Measuring the Effects of various Manual Therapy Interventions

Here's my response to a reader who is interested in "Measuring the Effects of various Manual Therapy Interventions".

People typically get Manual Therapy to 

*  Increase mobility/flexibility and/or to
*  Reduce Pain.

The reader pointed out - The Effects of various Manual Therapy Interventions typically cannot be tested/measured using cadavers or computer modeling, and often there is no valid “sham” therapy to measure against.

Let's look into this....

First let's start with a few references....

* Standardized Outcome Measures in Manual Therapy

* Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial - Commentary: Bootstrapping simplifies appreciation of statistical inferences

* Assessment tools for OT

* Guide to Outcomes Measurement for Patients With Low Back

*  The effectiveness of manual therapy, physiotherapy and treatment by the general practitioner for chronic non-specific back and neck complaints

*  Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial

*  Patient-Reported Outcome (PRO) questionnaires for people with pain in any spine region. A systematic review

*  Patients' treatment beliefs in low back pain: development and validation of a questionnaire in primary care

*  Physical Therapy Evaluation and Management of the Shoulder Complex

*  Effectiveness of Manual Physical Therapy for Painful Shoulder Conditions: A Systematic Review

*  Efficacy of Manual Therapy

*  The Science and Practice of Manual Therapy - body language

*  Immediate Changes Following Manual Therapy in Resting State Functional Connectivity As Measured By Magnetic Resonance Imaging (fMRI) In Subjects With Induced Low Back Pain

 * Placebo response to manual therapy: something out of nothing?

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Based on the above...."Measuring the Effects of various Manual Therapy Interventions" might be accomplished by....

*   Ask the patient whether the manual therapy is effective or not.  Listen to their story/narrative.  Observe body language.  Perhaps, use questionnaires.  

*  You can use more sophisticated efficacy measurement tools like fMRI, but these are usually out of the reach of most practitioners.  Stress/Pain Measurement Tools like those used in Biofeedback can be used to test relaxation level (skin conductance and/or heart rate variability).  Since stress/tension increases muscle tightness and increases pain, probably anything to reduce stress/anxiety will help therapy effectiveness

*  The Therapist could increase the perceived effectiveness of the therapy by words/actions.  This is due to enhancing the inherent Placebo Effect, which is a part of any health intervention. 

*  Lastly, if the perceived or measured effectiveness is slow going or non-existant, please consider psychological/emotional reasons for the chronic patient - "Are You “Sick and Tired” of Being “Sick and Tired”?" - Especially see questions therein.

*  I'm sure there are more ways to measure efficacy of Manual Therapy.  Perhaps the Measurement/Testing Modalities of related Health/Medical Interventions might be useful to measure the efficacy of Manual Therapy, too.  Please add your comments to add to this discussion.

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Article is for information only and is not medical advice.  See full disclaimers at TG Ideas LLC.