- Email: [email protected]
A description of the development of a post-graduate orthopaedic manual therapy residency program in Kenya
e162
Abstracts / Manual Therapy 25 (2016) e57ee169
the slump test as a diagnostic tool, however, the number of clinicians who use this test as a treatment modality was slightly lower (80%). Clinicians showed a preference for using the slump test as a diagnostic and treatment tool in patients with symptoms in the posterior chain, inclusive of the spine. The majority of clinicians focussed on overt (that is, replicating symptom) responses as an indicator of a positive slump test, rather than covert responses. Only 35% of clinicians responded to questions regarding sliding and tensioning techniques, with the majority showing a preference for using sliding techniques as a treatment strategy. Conclusion: Whilst research into neurodynamics has been expanding and developing rapidly in recent years, little is known about how practitioners use this technique. It would appear from this survey that the limited research on the slump test as a treatment modality in symptomatic patients could possibly be reflected in the relatively limited use of this test in practice amongst clinicians. Implications: This study highlights that despite the growing research in neurodynamics and the slump test specifically, there is a need to ensure the translation of new research is occurring into clinical practice Funding Acknowledgements: No funding was obtained for this undertaking or completion of this study Ethics Approval: Ethical approval was obtained by the University of Central Lancashire, Preston, UK Disclosure of Interest: None Declared
completion (0.03 s) and total time mobilization (0.09 s). In addition, the stability ranges (ICC test - retest) of the variables in G1 range between 0.768 and 0.903, and G2 range between 0.439 and 0.647. Conclusion: The methodology of parameterized learning process through inertial sensor shows, to the students, further evolution in the execution of the posterior-anterior thoracic manipulation, seeking higher range of motion, reduced execution time and higher stability in the execution of the technique. Implications: The information provided by the ISRTF during the execution of each manipulation during the student learning favour to increase the consistency in the execution of the technique and it reduce learning time thanks to increased student learning autonomy after to receive accurate and objective information after each manipulation. Funding Acknowledgements: NONE Ethics Approval: University of Malaga Ethical Approval committee has approved the present study. Disclosure of Interest: None Declared Keywords: Feedback, Kinematic, Manual Therapy Teaching, Learning and Professional Development PO1-ED-029 A DESCRIPTION OF THE DEVELOPMENT OF A POST-GRADUATE ORTHOPAEDIC MANUAL THERAPY RESIDENCY PROGRAM IN KENYA
Keywords: Clinicians, Neurodynamics, Survey S. Cunningham*, R. Jackson. Teaching, Learning and Professional Development PO1-ED-028 KINEMATIC e REAL TIME FEEDBACK. A NEW METHODOLOGY FOR TEACHING MANUAL THERAPY: A RANDOMIZED CONTROLLED TRIAL nnchez 1, 2,3, P. Vaes 1,*, M. Trinidad-Fern andez 2, C. Rolda M. Gonz alez-Sa 2 3 1 KINE & Manuele Therapie, Vrije Jimenez , A.I. Cuesta-Vargas . laga, Spain; Universiteit Brussel, Brussels, Belgium; 2 University of Ma 3 laga, Ma laga, Spain Physiotherapy, University of Ma * Corresponding author.
Background: The inertial sensors provide real-time kinematic information, making them an instrument with enormous educational potential. However, no study has found any Inertial Sensor use as a tool to generate real-time feedback during the learning techniques of high velocity, low amplitude on thoracic spine. Purpose: To compare inertial sensor real time-feedback (ISRTF) methods with traditional methodology to learn posterior-anterior thoracic manipulations. Methods: Design: 24 students (G1: 12 ISRTF - G2: 12 Traditional Method) with no experience in manual therapy, participated in this randomized Controlled Trial With Parallel intervention groups.Protocol: Each participant performed a training posterior-anterior thoracic manipulation for 60 minutes using one of two methods compared in this study. G1 training performed in front of a laptop where, in each manipulation received an ISRTF thanks to an inertial sensor positioned in T5 and compared it execution with a graph provided by the teacher. G2 Performed their training supervised by the professor, with a student-teacher ratio 12-1. Each participant performed three times, before and after intervention, a postero-anterior thoracic manipulation. Outcomes: measures before and after training were: maximum angular displacement, maximum linear displacement, maintenance of pre-manipulative position (pre-manipulative displacement), release time after the execution of the technique and total time of mobilization. Statistical analysis consisted in an intra-group comparison (pre-post intervention), a comparison inter-group (postintervention) and a measure of the stability of execution. Results: In the baseline analysis, no significant differences between the groups were found. In the intragroup analysis, significant differences were observed in all variables analysed. In the inter-group analysis (postintervention) significant differences in all the variables analysed were observed: maximum angular displacement (6.11º), maximum linear displacement (4.07 mm), maintenance-pre-manipulative position (premanipulative displacement) (1.26 mm), time of release after technical
* Corresponding author.
