Researching the measurement problem in musculoskeletal healthcare.
Dr Jo Abbott’s PhD research investigates how hands-on clinical assessment can be understood as embodied perceptual measurement — moving beyond assumptions, opinion and unreliable language towards clinician-as-instrument calibration, validity-first reasoning and defensible clinical interpretation.
The research evidence page that explains why HODA-A had to exist.
This body of work challenges how MSK assessment has been researched, how manual clinical findings have been judged, and how the clinician’s perceptual system must be considered when assessing validity, reliability and clinical reasoning.
From hands-on assessment to embodied perceptual measurement
HODA-A reframes hands-on assessment as a complex clinical measurement process. The hands do not work in isolation. They are the interface of a wider embodied perceptual system involving attention, prediction, sensory discrimination, memory, interpretation and clinical judgement.
The problem with testing reliability too soon
When a method is tested for inter-tester or intra-tester reliability before its construct has been clarified, poor agreement may reflect a poorly stabilised measurement system — not necessarily a useless clinical skill.
The assessor must be calibrated
In physical measurement systems, instruments are stabilised, calibrated and contextual variables are controlled before results are interpreted. HODA-A applies this same logic to the clinician-as-instrument.
Clinical relevance
This research has implications for manual therapists, physiotherapists, osteopaths, chiropractors, rehabilitation professionals, movement specialists, educators and researchers interested in MSK assessment, clinical reasoning and patient-centred care.
The 80-year research problem in hands-on assessment.
In this IFOMPT conference presentation, Dr Jo Abbott explains why hands-on clinical assessment may have been judged through an incomplete evidence-based research lens.
The issue is not simply whether clinicians can feel. The deeper problem is whether the construct, the clinician-as-instrument and the embodied conditions of measurement were properly defined before reliability was tested.
IFOMPT conference presentation exploring how evidence-based research may have misunderstood hands-on assessment by testing outputs before defining and calibrating the clinician-as-instrument.
Take part in current musculoskeletal and back pain research.
These opportunities invite patients, clinicians, bodyworkers and movement professionals to contribute to real-world research exploring pain, movement, MSK assessment and clinical practice.
Global Back Pain Research Initiative
A global project inviting people with back pain to share their lived experience and help shape future back pain support, education and clinical understanding.
View study → Online Survey4-Minute Online Survey for Bodyworkers
A short survey for clinicians and bodyworkers contributing to research around MSK screening, clinical perception and hands-on assessment.
Be a part of the study → Clinical StudyClinical Retrospective Study
A retrospective clinical research project exploring musculoskeletal presentations, assessment findings and clinical reasoning within real-world practice.
View study →Palpatory and observation-based methods in isolation
Exploring whether results gained through palpatory and observation-based MSK screening methods are similar when used by two testers at the same time.
Read study → 02Tester rotation and MSK screening agreement
Investigating how tester rotation influences outcomes when palpatory and observation-based methods are used in isolation.
Read study → 03Post-experiment interviews and poor agreement
Exploring whether interviews with testers after experiments help explain poor inter-tester and intra-tester agreement.
Read study → 04Repeating isolated assessment methods
Further investigation of tester rotation and isolated palpatory or observational methods during musculoskeletal screening.
Read study → 05HODA-A theories and parallax control
Investigating outcomes when proposed HODA-A measurement theories are applied and parallax error is controlled.
Read study → 06Parallax and perspective error control
Exploring HODA-A measurement theory when both parallax and perspective errors are actively controlled.
Read study → 07Larger-scale replication study
Replicating prior methodology at larger scale to explore HODA-A theory, parallax control and perspective control.
Read study → 08Sensorimotor memory stimulation
Investigating whether attitudes or biases in testers disrupt the MSK assessment process and influence clinical interpretation.
Read study → 09HODA-A and 3D motion capture
A pilot study using 3D Mocap as an independent gold standard to explore concurrent validity of HODA-A.
Read study → 10Expert panel on hands-on data acquisition
A multidisciplinary expert panel informing the foundations that underpin hands-on data acquisition systems.
Read study → 11Systematic review of HODA-A
A systematic review exploring HODA-A as a measurement instrument for diagnostic tests in musculoskeletal healthcare.
Read study → 12Single subject studies in MSK pain
Exploring musculoskeletal pain studies where rehabilitation interventions are applied and withdrawn.
Read study → 13Content validity and inter-tester reliability
Exploring the content validity and inter-tester reliability of an osteopathic manoeuvre.
Read study → 14Quiet standing and gold standard equipment
An experimental study using human and biomechanical gold standard equipment to measure alignment in quiet standing.
Read study → 15Dorset & Wiltshire Fire and Rescue Service
A longitudinal prospective study exploring injury prevention interventions with Dorset & Wiltshire Fire and Rescue Service.
Read study → 16Lumbopelvic hip complex tests
Exploring correlations and associations between different lumbopelvic hip complex tests.
Read study → 17Updated clinical assessment research
Supporting developments in world-class MSK understanding through updated assessment of previous clinical presentations.
Read study → 18Control and intervention MSK screening
An experimental study using two MSK screening systems with control and intervention groups to explore superior screening possibilities.
Read study →Before we test reliability, we must stabilise the instrument.
In HODA-A, the instrument is not only the method, protocol or test. The clinician’s calibrated perceptual system is part of the measurement process.
Validity before reliability
Define the construct before judging agreement.
Calibration before conclusion
Stabilise the clinician-as-instrument before interpreting the output.
Embodiment before interpretation
Recognise that perception, attention and bias shape clinical signal acquisition.
From research to HODA-A education, clinical practice and better MSK reasoning.
This body of work informs HODA-A education, clinical biomechanics, back pain systems, professional training and the broader call for better measurement science in musculoskeletal healthcare.
Define the construct
Clarify what the clinical test or perceptual assessment is actually claiming to measure.
Calibrate the assessor
Stabilise the clinician’s sensory, attentional and interpretive system before judging outputs.
Control the context
Identify variables that alter signal acquisition, including positioning, fatigue, bias, temperature and communication.
Test with precision
Build stronger validity and reliability frameworks for hands-on and movement-based MSK assessment.
Explore the science behind HODA-A and Dr Jo Abbott’s clinical work.
Whether you are a clinician, educator, researcher, patient or curious participant, this research invites you to look more carefully at how MSK information is acquired, interpreted and translated into care.
