A modern way to teach and practice manual therapy

Roger Kerry; Kenneth J. Young; David W. Evans; Edward Lee; Vasileios Georgopoulos; Adam Meakins; Chris McCarthy; Chad Cook; Colette Ridehalgh; Steven Vogel; Amanda Banton; Cecilia Bergström; Anna Maria Mazzieri; Firas Mourad; Nathan Hutting

doi:10.1186/s12998-024-00537-0

A modern way to teach and practice manual therapy

Roger Kerry, Kenneth J. Young, David W. Evans, Edward Lee, Vasileios Georgopoulos, Adam Meakins, Chris McCarthy, Chad Cook, Colette Ridehalgh, Steven Vogel, Amanda Banton, Cecilia Bergström, Anna Maria Mazzieri, Firas Mourad, Nathan Hutting

Research output: Contribution to journal › Review article › peer-review

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Abstract

Background: Musculoskeletal conditions are the leading contributor to global disability and health burden. Manual therapy (MT) interventions are commonly recommended in clinical guidelines and used in the management of musculoskeletal conditions. Traditional systems of manual therapy (TMT), including physiotherapy, osteopathy, chiropractic, and soft tissue therapy have been built on principles such as clinician-centred assessment, patho-anatomical reasoning, and technique specificity. These historical principles are not supported by current evidence. However, data from clinical trials support the clinical and cost effectiveness of manual therapy as an intervention for musculoskeletal conditions, when used as part of a package of care. Purpose: The purpose of this paper is to propose a modern evidence-guided framework for the teaching and practice of MT which avoids reference to and reliance on the outdated principles of TMT. This framework is based on three fundamental humanistic dimensions common in all aspects of healthcare: safety, comfort, and efficiency. These practical elements are contextualised by positive communication, a collaborative context, and person-centred care. The framework facilitates best-practice, reasoning, and communication and is exemplified here with two case studies. Methods: A literature review stimulated by a new method of teaching manual therapy, reflecting contemporary evidence, being trialled at a United Kingdom education institute. A group of experienced, internationally-based academics, clinicians, and researchers from across the spectrum of manual therapy was convened. Perspectives were elicited through reviews of contemporary literature and discussions in an iterative process. Public presentations were made to multidisciplinary groups and feedback was incorporated. Consensus was achieved through repeated discussion of relevant elements. Conclusions: Manual therapy interventions should include both passive and active, person-empowering interventions such as exercise, education, and lifestyle adaptations. These should be delivered in a contextualised healing environment with a well-developed person-practitioner therapeutic alliance. Teaching manual therapy should follow this model.

Original language	English
Article number	17
Journal	Chiropractic & Manual Therapies
Volume	32
Issue number	1
Early online date	21 May 2024
DOIs	https://doi.org/10.1186/s12998-024-00537-0
Publication status	E-pub ahead of print - 21 May 2024

Keywords

Soft-tissue therapy
Physiotherapy
Chiropractic
Person-centred healthcare
Evidence-based healthcare
Manual Therapy
Osteopathy

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Kerry, R., Young, K. J., Evans, D. W., Lee, E., Georgopoulos, V., Meakins, A., McCarthy, C., Cook, C., Ridehalgh, C., Vogel, S., Banton, A., Bergström, C., Mazzieri, A. M., Mourad, F., & Hutting, N. (2024). A modern way to teach and practice manual therapy. Chiropractic & Manual Therapies, 32(1), Article 17. Advance online publication. https://doi.org/10.1186/s12998-024-00537-0

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abstract = "Background: Musculoskeletal conditions are the leading contributor to global disability and health burden. Manual therapy (MT) interventions are commonly recommended in clinical guidelines and used in the management of musculoskeletal conditions. Traditional systems of manual therapy (TMT), including physiotherapy, osteopathy, chiropractic, and soft tissue therapy have been built on principles such as clinician-centred assessment, patho-anatomical reasoning, and technique specificity. These historical principles are not supported by current evidence. However, data from clinical trials support the clinical and cost effectiveness of manual therapy as an intervention for musculoskeletal conditions, when used as part of a package of care. Purpose: The purpose of this paper is to propose a modern evidence-guided framework for the teaching and practice of MT which avoids reference to and reliance on the outdated principles of TMT. This framework is based on three fundamental humanistic dimensions common in all aspects of healthcare: safety, comfort, and efficiency. These practical elements are contextualised by positive communication, a collaborative context, and person-centred care. The framework facilitates best-practice, reasoning, and communication and is exemplified here with two case studies. Methods: A literature review stimulated by a new method of teaching manual therapy, reflecting contemporary evidence, being trialled at a United Kingdom education institute. A group of experienced, internationally-based academics, clinicians, and researchers from across the spectrum of manual therapy was convened. Perspectives were elicited through reviews of contemporary literature and discussions in an iterative process. Public presentations were made to multidisciplinary groups and feedback was incorporated. Consensus was achieved through repeated discussion of relevant elements. Conclusions: Manual therapy interventions should include both passive and active, person-empowering interventions such as exercise, education, and lifestyle adaptations. These should be delivered in a contextualised healing environment with a well-developed person-practitioner therapeutic alliance. Teaching manual therapy should follow this model.",

keywords = "Soft-tissue therapy, Physiotherapy, Chiropractic, Person-centred healthcare, Evidence-based healthcare, Manual Therapy, Osteopathy",

author = "Roger Kerry and Young, {Kenneth J.} and Evans, {David W.} and Edward Lee and Vasileios Georgopoulos and Adam Meakins and Chris McCarthy and Chad Cook and Colette Ridehalgh and Steven Vogel and Amanda Banton and Cecilia Bergstr{\"o}m and Mazzieri, {Anna Maria} and Firas Mourad and Nathan Hutting",

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doi = "10.1186/s12998-024-00537-0",

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T1 - A modern way to teach and practice manual therapy

AU - Kerry, Roger

AU - Young, Kenneth J.