Background: There are very few opportunities for long term, comprehensive post- graduate clinical education in developing countries due to fiscal and human resource restraints. Therefore, physiotherapists have little opportunity following graduation to improve clinical reasoning and treatment skills. To assist with the progression of clinical reasoning and skill development, an orthopaedic manual therapy residency program was introduced in Nairobi, Kenya. Purpose: This structure of post-graduate residency education could provide a template for the development of additional programs in other developing countries to promote the profession of physiotherapy and assist with evidence- based practice. Residency programs emphasizing clinical reasoning and manual therapy could provide a means to optimize the effects of physiotherapy (minimize pain, normalize movement and maximize function) without the need for or access to expensive equipment. Methods: Multiple steps were taken to establish a long- term educational program, including comprehensive didactic education and clinical mentoring, to improve clinical practice and healthcare delivery by physiotherapists in Kenya. Information will be provided regarding recruitment of residents, the discovery of financial assistance for participants, cost of the program, and outcome results from quantitative and qualitative research. Results: Fifty-one volunteers from the United States have participated in the provision of residency education in Kenya since 2012. Volunteers served as instructors and provided clinical mentoring to the residents. The first cohort of the program graduated in December 2014 and the second cohort will graduate in December 2015. Currently, three additional cohorts are in progress of completing the 18-month residency program for a total of 80 residents. In addition, four graduates are being trained to continue the residency program and are serving as teaching assistants for the on campus modules. The training of graduates to provide ongoing education will result in a self sustaining program. Quantitative and qualitative research demonstrates a significant improvement in the ability to perform examinations and match evidence- based treatment techniques to examination findings. Furthermore, residents have noted an improvement in patient outcomes and resulting increase in patient referrals. Conclusion: Through the residency program, approximately 10 percent of the physiotherapists in Kenya have received post- graduate training. All of the residents have reported no previous access to continuing education, formal mentoring, or training. The residency has been successful in
Abstracts / Manual Therapy 25 (2016) e57ee169
e163
promoting access to evidence based practice, clinical reasoning and professional development of the residents. Implications: The manual therapy residency education model allowed for advancement of the participating physiotherapists treatment skills and clinical reasoning without need to alter the current education system within the country or provide access to expensive equipment in order to provide evidence based practice. The success of this program provides a template for the development of similar programs in other countries with limited resources. Funding Acknowledgements: The residency is funded through the Jackson Clinics Foundation. Ethics Approval: This research was approved by the University of Evansville Institutional Review Board.
Disclosure of Interest: None Declared
Disclosure of Interest: S. Cunningham: None Declared, R. Jackson Conflict with: Founder of the Jackson Clinics Foundation providing funding for the residency program
Background: Caseload sizes are not universally regulated in Canada and other countries. In Canada, physiotherapy are in both the public and private health care systems. Although there are various guidelines and evidence based summaries for various conditions, physiotherapy lacks standard therapy protocols in which clinicians should follow. There are numerous evidence based therapies which require one on one contact and more time spent with the patient such as various types of hands on therapy, education, sensory discrimination training and teaching exercises with a highly cognitive component such as specific motor control exercises. There are other therapies which can be allocated to an assistant such as remedial exercise, electrotherapy or in which the patient can be left on their own such as acupuncture. Given the common fee for service and commission based pay, there is a potential for the therapist to be biased towards the type of care provided and how many patients they see. Understanding caseload sizes is are important since several evidence based interventions take longer to administer and the patient contact time may influence patient satisfaction, which is a recommended core outcome measure. Purpose: The purpose of this project was to perform a health technology assessment of the caseload of physiotherapists. Stage 1: identify the stakeholders and priority issues; Stage 2: perform a survey of hospitals and private clinics in Canada and identify common practice in other countries with similar health care systems; Stage 3: identify the expectations of patients; Stage 4: understand physiotherapists perspective; Stage 5: identify treatment times used in high quality clinical trials of common physiotherapy interventions; Stage 