van Trijffel Emiel, Plochg Thomas, van Hartingsveld Frank, Lucas Cees, Oostendorp Rob A B
Department of Clinical Epidemiology, Biostatistics and Bioinformatics, The Netherlands.
J Man Manip Ther. 2010 Jun;18(2):111-8. doi: 10.1179/106698110X12640740712815.
Passive intervertebral motion (PIVM) assessment is a characterizing skill of manual physical therapists (MPTs) and is important for judgments about impairments in spinal joint function. It is unknown as to why and how MPTs use this mobility testing of spinal motion segments within their clinical reasoning and decision-making. This qualitative study aimed to explore and understand the role and position of PIVM assessment within the manual diagnostic process. Eight semistructured individual interviews with expert MPTs and three subsequent group interviews using manual physical therapy consultation platforms were conducted. Line-by-line coding was performed on the transcribed data, and final main themes were identified from subcategories. Three researchers were involved in the analysis process. Four themes emerged from the data: contextuality, consistency, impairment orientedness, and subjectivity. These themes were interrelated and linked to concepts of professionalism and clinical reasoning. MPTs used PIVM assessment within a multidimensional, biopsychosocial framework incorporating clinical data relating to mechanical dysfunction as well as to personal factors while applying various clinical reasoning strategies. Interpretation of PIVM assessment and subsequent decisions on manipulative treatment were strongly rooted within practitioners' practical knowledge. This study has identified the specific role and position of PIVM assessment as related to other clinical findings within clinical reasoning and decision-making in manual physical therapy in The Netherlands. We recommend future research in manual diagnostics to account for the multivariable character of physical examination of the spine.
被动椎间运动（PIVM）评估是手法物理治疗师（MPT）的一项特色技能，对于判断脊柱关节功能障碍很重要。目前尚不清楚MPT在临床推理和决策过程中为何以及如何运用这种脊柱运动节段的活动度测试。这项定性研究旨在探索和理解PIVM评估在手法诊断过程中的作用和地位。对专家MPT进行了8次半结构化个人访谈，并随后利用手法物理治疗咨询平台进行了3次小组访谈。对转录数据进行逐行编码，并从子类别中确定最终的主要主题。三名研究人员参与了分析过程。数据中出现了四个主题：情境性、一致性、损伤导向性和主观性。这些主题相互关联，并与专业精神和临床推理的概念相关联。MPT在一个多维的生物心理社会框架内使用PIVM评估，该框架纳入了与机械功能障碍以及个人因素相关的临床数据，同时应用各种临床推理策略。对PIVM评估的解释以及随后关于手法治疗的决策深深植根于从业者的实践知识。本研究确定了在荷兰手法物理治疗的临床推理和决策中，PIVM评估与其他临床发现相关的具体作用和地位。我们建议未来对手法诊断进行研究，以考虑脊柱体格检查的多变量特征。
