Since 2016, the Centers for Disease Control and Prevention (CDC) and European guidelines have recommended manual therapy as first- line treatment for MSK ill-health. Manual therapy is an approach where Practitioners of Manual Therapy (PoMT) use hands-on data acquisition and analysis (HODA-A) as a measurement instrument for research, diagnosis, prognosis, and a tool for treatment. Yet manual therapy techniques fail all reliability studies, therefore without proof that hands-on is a valid and reliable method of data collection, this very much limits the conclusions that can be drawn from using the hands in MSK healthcare.
INTRODUCTION
HYPOTHESIS
When palpatory-based methods and observation-based methods are used in isolation (two testers) at the same time, the results gained during a musculoskeletal screening of a person will be similar?
RECRUITMENT
Twenty-three healthy volunteers with recognised manual therapy qualifications (one man aged 36 years and 22 women aged 39.5 ± 9.4 years) were recruited within manual therapy learning institute. Of the volunteers, six women aged 46 ± 8.6 years with 18 ± 9.5 years’ experience were the randomly allocated to be tester’s.
Volunteers were randomly assigned to either the ‘tester’ (person who conducted the MSK test) or ‘testee’ (person who were tested) group. Prior to each experiment, the testers had 30 minutes training together on the experimental protocols (Gerwin et al., 1997; Sciotti et al., 2001; Van Dillen et al., 1998). During this training the examiner (author) MSK assessed, and noted, craniovertebral and upper thorax alignment of each tester, in MSK assessment position. Accuracy and validity of author’s use of HODA-A was assessed in Chapter 6 and noted to be accurate to a 91% agreement between the tester and 3D Mocap, with a kappa of 0.80 suggesting a strong level of agreement between tester and 3D Mocap with 64-81% of data reliable (95% CI -0.64-2.35) (Table 25). Any history of tester head trauma was noted. No communication was allowed during the experiment. If any communication was observed the relevant person(s) was immediately removed from the experiment. Testee’s were instructed to remain still to ensure the construct being measured did not change between testers (Dworkin & Whitney, 1992). There were no exclusion criteria for this experiment. Each experiments methodology was informed by preceding experiments conclusions.
Prior to any data collection, the examiner set-up each testee in all experiments to meet the specific criteria that had evolved from preceding experiments. A reflective journal was kept by the examiner noting observations from the testee’s and testers during each experiment. This reflection prevented any impaired memories when recalling the experience over a longer time frame (Almeida, 2005). The examiner oversaw all experiments, journaled any events that may be of interest, and analysed the final data submitted by the tester’s.
To investigate the outcomes when controlling two HODA-A measurement theories (Figure 41) in isolation: observation-based methods (3.5.2 Construct 2, Sensory cross-model judgement), and palpatory-based methods (3.5.3 Construct 3, Sensory stimulation). Two paired testers were randomly allocated to use either their HODA-A observation-based methods (Construct 2) or their palpatory-based methods (Construct 3), in isolation, to test the testee’s seated pelvic rotation and provide the relative position of the left and right innominates (Figure 43). For the palpatory-based method, the tester was asked to close their eyes and kneel behind the seated testee with their knees flexed to 90 degrees, hips extended, and arms reached forward. For the observation-based method, the tester either knelt or squatted behind the palpatory-based tester with their arms by their sides, observing the palpatory-based methods of their paired tester. Blinded to one another, both testers completed, and submitted, a data ticket (Appendix 27). The testers then moved to the next testee and only one round of testing was conducted. There was no true result for these experiments. The seated testee’s were identified with a numbered sticky label and chose where to place their arms. Once the experiment began, they were instructed not to fidget, talk, chew, or look around the room, they were to focus on something that was parallel to their sight of view. Upon completion of the experiment, the testers were allocated a two-minute break and not discuss the experiment with one another prior to the next experiment, experiment 2.
Conclusion
Poor inter-tester agreement may be explained by either; a lack of sensorimotor integration, or reduced capacity of the tester to apply specific constructs i.e., observation-based methods or palpatory-based methods.
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