6: provide a summary, recommendations. This paper will report stage 2 of the project. Methods: Clinics and hospitals from all Canadian provinces were searched from the Canadian Physiotherapy web site and through the yellow pages. All clinics and hospitals from the smaller Atlantic provinces were contacted and asked how many clients were booked per hour and how much time was allotted for the initial assessments. In the other provinces, the contact list was given a number and a random number generator was used to call the mean number of clinics in each province. To identify common practice in other countries, participants from continuing education courses in 22 countries were contacted and asked how many patients they saw per hour and how much time was allotted for an initial assessment. Results: In private practice, the mean number of patients per hour for the clinics that responded in Canada was 3.8. 36 per cent of clinics refused to answer. Atlantic Canada was the highest at 4.4 while Quebec was lowest at 2.3. The time for a new assessment ranged from “no extra time” to “one hour”. In hospitals, it was standard to see 2 patients per hour with new assessment times ranging from 30, 45 or 60 minutes. From the 483 course participants that were contacted, the per hour treatment time ranged from 1.5 - 2.4. The initial assessment time ranged from 40 minutes to 1.5 hours. There were no reports of seeing more than 3 patients per hour. Conclusion: The caseload practice in Canadian private practice is diverse and Canada has a higher average patient per hour average than other countries. Future work should aim to understand why the physiotherapy culture is so different in Canadian private practice and if this makes a difference to clinically relevant outcomes, skill development, therapist burnout, and professional recruitment / interest in the profession Implications: There may be a need for regulation or implementation of policies by professional associations. Third party payers may want preferred providers or change fees. Funding Acknowledgements: There was no funding
Keywords: Kenya, Residency Program Teaching, Learning and Professional Development PO2-AP-003 STUDENT PHYSICAL THERAPIST CLINICAL PRACTICE, DECISION MAKING AND UTILIZATION OF THRUST JOINT MANIPULATION DURING CLINICAL EDUCATION EXPERIENCES M. Corkery*, K. Hazel, C. Cesario. Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, United States * Corresponding author.
Background: High velocity thrust joint manipulation (TJM) techniques are taught in physical therapy programs in the US, however their utilization rate during student clinical education experiences is variable. Purpose: The purpose of this study was to explore student physical therapist clinical practice; including frequency and type of TJM utilized and clinical decision-making regarding the use of TJM during clinical education experiences. Methods: An electronic survey was sent to 107, final year Doctor of Physical Therapy students, regarding their final outpatient clinical experience. Survey data queried students about clinic demographics, clinical instructor credentials, clinical practice patterns and techniques. Results: The survey response rate was 67% (n¼72). Clinics were located in 21 states. A majority of patients treated had a physician’s referral however a majority of respondents reported establishing a diagnosis or classification for patients. Students reported confidence in their differential diagnosis and clinical reasoning skills and a majority reported recommending interdisciplinary referrals if medically necessary. Students reported a high utilization of therapeutic exercise and manual therapy and a broad range of biophysical agents. Forty percent of respondents reported using TJM techniques, 96% non-thrust joint mobilization and 89% manual traction. Students who utilized TJM were more likely to use clinical prediction rules to assist with clinical decision-making (x2¼7.0028, p¼0.0081) than students who did not utilize TJM. Students who utilized TJM were more likely to have a clinical instructor who used TJM (x2¼43.01, p<0.001). Conclusion: Students reported a high utilization rate of manual therapy techniques in outpatient clinical experiences, and a lower utilization of TJM. Students who worked with clinical instructors who used TJM were more likely to use TJM as a clinical intervention. Clinical prediction rules aided student clinical decision-making regarding the use of TJM. Implications: It is important that academic programs provide students with a strong foundation in TJM skills and that clinical education experiences provide students with opportunities to be mentored by clinical instructors with advanced manual therapy training. Residencies and fellowships providing more intense mentoring, instruction and opportunities to use TJM play an important role in the development of these skills for physical therapists. Funding Acknowledgements: This work was unfunded. Ethics Approval: This study was approved by the Institutional Review Board at Northeastern University.
Keywords: thrust joint manipulation, clinical prediction rule Teaching, Learning and Professional Development PO2-AP-007 WHAT IS THE IDEAL TREATMENT TIME FOR MUSCULOSKELETAL PHYSIOTHERAPISTS? A SURVEY OF CASELOADS IN CANADA AND COUNTRIES WITH SIMILAR HEALTH CARE SYSTEMS S. Gibbons*, J. Quirk. SMARTERehab, St John's, Canada * Corresponding author.
