Joint Mobilizations and Manipulations: Evidenced-based Teaching and Learning

This course discusses the research investigating various strategies for delivering manual therapy education, with the intent of improving the reliability and efficacy of a clinician's manual therapy technique. These findings could be applied to college and university programs, continuing education courses, and manual therapy technique certifications, as well as used by clinical educators working to improve clinical practice at their clinics (e.g. with staff physical therapists, physical therapy students during clinical affiliations, etc.). This course does not cover the construction of a quality written exam or multiple-choice question test; however, the information in this course likely has significant implications for practical examination, and perhaps patient education.

Although this course does not cover material that would be considered part of a "conventional" manual therapy course or manual technique certification, it is recommended that all sports medicine professionals and health care providers (physical therapists, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) take this course with the intent of improving the profession, and our ability to teach manual techniques for the treatment of pain. It is time the industry went beyond teaching anatomy, body mechanics, musculoskeletal dysfunction, and manual therapy techniques, and started thinking about how better teaching could improve the delivery, retention, and application of all coursework.

Brookbush Institute Position Statement:

• Research implies that ideal lesson plan development would include video instruction and step-by-step demonstration prior to live instruction. Live instruction would prioritize lab and blocked-practice sessions taught by the most experienced instructors. Feedback should be concurrent, student-paced, qualitative, and quantitative, and students should have opportunities to teach the techniques back to instructors and/or peers. Random-variable practice with progressively less feedback may be used to optimize retention.

Research Summary:

• More Lab: Studies suggest that students are generally dissatisfied with the proportion of lecture time dedicated to lab and practicing techniques.
• Lesson Plan Construction: Step-by-step instruction may be beneficial during the initial demonstration; however, whole technique practice is as effective during labs. Further, it may be beneficial to have students attempt to instruct a teacher and/or peer as part of proficiency development.
• Integrating Didactic and Lab Instruction: Research suggests that ideal lesson plans might begin with video instruction prior to live instruction and live instruction would focus on practical application with concurrent feedback.
• Types of Feedback: Staff instructors are most beneficial during lab instruction and should provide both qualitative and quantitative feedback.
• Feedback Timing: Feedback should be concurrent and student-paced, blocked practice should be used for skill acquisition, and random-variable practice with progressively less feedback may be ideal for optimizing retention.
• Validity of Feedback: Few studies are available to refine the validity of feedback; however, these studies should inspire more research comparing various instruction sets, cues, and alignment between student, instructor, and patient perception.
• Additional Findings: Lectures may have important effects on practice beyond the recall of testable information (e.g. prevalence of use, confidence, etc.), and an exercise program may be beneficial for new students learning joint manipulation techniques.