Hands-On: The Evidence-Based Research is flawed x5
This review has identified, for the first time, HODA-A lacks the necessary developmental research to be used as a measurement instrument in MSK healthcare. The HODA-A debate is a mix of both direct and indirect uncertainty for all those involved in MSK healthcare. HODA-A continues to be used in MSK healthcare due to a lack of practical/accessible alternatives. However, to continue using HODA-A, knowing reliability studies continually render the measurement instrument inaccurate, suggests inductive values consume rational thinking. Since 2011, standards and guides have been developed providing a stepwise approach for challenging the validity of a measurement instrument. It would be these steps that HODA-A would need to complete satisfactorily to demonstrate validity as a measurement instrument prior to any reliability studies being conducted.
Touch
Is our oldest most primitive and pervasive sense and plays an integral role in biological, cognitive, and social development. Touch is the first sense to develop and respond to stimuli in the womb, and the last one we lose before death.
When the hands are fully developed the fingertips contain an estimated at 25,000 nerve receptors per square cm. Established in ancient history, physically touching a person with the aim to comfort, heal, or soothe physical or emotional pain is common to all civilisations for 30,000 years.
Active Touch
During active touch, sensory receptors and sensory organs are components of the nervous system that allow us to participate and respond to the world around us, whilst keeping us informed of changes in our external environment (somatic), and any fluctuations in our internal environment (autonomic).
The sensory nerves (afferent) serve as communication lines, transmitting messages to the brain and spinal cord, the main control centres of the body.
The brain interprets and evaluates the messages, transmitting the outcome decisions through the motor nerves (efferent) to the appropriate muscles or glands which carry out the appropriate response.
Therefore, when a person actively touches an object, information is provided about the object.
There are two distinct mechanisms to active touch perception: hands-on data acquisition, and analysis (HODA-A). It is important not to separate the two levels required for touch perception because one does not happen without the other.
The Science of Touch
HODA-A is dependent upon a number of neural factors within the peripheral (mechanoreceptors) and central (spinal cord and brain) nervous system, working at optimal capacity, with no confounding variables.
Albeit is has been suggested we all have the tools to be able to conduct HODA-A, it does not necessarily mean the tool has capacity to be a valid and reliable measurement instrument.
The application of how the hand(s) is applied during HODA-A has emerged to be a critical component of ensuring all mechanisms are employed for maximal information gathering.
The widespread non-linear distribution of the various mechanoreceptors suggest not one part of the hand has the same sensorimotor feedback mechanism. Because of these variabilities a whole-hand approach to MSK assessments supersedes any other format (thumbs or fingers only).
Learn more about how your active touch acquires and analyses data collected in the short presentation below.
HODA-A - A GOLD STANDARD MEASUREMENT INSTRUMENT IN HEALTH CARE?
In musculoskeletal (MSK) healthcare, HODA-A is used as a measurement instrument to identify specific characteristics of a person’s anatomy that proceed to inform and manage patient care. Therefore, the validity and reliability of HODA-A as a measurement instrument is central to understanding and informing MSK healthcare, right?
But, for 70 years, HODA-A has undergone reliability studies and has yet to demonstrate acceptable validity and reliability, with the most recent studies concluding HODA-A is clinically unacceptable and should not be used in MSK healthcare. Note to reader… although there are many MSK healthcare professionals using HODA-A to inform MSK health, practitioners of manual therapy (PoMT) seem to be the only discipline who are targeted to prove their HODA-A reliability (population bias).
WHY DOES HODA-A CONTINUE TO BE USED IF ITS NOT YET VALID NOR RELIABLE?
Clinically, in a real-world setting, implementation of HODA-A provides a safe, cost effective, and environmentally convenient assessment of a person’s MSK system, and anecdotal evidence suggests HODA-A has ‘face validity‘ – a term used to describe if something “looks like” it is going to measure what it is supposed to measure.
HODA-A continues to be used clinically because many researchers perpetually use HODA-A to construct scientific studies (see Researcher in table above), with some studies being termed ‘Gold Standard‘ i.e., 3D Mocap, yet the critical data capture points of the markers were located using HODA-A.
When critically analysing the literature, HODA-A lacks any validity studies – validity is the most important measurement property for a measurement instrument, a measurement instrument has no reliability if validity has not first been established.
Feedback so far...
Trish Gipson
Registered Physiotherapist
“Finally research that resonates with how we actually practice as manual therapists; that takes in all the nuances of what we do beyond just taking in information from our mechanoreceptors. I’m very excited to see where this leads; what research stems from this, how it evolves our teaching methods, and how it changes the landscape of rehabilitation.”
Doreen Killens
Orthopaedic Musculoskeletal Physiotherapist (FCAMT)
“Finally, a study that makes sense of what I feel logically and intuitively when I put my hands on my patients as I try to sort out their issues. I am blown away.”
Lasse Liikanen
Physiotherapist & Lecturer
“HODA-A is giving musculoskeletal healthcare professionals a clear framework explaining what happens during active touch; something that science has failed to do before.”
Dr Gert Petrus Visser
Dentist
“The importance of valid and reliable manual assessments in evaluating and treatment to achieve a stable jaw ( TMJ) and normal oromyofacial function such as swallowing and breathing are fundamental in helping a huge variety of patients suffering with various dysfunctions, disabilities and chronic pain.”
Rachael Dickinson
Registered Physiotherapist
“After listening to Jo’s presentation, I am more focused on trying to critically evaluate my own practical assessment techniques in an attempt to add validity and reliability to my findings, and therefore improve the quality of service I offer to my clients.“
Christopher Chi Ngai Lo
Master of Musculoskeletal and Sports Physiotherapy
“The idea of this research project impressed me much at the very beginning because the accuracy and validity of palpation are the keystones of manual therapy. Our professional education is waiting for a quantifiable standard on palpation as well as other physical tests. This research project will make a new page on the development of training and clinical practice and our profession.”
Charles Hazle, PT, PhD
Associate Professor, Division of Physical Therapy
“Jo’s research is remarkable in that it explores dimensions of manual therapy that practitioners have pondered and discussed for decades, but not actually identified or quantified. I suspect her results will be a noteworthy addition to how manual therapy is conceptualized and taught in the future—perhaps across disciplines.”
Jay Cunningham
BAppSci (Physiotherapy)and Certified Clinical Pilates Instructor (APMA)
“At last, with HODA-A, a framework and language to describe a gold standard for hands on clinical assessment that challenges the simplification of hands-on practise previously assumed in research, and presents great opportunity to positively impact future education, especially in nurturing new and returning practitioners within and across professions – let the fun begin!”
Time to delve in!
Keeping In Touch
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