Abstracts / Manual Therapy 25 (2016) e57ee169
the slump test as a diagnostic tool, however, the number of clinicians who use this test as a treatment modality was slightly lower (80%). Clinicians showed a preference for using the slump test as a diagnostic and treatment tool in patients with symptoms in the posterior chain, inclusive of the spine. The majority of clinicians focussed on overt (that is, replicating symptom) responses as an indicator of a positive slump test, rather than covert responses. Only 35% of clinicians responded to questions regarding sliding and tensioning techniques, with the majority showing a preference for using sliding techniques as a treatment strategy. Conclusion: Whilst research into neurodynamics has been expanding and developing rapidly in recent years, little is known about how practitioners use this technique. It would appear from this survey that the limited research on the slump test as a treatment modality in symptomatic patients could possibly be reflected in the relatively limited use of this test in practice amongst clinicians. Implications: This study highlights that despite the growing research in neurodynamics and the slump test specifically, there is a need to ensure the translation of new research is occurring into clinical practice Funding Acknowledgements: No funding was obtained for this undertaking or completion of this study Ethics Approval: Ethical approval was obtained by the University of Central Lancashire, Preston, UK Disclosure of Interest: None Declared
completion (0.03 s) and total time mobilization (0.09 s). In addition, the stability ranges (ICC test - retest) of the variables in G1 range between 0.768 and 0.903, and G2 range between 0.439 and 0.647. Conclusion: The methodology of parameterized learning process through inertial sensor shows, to the students, further evolution in the execution of the posterior-anterior thoracic manipulation, seeking higher range of motion, reduced execution time and higher stability in the execution of the technique. Implications: The information provided by the ISRTF during the execution of each manipulation during the student learning favour to increase the consistency in the execution of the technique and it reduce learning time thanks to increased student learning autonomy after to receive accurate and objective information after each manipulation. Funding Acknowledgements: NONE Ethics Approval: University of Malaga Ethical Approval committee has approved the present study. Disclosure of Interest: None Declared Keywords: Feedback, Kinematic, Manual Therapy Teaching, Learning and Professional Development PO1-ED-029 A DESCRIPTION OF THE DEVELOPMENT OF A POST-GRADUATE ORTHOPAEDIC MANUAL THERAPY RESIDENCY PROGRAM IN KENYA
Keywords: Clinicians, Neurodynamics, Survey S. Cunningham*, R. Jackson. Teaching, Learning and Professional Development PO1-ED-028 KINEMATIC e REAL TIME FEEDBACK. A NEW METHODOLOGY FOR TEACHING MANUAL THERAPY: A RANDOMIZED CONTROLLED TRIAL nnchez 1, 2,3, P. Vaes 1,*, M. Trinidad-Fern andez 2, C. Rolda M. Gonz alez-Sa 2 3 1 KINE & Manuele Therapie, Vrije Jimenez , A.I. Cuesta-Vargas . laga, Spain; Universiteit Brussel, Brussels, Belgium; 2 University of Ma 3 laga, Ma laga, Spain Physiotherapy, University of Ma * Corresponding author.
Background: The inertial sensors provide real-time kinematic information, making them an instrument with enormous educational potential. However, no study has found any Inertial Sensor use as a tool to generate real-time feedback during the learning techniques of high velocity, low amplitude on thoracic spine. Purpose: To compare inertial sensor real time-feedback (ISRTF) methods with traditional methodology to learn posterior-anterior thoracic manipulations. Methods: Design: 24 students (G1: 12 ISRTF - G2: 12 Traditional Method) with no experience in manual therapy, participated in this randomized Controlled Trial With Parallel intervention groups.Protocol: Each participant performed a training posterior-anterior thoracic manipulation for 60 minutes using one of two methods compared in this study. G1 training performed in front of a laptop where, in each manipulation received an ISRTF thanks to an inertial sensor positioned in T5 and compared it execution with a graph provided by the teacher. G2 Performed their training supervised by the professor, with a student-teacher ratio 12-1. Each participant performed three times, before and after intervention, a postero-anterior thoracic manipulation. Outcomes: measures before and after training were: maximum angular displacement, maximum linear displacement, maintenance of pre-manipulative position (pre-manipulative displacement), release time after the execution of the technique and total time of mobilization. Statistical analysis consisted in an intra-group comparison (pre-post intervention), a comparison inter-group (postintervention) and a measure of the stability of execution. Results: In the baseline analysis, no significant differences between the groups were found. In the intragroup analysis, significant differences were observed in all variables analysed. In the inter-group analysis (postintervention) significant differences in all the variables analysed were observed: maximum angular displacement (6.11º), maximum linear displacement (4.07 mm), maintenance-pre-manipulative position (premanipulative displacement) (1.26 mm), time of release after technical
* Corresponding author.
