Student Perception of Applying Joint Manipulation Skills During Physical Therapist Clinical Education: Identification of Barriers

Abstract

Introduction/Review of Literature. A 2004 survey of physical therapist education programs indicated that out of 116 responding programs, 44% were including thrust joint manipulation (TJM) in their curriculums. CAPTE accreditation includes instruction of TJM during physical therapist professional education. TJM has been shown to be effective in certain patient populations and adoption of TJM by graduating students is likely dependent on both didactic and clinical education. The purpose of this study was to identify and describe potential student-perceived barriers to learning and practicing TJM. Subjects and Methods. Students targeted from all professional PT education programs in their final year of graduation and within 3 months following graduation were asked to complete a survey that was sent to program directors to distribute to students. Results. 460 subjects responded from 38 states (all US regions). The median age was 26 and 73% were female. Results indicated a high level of didactic education in TJM (95%), but a lesser percentage of opportunities to utilize techniques clinically. When asked about their experience during outpatient orthopedic-based clinical education, 54% of the student respondents indicated that they perceived that their clinical instructors (CIs) were not completely comfortable with students performing TJM. When students did not utilize TJM, despite clinical indication, they cited lack of confidence (55%), personal skill level (48%), and not feeling academically prepared to utilize techniques (26%) as some of the reasons. Discussion and Conclusion. This survey suggests an increase in the number of professional physical therapist education programs teaching TJM. However, the students surveyed perceived barriers to practicing TJM during clinical experiences, which may limit their use of these techniques during their clinical practice. While TJM instruction in academic programs appears to be increasing, full adoption clinically requires practice. Enhanced CI education may increase the opportunity for student TJM practice during internships and may result in adoption of TJM practice after graduation.