Health & Wellness Services

STUDY 11

Completed

INTRODUCTION

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.

The subject matter of whether HODA-A is valid and reliable often becomes an area of contention between MSK professionals (Pettman, 2007; Schiotz & Cyriax, 1974), dividing those who are ‘for’ and those who are ‘against’ using HODA-A to inform MSK healthcare (Lewit, 2010; Pettman, 2007; Reverby, 1987). This review will consider HODA-A used by multiple disciplines in MSK health to gain insights from target populations with a specific purpose, i.e., Performance Based Outcome Measurements (PerBOMs) e.g., marker placement for three-dimensional motion capture (Van Sint Jan & Della Croce, 2005); Clinician Reported Outcome Measurements (ClinROMs) e.g., normal and abnormal position, motion, tissue tone and sensitivity, and symmetry (Streiner, 2003); Patient Reported Outcome Measurements (PROMs) e.g., pain provocation tests (Arab et al., 2009).

HYPOTHESIS

This systematic review focuses on the use of Hands-On Data Acquisition & Analysis (HODA- A) as a measurement instrument used to conduct diagnostic tests, within a MSK assessment, by MSK professionals in MSK healthcare

RECRUITMENT

A comprehensive systematic literature search was performed using five online databases: PubMed, ScienceDirect, Cochrane, Web of Science, and BioMed Central, begun 21st March 2020 through till 30th May 2020.

Jo Abbott Blueprint Patient MSK Health Chat

There were seven levels of enquiry placed upon included studies in this systematic review. For standardised data extraction and filtering of the articles within DistillerSR. The software was programmed with specific closed-ended questions on digital screening forms to provide; accurate (reducing typing errors) and efficient (reducing time to answer) inclusion/exclusion criteria, whilst creating machine learning models for the Artificial Intelligence (AI) to be able to score and order unreviewed references by relative inclusion probability (Stefanison, 2020).

DistillerSR was used as the data management system for this systematic review, whilst also offering AI as an independent reviewer for this study. AI was used, after manual review, throughout all steps of the review due to this project being part of a Ph.D. thesis where a secondary human reviewer was not an option. Whilst supporting the efficiency of the review, AI supported the production of cleaner, better structured, and easier to analyse data that offers transparency and reproducible results throughout the screening and data extraction methods. DistillerSR allows for transparency of all processes taken during the systematic review through Project Audit Log.

Quality assessment is an integral part of any systematic review (Whiting et al., 2003). For this reason, a two-stage process implementing two existing literature assessment protocols shall be used. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias (RoB) standards for the evaluation of measurement instrument properties (Mokkink et al., 2006) informing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (Moher et al., 2009). COSMIN, an initiative developed by an international multidisciplinary team of researchers with backgrounds in epidemiology, psychometrics, medicine, qualitative research, and healthcare, provide standards for the evaluation of measurement properties of instruments to measure health status by defining explicit criteria for what constitutes good measurement properties i.e., validity and reliability (Mokkink et al., 2006). PRISMA, is an evidence-based minimal set of 27-item checklist and a four-phase flow diagram for reporting systematic reviews and meta- analyses that evaluate healthcare interventions (Liberati et al., 2009).

Conclusion

The COSMIN RoB checklist provides necessary standards to scrutinise the measurement instrument used in diagnostic studies. By applying the COSMIN RoB checklist to the final stages in this systematic review, no studies were eligible for the final review. This systematic review has provided very clear evidence that continued use of HODA-A as a measurement instrument in MSK healthcare, without the necessary developmental studies, exaggerates and biases any data obtained using HODA-A. This can trigger premature dissemination and lead readers into making incorrect treatment decisions (P. M. Bossuyt, J. B. Reitsma, D. E. Bruns, C. A. Gatsonis, P. P. Glasziou, L. M. Irwig, J. G. Lijmer, D. Moher, D. Rennie, H. C. de Vet, et al., 2003). This systematic review has clearly identified gaps in the current knowledge of the measurement properties for HODA-A, providing a starting point for rigorous investigations to commence on HODA-A.

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