School of Physical Therapy, Texas Woman's University, Houston, TX, USA.
Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
J Man Manip Ther. 2024 Jun;32(3):295-303. doi: 10.1080/10669817.2024.2363033. Epub 2024 Jun 28.
To identify factors and barriers, which affect the utilisation of spinal manipulation and mobilisation among infants, children, and adolescents.
Twenty-six international expert physiotherapists in manual therapy and paediatrics were invited to participate in a Delphi investigation using Qualtrics. In Round-1 physiotherapists selected from a list of factors and barriers affecting their decision to use spinal manipulation and mobilisation in the paediatric population and had opportunity to add to the list. Round-2 asked respondents to select as many factors and barriers that they agreed with, resulting in a frequency count. The subset of responses to questions around barriers and facilitators are the focus of this study.
Twelve physiotherapists completed both rounds of the survey. Medical diagnosis, mechanism of injury, patient presentation, tolerance to handling, and therapist's knowledge of techniques were the dominant deciding factors to use spinal manipulation and mobilisation among infants, children, and adolescents across spinal levels. More than 90% of the respondents selected manipulation as inappropriate among infants as their top barrier. Additional dominant barriers to using spinal manipulation among infants and children identified by ≥ 75% of the respondents included fear of injuring the patient, fear of litigation, lack of communication, lack of evidence, lack of guardian consent, and precision of the examination to inform clinical reasoning.
This international survey provides much needed insight regarding the factors and barriers physiotherapists should consider when contemplating the utilisation of spinal mobilisation and manipulation in the paediatric population.
确定影响婴儿、儿童和青少年脊柱手法治疗和松动术应用的因素和障碍。
邀请 26 名国际手法治疗和儿科领域的专家物理治疗师使用 Qualtrics 参与 Delphi 调查。在第 1 轮中，物理治疗师从影响他们决定在儿科人群中使用脊柱手法治疗和松动术的因素和障碍列表中进行选择，并可添加更多内容。第 2 轮要求受访者选择他们同意的多个因素和障碍，从而进行频数统计。本研究的重点是围绕障碍和促进因素的问题子集。
12 名物理治疗师完成了两轮调查。在脊柱各节段，医学诊断、损伤机制、患者表现、对处理的耐受性以及治疗师对技术的了解是决定对婴儿、儿童和青少年使用脊柱手法治疗和松动术的主要因素。超过 90%的受访者选择婴儿期不适合进行手法治疗，这是他们的首要障碍。超过 75%的受访者还认为，在婴儿和儿童中使用脊柱手法治疗的其他主要障碍包括担心伤害患者、担心诉讼、缺乏沟通、缺乏证据、缺乏监护人同意以及为明确临床推理而进行的检查精度。
这项国际调查为物理治疗师在考虑在儿科人群中应用脊柱松动术和手法治疗时应考虑的因素和障碍提供了急需的深入了解。
