News from Overseas
By Professor Andries Kleynhans

UNITED KINGDOM

Interprofessional Collaboration In Manipulation
Trials of manipulative treatment have been compromised by, amongst other things, different definitions of the therapeutic procedures involved.

A paper published in the Manual Therapy journal describes a spinal manipulation package agreed by the UK professional bodies that represent chiropractors, osteopaths and physiotherapists. It was devised for use in the UK Back Pain Exercise And Manipulation (UK BEAM) trial, a national study of physical treatments in primary care funded by the Medical Research Council and the National Health Service Research and Development Programme.

Although systematic reviews have reported some beneficial effects of spinal manipulation for low-back pain, due to the limited methodological quality of primary studies and difficulties in defining manipulation, important questions have remained unanswered. The UK BEAM trial was designed to answer some of those questions. Early in the design of the trial, it was acknowledged that the spinal manipulation treatment regimes provided by practitioners from the three professions shared more similarities than differences.

Because the trial design specifically precluded comparison of the effect between the professions, it was necessary to devise a homogenous package representative of and acceptable to, all three. The resulting package is “pragmatic”, in that it represents what happens to most people undergoing manipulation, and “explanatory” in that it excludes discipline-specific variations and other ancillary treatments.

Reference:

• Harvey E, et al. Spinal manipulation for low-back pain: a treatment package agreed by the UK chiropractic, osteopathy and physiotherapy professional associations. Manual Therapy. February 2003; Vol. 8, Iss. 1, pp. 46-51. (From: FCER’s The Week in Chiropractic * Vol 9 No 42 * July 28, 2003).

NEW ZEALAND

In New Zealand, a new approach to manual therapy of the cervical spine has integrated physiotherapy and osteopathy techniques. The combination of the philosophies of these two professions has added a new dimension to the management of cervical spine pain. Emphasis is placed on issues of safety, such as the degree of cervical rotation and comfort for both the patient and the therapist. This is combined with biomechanical considerations, which have made the teaching and learning of these manipulative techniques less complicated and easy to progress from palpation to mobilization and onto manipulation. Appropriate patient screening and thorough subjective and objective assessments are important aspects of this approach and reflective interpretation of all clinical findings is essential. The refinement of cervical joint positioning and an increased anatomical awareness have led to the utilization of new upper cervical high-velocity thrust techniques. Consequently, it is envisaged that an increase in the safety and specificity of cervical manipulative techniques is achieved.

Reference:

• Hing WA, et al. Manipulation of the cervical spine. Manual Therapy. February 2003; Vol. 8, Iss. 1, pp. 2-9. (From FCER’s The Week in Chiropractic * Vol 9 No 42 * July 28, 2003).

UNITED STATES OF AMERICA

Undergraduate Medical Education in Musculoskeletal Problems
At a June 2003 meeting of the American Medical Association House of Delegates a resolution sponsored by the American Academy of Orthopedic Surgeons pointed out the lack of adequate training for medical students in the area of musculoskeletal education. They encouraged medical schools to take various steps to strengthen their curriculum in this area.