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Publications & Research Output

Advancing the science of hands-on assessment.

Dr Jo Abbott’s publications explore how hands-on musculoskeletal assessment can be understood, tested and developed as a disciplined measurement process — moving the conversation beyond the traditional hands-on versus hands-off debate.

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Why this work matters

Reframing manual therapy through measurement science.

For decades, hands-on musculoskeletal assessment has often been judged through reliability studies before the underlying measurement construct has been properly defined. This creates a methodological problem: if the instrument has not been stabilised, trained or validated, poor agreement may reflect flaws in the research design — not necessarily the clinical value of touch.

Dr Jo Abbott’s research challenges this sequence. It proposes that hands-on assessment should be examined as a complex perceptual measurement process, where the clinician, their nervous system, their sensory calibration, and the assessment context all influence the quality of the information acquired.

Featured publication

A multidisciplinary approach to hands-on manual therapy as a valid measurement instrument.

Musculoskeletal Science and Practice journal cover, Volume 83, June 2026
Musculoskeletal Science & Practice
Musculoskeletal Science & Practice Journal

A multidisciplinary approach providing strong evidence for hands-on manual therapy as a valid measurement instrument in MSK healthcare

Authors: Dr Jo Abbott, Professor Beverly Hale, Dr Penny Hudson, Professor Jason Lake
Affiliation: University of Chichester, Institute of Applied Sciences

This work examines hands-on manual assessment, described through the HODA-A framework, as a proposed measurement instrument in musculoskeletal healthcare. It argues that reliability studies alone are insufficient if the validity, construct definition and performance conditions of the instrument have not first been established.

Read More Research Learn About HODA-A
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MSK Focused on musculoskeletal healthcare and clinical practice
Publication summary

The core argument.

This publication questions whether historical evidence has been asking the right methodological question. Rather than treating hands-on assessment as an undefined clinical behaviour, it positions HODA-A as a measurement process requiring construct clarity, assessor calibration and validity testing.

Background

Musculoskeletal ill-health represents a significant global healthcare burden. Manual assessment remains widely used across MSK practice, yet its research evaluation has often focused on reliability without first establishing the validity of what is being measured.

Purpose

The work argues that many studies investigating hands-on assessment are methodologically limited because HODA-A has not historically undergone the necessary developmental validity studies required of a measurement instrument.

Methods

The research drew on neurophysiological literature, active touch, prosthetics and robotics science, alongside a phenomenographic study involving international expert panellists examining the scientific claims of HODA-A in MSK healthcare.

Results

HODA-A was identified as a complex system requiring multiple constructs and items to be understood in relation to one another. The clinician is not a passive observer; they are part of the measurement process.

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Conclusion

Before hands-on assessment can be judged by reliability statistics, the underlying measurement theories, constructs, assessor conditions and validity arguments must be established. Without this, research risks measuring instability in the instrument rather than the usefulness of the clinical information acquired.

Measurement science

The clinician is part of the instrument.

HODA-A reframes manual assessment as an active, embodied, sensorimotor process. The quality of the assessment depends not only on the tissue being examined, but also on the assessor’s perception, attention, calibration, sensory discrimination, interpretation and context.

This is why validity must come first. If the construct is vague, the assessor is uncalibrated, and the performance conditions are uncontrolled, reliability findings may tell us more about methodological noise than clinical truth.

01

Define the construct

Clarify exactly what hands-on assessment is intended to detect, interpret or discriminate before testing agreement.

02

Stabilise the instrument

Recognise that the clinician’s nervous system, sensory capacity, attention and bias influence the measurement process.

03

Test validity before reliability

Reliability studies are only meaningful when the instrument, construct and assessment conditions have first been properly developed.

04

Use a complex systems lens

HODA-A performance emerges from multiple interacting constructs, not from a single isolated palpation technique.

Clinical and research implications

What this changes.

For researchers

The research sequence matters. Studies should not rush to reliability testing before defining the construct, clarifying the instrument and establishing validity evidence.

For clinicians

Hands-on assessment requires training beyond technique. It requires perceptual discipline, calibration, reflective practice and awareness of the variables that influence interpretation.

For MSK healthcare

Rather than dismissing hands-on assessment as unreliable, the field needs stronger methodological frameworks capable of evaluating it as a complex measurement process.

Publication details

Academic information.

The following details summarise the publication information currently listed for this research output.

Title
A multidisciplinary approach providing strong evidence for hands-on manual therapy as a valid measurement instrument in MSK healthcare
Authors
Dr Jo Abbott, Professor Beverly Hale, Dr Penny Hudson, Professor Jason Lake
Institution
University of Chichester, Institute of Applied Sciences, Bishop Otter Campus, College Lane, Chichester, West Sussex, United Kingdom
Presenting author
Dr Jo Abbott
Keywords
Hands-on, musculoskeletal, reliability
Funding
This work was unfunded.
Ethics
The experiment was approved by the University of Chichester’s ethics committee and conducted in accordance with the University’s Research Ethics Policy.
Continue the research journey

Explore the framework behind the publication.

HODA-A develops this research into a practical educational framework for clinicians who want to understand hands-on assessment through perception, calibration, validity, sensorimotor science and complex systems thinking.

Explore HODA-A Visit HODA-A Academy Contact Dr Jo
Dr Jo Abbott Ph.D
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