Carol Jo Tichenor. These previous recipients, leaders, and activists in our profession have made a difference in PT practice in many arenas: clinical, educational and political. We recognized a common theme among us all: we are all passionate about what we do. This theme certainly extends to everyone in the audience or we would not be here as an organization.

AAOMPT Conference, 2001

The following abstracts are to be presented at the 7th annual meeting of the American Academy of Orthopaedic Manual Physical Therapists held in San Antonio, TX from October 19-21, 2001. Presentations are either by poster or platform. Inclusion of abstracts in this supplement does not constitute peer-reviewed journal publications. The publication of abstracts alerts readers to research that is presently being conducted. It is hoped that the research presented in brief here will eventually be submitted as full-length manuscripts for review and potential publication.