AU - Evans, David W.

AU - Lee, Edward

AU - Georgopoulos, Vasileios

AU - Meakins, Adam

AU - McCarthy, Chris

AU - Cook, Chad

AU - Ridehalgh, Colette

AU - Vogel, Steven

AU - Banton, Amanda

AU - Bergström, Cecilia

AU - Mazzieri, Anna Maria

AU - Mourad, Firas

AU - Hutting, Nathan

PY - 2024/5/21

Y1 - 2024/5/21

N2 - Background: Musculoskeletal conditions are the leading contributor to global disability and health burden. Manual therapy (MT) interventions are commonly recommended in clinical guidelines and used in the management of musculoskeletal conditions. Traditional systems of manual therapy (TMT), including physiotherapy, osteopathy, chiropractic, and soft tissue therapy have been built on principles such as clinician-centred assessment, patho-anatomical reasoning, and technique specificity. These historical principles are not supported by current evidence. However, data from clinical trials support the clinical and cost effectiveness of manual therapy as an intervention for musculoskeletal conditions, when used as part of a package of care. Purpose: The purpose of this paper is to propose a modern evidence-guided framework for the teaching and practice of MT which avoids reference to and reliance on the outdated principles of TMT. This framework is based on three fundamental humanistic dimensions common in all aspects of healthcare: safety, comfort, and efficiency. These practical elements are contextualised by positive communication, a collaborative context, and person-centred care. The framework facilitates best-practice, reasoning, and communication and is exemplified here with two case studies. Methods: A literature review stimulated by a new method of teaching manual therapy, reflecting contemporary evidence, being trialled at a United Kingdom education institute. A group of experienced, internationally-based academics, clinicians, and researchers from across the spectrum of manual therapy was convened. Perspectives were elicited through reviews of contemporary literature and discussions in an iterative process. Public presentations were made to multidisciplinary groups and feedback was incorporated. Consensus was achieved through repeated discussion of relevant elements. Conclusions: Manual therapy interventions should include both passive and active, person-empowering interventions such as exercise, education, and lifestyle adaptations. These should be delivered in a contextualised healing environment with a well-developed person-practitioner therapeutic alliance. Teaching manual therapy should follow this model.

AB - Background: Musculoskeletal conditions are the leading contributor to global disability and health burden. Manual therapy (MT) interventions are commonly recommended in clinical guidelines and used in the management of musculoskeletal conditions. Traditional systems of manual therapy (TMT), including physiotherapy, osteopathy, chiropractic, and soft tissue therapy have been built on principles such as clinician-centred assessment, patho-anatomical reasoning, and technique specificity. These historical principles are not supported by current evidence. However, data from clinical trials support the clinical and cost effectiveness of manual therapy as an intervention for musculoskeletal conditions, when used as part of a package of care. Purpose: The purpose of this paper is to propose a modern evidence-guided framework for the teaching and practice of MT which avoids reference to and reliance on the outdated principles of TMT. This framework is based on three fundamental humanistic dimensions common in all aspects of healthcare: safety, comfort, and efficiency. These practical elements are contextualised by positive communication, a collaborative context, and person-centred care. The framework facilitates best-practice, reasoning, and communication and is exemplified here with two case studies. Methods: A literature review stimulated by a new method of teaching manual therapy, reflecting contemporary evidence, being trialled at a United Kingdom education institute. A group of experienced, internationally-based academics, clinicians, and researchers from across the spectrum of manual therapy was convened. Perspectives were elicited through reviews of contemporary literature and discussions in an iterative process. Public presentations were made to multidisciplinary groups and feedback was incorporated. Consensus was achieved through repeated discussion of relevant elements. Conclusions: Manual therapy interventions should include both passive and active, person-empowering interventions such as exercise, education, and lifestyle adaptations. These should be delivered in a contextualised healing environment with a well-developed person-practitioner therapeutic alliance. Teaching manual therapy should follow this model.

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KW - Physiotherapy

KW - Chiropractic

KW - Person-centred healthcare

KW - Evidence-based healthcare

KW - Manual Therapy

KW - Osteopathy

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U2 - 10.1186/s12998-024-00537-0

DO - 10.1186/s12998-024-00537-0

M3 - Review article

SN - 2045-709X

VL - 32

JO - Chiropractic & Manual Therapies

JF - Chiropractic & Manual Therapies

IS - 1

M1 - 17

ER -

A modern way to teach and practice manual therapy

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