Beliefs and practice patterns of spinal thrust manipulation for mechanical low back pain of physical therapists in the state of Minnesota

ABSTRACT

Introduction

The primary purpose of this study was to examine the perceptions and utilization of spinal thrust manipulation (STM) techniques of physical therapists who treat patients with low back pain (LBP) in the State of Minnesota. A secondary purpose was to investigate differences between physical therapists who perform STM and those who do not.

Methods

A cross-sectional design was utilized through the completion of an electronic survey. 74 respondents completed the survey. Descriptive measures were recorded as frequencies for categorical data or mean ± standard deviation for continuous data. For between-group comparisons, chi-square analyses were used for categorical items of nominal or ordinal data and t-tests were utilized for continuous data. The alpha level was set at p < 0.05.

Result

60.2% of respondents reported using STM when treating patients with LBP. 69.9% of respondents utilize a classification system. 76.7% of individuals answered correctly regarding the Minnesota State practice act. Of those who use STM, 81.8% utilize a Clinical Prediction Rule. Respondents who use STM were more likely to have a specialist certification (chi-square = 6.471, p = 0.011) and to have completed continuing education courses on manual therapy (chi-square = 4.736, p = 0.030).

Discussion/Conclusions

Physical therapists who perform STM are more likely to have a better understanding of their state practice act, be board certified, and have completed continuing education in manual therapy.

KEY POINTS

• This research builds upon the understanding of clinical practice patterns of physical therapists, specific to utilization and clinical decision making for manual therapy treatment interventions for LBP.

• Adherence to treatment recommendations for LBP could benefit from further educational within the profession of physical therapy, mainly continuing education, promotion of clinical residency training, and/or attainment of specialist board certification.

• Physical therapists who perform STM are more likely to have a better understanding of their state physical therapy practice act, have further training as evidenced by board certification, and have pursued continuing education in the realm of manual therapy or manipulation techniques.

KEYWORDS:

• Cross-sectional studies
• surveys and questionnaires
• Physical therapists
• low back pain
• spinal manipulation
• clinical decision making
• Spine
• manual therapy

Acknowledgements

The author would like to thank Dr. Laurie Walsh (Daemen College Amherst, NY) and Dr. Michael Ross (Daemen College Amherst, NY) for providing the original survey for their 2019 publication, and allowing adaptation of their document to better fit the needs of this study. The author would like to thank Dr. Lindsey Philpot (Mayo Clinic, Survey Research Center) for involvement as a survey flow and ease of use reviewer of the secondary survey draft developed for this project. This research was completed as a capstone project within the Mayo Clinic Physical Therapy Orthopaedic Residency.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors’ contribution statement

One author (MK) was involved with generation of the research project concept, development and distribution of the research survey, and creation of the full manuscript. Two authors (MK, JH) were involved with data analysis processes. All authors (MK, JH, DC, RB) were involved with refinement of the research survey prior to distribution, and review of the manuscript prior to submission for publication.

Data sharing

Data are available upon request. This includes data based on responses from participants for the research survey, via multiple choice selections and free text responses.

Geo lo cation infor mation

All respondents to this research survey are licensed physical therapists in the State of Minnesota, USA.

Irb

Mayo Clinic Institutional Review Board. IRB #22–011123

Patient involvement statement

Study participants were not involved in the design, conduct, interpretation, or translation of the current research.

Supplementary Material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10669817.2023.2279821

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Matthew Kuik

Matthew Kuik, PT, DPT graduated from the University of Wisconsin-Madison Doctor of Physical Therapy program in 2022. He is currently completing the Mayo Clinic Physical Therapy Orthopaedic Residency. His research interests include biomechanics of running, return to sport rehabilitation programming, and clinical utility of interventions within physical therapy.

Darren Calley

Darren Calley, PT, DScPT, OCS has 27 years of clinical experience specializing in orthopedics, is an Assistant Professor of Physical Therapy at the Mayo Clinic School of Health Sciences, and has served as the director of the Mayo Clinic Orthopedic Physical Therapy Residency for 8 years. His primary research interests include the study of psychosocial factors, clinical education, and musculoskeletal examination and interventions.

Ryan Buus

Ryan Buus, PT, DPT, OCS has 9 years of clinical experience in the orthopedic setting, has completed an orthopedic physical therapy residency program, and is an assistant director of the Mayo Clinic Orthopedic Physical Therapy Residency. His interests include the neurobiology of pain, integrating outcome measures into practice and clinical mentorship.

John Hollman

John Hollman, PT, PhD has 29 years of experience in orthopedic physical therapy, is currently the Chair for Research of the Department of Physical Medicine & Rehabilitation at Mayo Clinic in Rochester, MN, and has a depth of experience with developing and authoring peer-reviewed publications. His primary research interests include lower extremity biomechanics and gait mechanics during walking.