Objective: To determine which assessments and treatments are most commonly chosen by physical therapists who are either credentialed in MDT only vs. MDT + FAAOMT

Design: Observational case study survey

Setting: Online survey sent out of Daemen College, Amherst, NY, USA

Patients: Survey administered to 714 members of the McKenzie Institute; 11.6% completed the patient vignette – 6 with MDT + FAAOMT, and 77 with MDT only

Intervention: Survey participants were provided with a history of a simulated patient with acute cervical spine pain. 15 questions were then asked about clinical decision-making for next steps in the assessment. Upon selecting an answer about what would be assessed next, additional information was provided. For instance, when asked “How would you begin the examination?” if “Structural Exam” was selected then the survey revealed that upon exam the patient presented with forward head posture. The last three questions of the survey asked which initial and follow-up interventions would be chosen.

Main outcome measures: No outcome measures were used but a descriptive analysis was made of the responses using contingency tables and chi-square analysis.

Main Results: Both groups most commonly started the examination with a structural exam of the patient. The majority of both then chose active range of motion, followed by end-range repeated movements. This is the point at which the clinical decision-making differed: 74% of the MDT group selected that no further tests were needed for the assessment, whereas 50% of the MDT+FAAOMT group chose to assess passive intervertebral motion and passive range of motion, as well as special tests.

For interventions, 79% of the MDT group chose directional preference exercises to start, compared to 66% of the MDT+FAAOMT group. Most of the participants in both groups chose to continue with these exercises for the second intervention as well. The main difference for intervention was that if the patient had returned no better, most of the MDT group chose to continue with directional preference exercises, while the MDT+FAAOMT group chose grade 1-4 non-thrust manipulation most often.

Conclusions: The type of post-graduate training likely influences bias towards clinical decision-making for the assessment and treatment of acute cervical derangement.

Comments and Implications for the MDT Clinician: As practitioners, we sometimes see examples where taking post-graduate studies has no influence over clinical decisions and practice. This study, although it was a small sample size, shows that clinicians are taking in material learned from post-graduate studies and using it to alter their decision-making. For instance, clinicians with FAAOMT credentialing tended to use hands-on assessment and treatment techniques more readily than the MDT group. In essence, clinicians were making choices based on a thoughtful, structured process influenced by their training.

This study was set up in a novel way by delivering its questions to participants sequentially to determine differences in clinical decision-making throughout different steps of the assessment, as well as the choices for therapy. For the neck, evidence is sparse as to what decisions for assessment and treatment are the correct ones. As MDT clinicians, we tend to take the evidence we have through studies of the lumbar spine and apply the same principles to the cervical spine. Until future studies refute or support our decisions for assessment and treatment, at this point this study suggests that at least clinicians are applying a system to their decisions influenced by their post-graduate training.

Cervical: Studies into assessment, diagnosis and procedures