Background: There are very few opportunities for long term, comprehensive post- graduate clinical education in developing countries due to fiscal and human resource restraints. Therefore, physiotherapists have little opportunity following graduation to improve clinical reasoning and treatment skills. To assist with the progression of clinical reasoning and skill development, an orthopaedic manual therapy residency program was introduced in Nairobi, Kenya. Purpose: This structure of post-graduate residency education could provide a template for the development of additional programs in other developing countries to promote the profession of physiotherapy and assist with evidence- based practice. Residency programs emphasizing clinical reasoning and manual therapy could provide a means to optimize the effects of physiotherapy (minimize pain, normalize movement and maximize function) without the need for or access to expensive equipment. Methods: Multiple steps were taken to establish a long- term educational program, including comprehensive didactic education and clinical mentoring, to improve clinical practice and healthcare delivery by physiotherapists in Kenya. Information will be provided regarding recruitment of residents, the discovery of financial assistance for participants, cost of the program, and outcome results from quantitative and qualitative research. Results: Fifty-one volunteers from the United States have participated in the provision of residency education in Kenya since 2012. Volunteers served as instructors and provided clinical mentoring to the residents. The first cohort of the program graduated in December 2014 and the second cohort will graduate in December 2015. Currently, three additional cohorts are in progress of completing the 18-month residency program for a total of 80 residents. In addition, four graduates are being trained to continue the residency program and are serving as teaching assistants for the on campus modules. The training of graduates to provide ongoing education will result in a self sustaining program. Quantitative and qualitative research demonstrates a significant improvement in the ability to perform examinations and match evidence- based treatment techniques to examination findings. Furthermore, residents have noted an improvement in patient outcomes and resulting increase in patient referrals. Conclusion: Through the residency program, approximately 10 percent of the physiotherapists in Kenya have received post- graduate training. All of the residents have reported no previous access to continuing education, formal mentoring, or training. The residency has been successful in
Abstracts / Manual Therapy 25 (2016) e57ee169
e163
promoting access to evidence based practice, clinical reasoning and professional development of the residents. Implications: The manual therapy residency education model allowed for advancement of the participating physiotherapists treatment skills and clinical reasoning without need to alter the current education system within the country or provide access to expensive equipment in order to provide evidence based practice. The success of this program provides a template for the development of similar programs in other countries with limited resources. Funding Acknowledgements: The residency is funded through the Jackson Clinics Foundation. Ethics Approval: This research was approved by the University of Evansville Institutional Review Board.
Disclosure of Interest: None Declared
Disclosure of Interest: S. Cunningham: None Declared, R. Jackson Conflict with: Founder of the Jackson Clinics Foundation providing funding for the residency program
Background: Caseload sizes are not universally regulated in Canada and other countries. In Canada, physiotherapy are in both the public and private health care systems. Although there are various guidelines and evidence based summaries for various conditions, physiotherapy lacks standard therapy protocols in which clinicians should follow. There are numerous evidence based therapies which require one on one contact and more time spent with the patient such as various types of hands on therapy, education, sensory discrimination training and teaching exercises with a highly cognitive component such as specific motor control exercises. There are other therapies which can be allocated to an assistant such as remedial exercise, electrotherapy or in which the patient can be left on their own such as acupuncture. Given the common fee for service and commission based pay, there is a potential for the therapist to be biased towards the type of care provided and how many patients they see. Understanding caseload sizes is are important since several evidence based interventions take longer to administer and the patient contact time may influence patient satisfaction, which is a recommended core outcome measure. Purpose: The purpose of this project was to perform a health technology assessment of the caseload of physiotherapists. Stage 1: identify the stakeholders and priority issues; Stage 2: perform a survey of hospitals and private clinics in Canada and identify common practice in other countries with similar health care systems; Stage 3: identify the expectations of patients; Stage 4: understand physiotherapists perspective; Stage 5: identify treatment times used in high quality clinical trials of common physiotherapy interventions; Stage 