1. Spinal Evaluation Techniques
A Survey Of Entry-Level Physical Therapy
Curricula In The United States
Allan Besselink, P.T., Cert.MDT
Lecturer, Southwest Texas State University
San Marcos, TX
Staff PT, Columbia/St. David’s Spine Center
Austin, TX

2. Introduction
• Importance of diagnosis and the establishment
of treatment criteria defined by:
– American Physical Therapy Association “Guide
To Physical Therapist Practice, Volume I” (1995)
– Commission On Accreditation In Physical
Therapy Education (1997)

3. Purpose
• Establish current trends in spinal evaluation
curriculum content in entry-level physical
therapy educational programs
• Provide a foundation for further comparison
with the literature on reliability and validity of
spinal evaluation techniques

4. Methods And Research Design
• Survey consisting of questions regarding -
– 1. Authors or references cited in the development
of the curriculum content
– 2. Evaluation techniques taught in the curriculum
– 3. Relative importance of each technique to the
overall scope of the spinal evaluation curriculum

5. Survey Results
• Survey sent to 148 accredited entry-level
physical therapy educational programs in the
United States
• Return rate of 62.8 % (n = 93)
– 25 Bachelors programs (26.9 %)
– 68 Masters programs (73.1 %)

6. Faculty Profile
• Gender: 57.0 % male, 38.7 % female
• PT Educational Level
– Bachelors 45.2 %
– Masters 45.2 %
• Highest Educational Level Attained
– Masters 63.4 %
– Doctorate 33.3 %
– 54.8 % have terminal degree in physical therapy

7. Faculty Profile
• 38.6 % have post-graduate certifications
– OCS 28.0 %
– Manual Therapy 8.6 %
– Paris 7.5 %
– McKenzie 5.4 %
• 79.6 % are currently active in spine care
– 8.57 clinical hours per week (median = 6.0)
• 9.54 years clinical experience in spine care

8. Spinal Evaluation Curriculum:
Content
• McKenzie 95.7 % • Butler 51.6 %
• Maitland 93.6 % • Waddell 50.5 %
• Cyriax 91.4 % • Grieve 44.1 %
• Kaltenborn 75.3 % • Evjenth 26.9 %
• Paris 72.0 % • Janda 25.8 %
• Kendall 67.7 % • Mulligan 21.5 %
• Saunders 64.5 % • Greenman 17.2 %
• Travell 60.2 % • Stoddard 12.9 %

9. Spinal Evaluation Curriculum:
Content
• References that critically examine the current
status of spinal evaluation and treatment:
– Spitzer et al 1987 (QTF) 1.1 %
– Bigos et al 1994 (AHCPR) 2.1 %

10. Spinal Evaluation Curriculum:
Techniques
• > 95 % of all programs • Postural Asymmetry
teach the following • Neurological Testing
spinal evaluation • Flexibility
techniques:
• Provocative Testing
Sacroiliac/Spine
• Neural Tension
• ROM

11. Spinal Evaluation Curriculum:
Techniques
• > 90 % of all programs • Palpation
teach the following • Repeated Movement
spinal evaluation • Passive Intervertebral
techniques: Joint Motion
• Manual Muscle Tests
• Pain Patterns/Behavior

12. Spinal Evaluation Curriculum:
Techniques
• Others: • Non-Organic Tests
(69 %)
• Isokinetic Testing
(9 %)

13. Relative Importance To Curriculum
• What is the relative importance of each
technique to the overall scope of the spinal
evaluation curriculum?
• Prioritized ranking of 0 - 10
– 0 = “no priority/not taught”
– 10 = “high priority/great deal of time spent on that
particular technique”

14. RI Score
As
ym
0
1
2
3
4
5
6
7
8
9
10
m
et
ry
Ne
ur
Pa o
lp
at
io
Fl n
ex
ib
ilit
y
R
O
Pr M
ov
.S
pi
ne
PI
VM
R
ep
ea
te
d
Pa
in
Techniques
Pr
ov
.S
Te I
ns
io
n
No MM
n- T
O
rg
an
Is ic
ok
in
et
ic
Mean
Mode
Median
Relative Importance Of Techniques

15. % Of Respondents
As
ym
m
0%
20%
40%
60%
80%
100%
et
ry
N
e
Pa uro
lp
a
Fl tion
ex
ib
ilit
y
R
Pr O
ov M
.S
pi
ne
P
R IVM
ep
ea
te
d
Pa
Techniques
Pr in
ov
Te .SI
ns
io
n
N
on MM
-O T
rg
a
Is nic
ok
in
et
ic
10
Relative Importance Of Techniques
7 to 9
4 to 6
0 to 3

16. Relative Importance And
Faculty Certification
100
% Respondents Scoring 7 - 10
80
OCS
60 ManTher
Paris
40 McKenzie
Sample
20
0
Pain Flexibility Repeated Non-Organic

17. % Respondents Scoring 7 - 10
As
y m
0
20
40
60
80
100
m
et
r
Ne y
Pa u r
lp o
a
F l t io
ex n
ib
ilit
y
P r RO
ov M
.S
pi
ne
Re PIV
pe M
at
ed
Pa
Techniques
Pr in
ov
Te .SI
ns
io
No n
n - MM
O
rg T
Is an
ok ic
in
et
ic
Relative Importance And Degree
Masters
Bachelors

18. Inter-Rater Reliability Of Spinal
Evaluation Techniques
• Significant difficulties when reviewing the
current literature secondary to:
– lack of published studies on any given technique
– lack of standardized protocols for any given
technique
– variations in statistical analysis

19. Conclusions And Future Research
• Current trends in entry-level physical therapy
spinal evaluation curriculum have been
defined
• Statistical comparison to data on the inter-
rater reliability of each technique
• Other nationalities (Canada, Australia)
• Other health care professions utilizing similar
physical examination procedures