Effective teaching of manual skills to physiotherapy students: a randomised clinical trial.

CONTEXT: To date, despite the relevance of manual skills laboratories in physiotherapy education, evidence on the effectiveness of different teaching methods is limited. OBJECTIVES: Peyton's four-step and the 'See one, do one' approaches were compared for their effectiveness in teaching manual skills. METHODS: A cluster randomised controlled trial was performed among final-year, right-handed physiotherapy students, without prior experience in manual therapy or skills laboratories. The manual technique of C1-C2 passive right rotation was taught by different experienced physiotherapist using Peyton's four-step approach (intervention group) and the 'See one, do one' approach (control group). Participants, teachers and assessors were blinded to the aims of the study. Primary outcomes were quality of performance at the end of the skills laboratories, and after 1 week and 1 month. Secondary outcomes were time required to teach, time required to perform the procedure and student satisfaction. RESULTS: A total of 39 students were included in the study (21 in the intervention group and 18 in the control group). Their main characteristics were homogeneous at baseline. The intervention group showed better quality of performance in the short, medium and long terms (F1,111  = 35.91, p < 0.001). Both groups demonstrated decreased quality of performance over time (F2,111  = 12.91, p < 0.001). The intervention group reported significantly greater mean ± standard deviation satisfaction (4.31 ± 1.23) than the control group (4.03 ± 1.31) (p < 0.001). Although there was no significant difference between the two methods in the time required for teaching, the time required by the intervention group to perform the procedure was significantly lower immediately after the skills laboratories and over time (p < 0.001). CONCLUSIONS: Peyton's four-step approach is more effective than the 'See one, do one' approach in skills laboratories aimed at developing physiotherapy student competence in C1-C2 passive mobilisation.

Intrarater and Inter-rater Reliability of Active Cervical Range of Motion in Patients With Nonspecific Neck Pain Measured With Technological and Common Use Devices: A Systematic Review With Meta-regression.

OBJECTIVES: The purpose of this systematic review was to compare intrarater and inter-rater reliability of active cervical range of motion (ACROM) measures obtained with technological devices to those assessed with low-cost devices in patients with nonspecific neck pain. As a secondary outcome, we investigated if ACROM reliability is influenced by the plane of the assessed movement. METHODS: Medline, Scopus, Embase, the Cochrane Library, CINHAL, PEDro, and gray literature were searched until August 2016. Inclusion criteria were reliability design, population of adults with nonspecific neck pain, examiners of any level of experience, measures repeated at least twice, and statistical indexes on reliability. A device was considered inexpensive if it cost less than €500. The risk of bias of included studies was assessed by Quality Appraisal of Reliability Studies. RESULTS: The search yielded 35 151 records. Nine studies met all eligibility criteria. Their Quality Appraisal of Reliability Studies mean score was 3.7 of 11. No significant effect of the type of device (inexpensive vs expensive) on intraclass correlation coefficient (ICC) was identified for intrarater (ICC = 0.93 vs 0.91; P > .99) and inter-rater reliability (ICC = 0.80 vs 0.87; P > .99). The plane of movement did not affect inter-rater reliability (P = .11). Significant influences were identified with intrarater reliability (P = .0001) of inexpensive devices, where intrarater reliability decreased (P = .01) in side bending, compared with flexion-extension. CONCLUSIONS: The use of expensive devices to measure ACROM in adults with nonspecific neck pain does not seem to improve the reliability of the assessment. Side bending had a lower level of intrarater reliability.

Prevalence and risk factors of thumb pain in Italian manual therapists: An observational cross-sectional study.

BACKGROUND: Work-related musculoskeletal disorders (WMSDs) affect physical therapists with loss of health status and social costs. MSD is a relevant problem in upper limb extremities, especially when associated with manual techniques. OBJECTIVE: The study aims to investigate the prevalence and risk factors associated with thumb pain in Italian physiotherapists who perform manual therapy. METHODS: A self-administered questionnaire was sent by email, exploring demographics, thumb mobility, job, thumb pain, manual techniques, aggravating factors, management strategies and consequences of thumb pain. RESULTS: The survey was sent to 523 manual therapists, 219 of which fully completed it. 49.3% of respondents experienced thumb pain at least once in the previous 12 months and 70.8% at least once in their lifetime. Statistically significant associations suggest that within 12 months manual therapists with more than 5 years of experience are less likely to report thumb pain (6-10 years of work: OR = 0.408, 95% CI: 0.215-0.775; 11-20 years of work: OR = 0.346, 95% CI: 0.139-0.859), whereas those who performs trigger point pressure release (OR = 1.832, 95% CI: 1.005-3.340), trigger point ischemic compression (OR = 2.999, 95% CI: 1.184-7.597) and fascial neuro-connective manipulation (OR = 3.086, 95% CI: 1.346-7.077) are more likely to experience it. In terms of lifetime prevalence, female manual therapists and those who perform trigger point ischemic compression are more likely to suffer from thumb pain (females: OR = 2.569, 95% CI: 1.339-4.930; trigger point ischemic compression: OR = 2.878, 95% CI: 1.319-6.281). CONCLUSIONS: Special attention should be paid to prevention during manual skills training, since inexperience exposes manual therapist to a higher risk of developing thumb pain.

Intra- and inter-rater reliability of 3D passive intervertebral motion in subjects with nonspecific neck pain assessed by physical therapy students: A pilot study.

BACKGROUND: Passive Intervertebral Movements (PIVMs) are commonly used to assess and treat patients with nonspecific neck pain. Only very few studies have investigated 3D movements until now. OBJECTIVE: This study assessed intra- and inter-rater reliability of three-dimensional (3D) cervical PIVMs performed by physical therapy students in patients with nonspecific neck pain. METHODS: Thirty-one patients, mean age 47.2 ± 7.2 years, were independently evaluated by 2 physical therapy students. The raters (A and B) assessed mobility, end-feel and pain provocation performing bilaterally the 3D cervical segmental side-bending test (3D CSSB) from levels C2-C3 to C6-C7. Percentage agreement (raw, positive and negative), Cohen's kappa (95% CI), prevalence index and bias index were calculated to estimate intra- and inter-reliability. RESULTS: Intra-rater reliability showed kappa values ranging between fair and substantial (k 0.29-0.80) for pain provocation, mobility and end-feel, with percentage agreements between 61%-90%. Inter-rater reliability presented kappa values ranging between fair and substantial (k 0.22-0.62) for pain provocation, mobility and end-feel, with percentage agreements between 61% and 80%. CONCLUSIONS: Intra-rater reliability of 3D PIVMs was superior to inter-rater reliability in patients with nonspecific neck pain. The most repeatable evaluation parameter was pain. However overall poor reliability suggests avoiding the use of these techniques alone to examine patients and measure their outcome. Further studies are needed to investigate PIVMs reliability in combination with other assessment procedure in symptomatic patients.