6: provide a summary, recommendations. This paper will report stage 2 of the project. Methods: Clinics and hospitals from all Canadian provinces were searched from the Canadian Physiotherapy web site and through the yellow pages. All clinics and hospitals from the smaller Atlantic provinces were contacted and asked how many clients were booked per hour and how much time was allotted for the initial assessments. In the other provinces, the contact list was given a number and a random number generator was used to call the mean number of clinics in each province. To identify common practice in other countries, participants from continuing education courses in 22 countries were contacted and asked how many patients they saw per hour and how much time was allotted for an initial assessment. Results: In private practice, the mean number of patients per hour for the clinics that responded in Canada was 3.8. 36 per cent of clinics refused to answer. Atlantic Canada was the highest at 4.4 while Quebec was lowest at 2.3. The time for a new assessment ranged from “no extra time” to “one hour”. In hospitals, it was standard to see 2 patients per hour with new assessment times ranging from 30, 45 or 60 minutes. From the 483 course participants that were contacted, the per hour treatment time ranged from 1.5 - 2.4. The initial assessment time ranged from 40 minutes to 1.5 hours. There were no reports of seeing more than 3 patients per hour. Conclusion: The caseload practice in Canadian private practice is diverse and Canada has a higher average patient per hour average than other countries. Future work should aim to understand why the physiotherapy culture is so different in Canadian private practice and if this makes a difference to clinically relevant outcomes, skill development, therapist burnout, and professional recruitment / interest in the profession Implications: There may be a need for regulation or implementation of policies by professional associations. Third party payers may want preferred providers or change fees. Funding Acknowledgements: There was no funding
Keywords: Kenya, Residency Program Teaching, Learning and Professional Development PO2-AP-003 STUDENT PHYSICAL THERAPIST CLINICAL PRACTICE, DECISION MAKING AND UTILIZATION OF THRUST JOINT MANIPULATION DURING CLINICAL EDUCATION EXPERIENCES M. Corkery*, K. Hazel, C. Cesario. Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, United States * Corresponding author.
Background: High velocity thrust joint manipulation (TJM) techniques are taught in physical therapy programs in the US, however their utilization rate during student clinical education experiences is variable. Purpose: The purpose of this study was to explore student physical therapist clinical practice; including frequency and type of TJM utilized and clinical decision-making regarding the use of TJM during clinical education experiences. Methods: An electronic survey was sent to 107, final year Doctor of Physical Therapy students, regarding their final outpatient clinical experience. Survey data queried students about clinic demographics, clinical instructor credentials, clinical practice patterns and techniques. Results: The survey response rate was 67% (n¼72). Clinics were located in 21 states. A majority of patients treated had a physician’s referral however a majority of respondents reported establishing a diagnosis or classification for patients. Students reported confidence in their differential diagnosis and clinical reasoning skills and a majority reported recommending interdisciplinary referrals if medically necessary. Students reported a high utilization of therapeutic exercise and manual therapy and a broad range of biophysical agents. Forty percent of respondents reported using TJM techniques, 96% non-thrust joint mobilization and 89% manual traction. Students who utilized TJM were more likely to use clinical prediction rules to assist with clinical decision-making (x2¼7.0028, p¼0.0081) than students who did not utilize TJM. Students who utilized TJM were more likely to have a clinical instructor who used TJM (x2¼43.01, p<0.001). Conclusion: Students reported a high utilization rate of manual therapy techniques in outpatient clinical experiences, and a lower utilization of TJM. Students who worked with clinical instructors who used TJM were more likely to use TJM as a clinical intervention. Clinical prediction rules aided student clinical decision-making regarding the use of TJM. Implications: It is important that academic programs provide students with a strong foundation in TJM skills and that clinical education experiences provide students with opportunities to be mentored by clinical instructors with advanced manual therapy training. Residencies and fellowships providing more intense mentoring, instruction and opportunities to use TJM play an important role in the development of these skills for physical therapists. Funding Acknowledgements: This work was unfunded. Ethics Approval: This study was approved by the Institutional Review Board at Northeastern University.
Keywords: thrust joint manipulation, clinical prediction rule Teaching, Learning and Professional Development PO2-AP-007 WHAT IS THE IDEAL TREATMENT TIME FOR MUSCULOSKELETAL PHYSIOTHERAPISTS? A SURVEY OF CASELOADS IN CANADA AND COUNTRIES WITH SIMILAR HEALTH CARE SYSTEMS S. Gibbons*, J. Quirk. SMARTERehab, St John's, Canada * Corresponding author.