Spinal Evaluation Techniques: The Ugly Relationship Between Research, Education, And Clinical Practice

Knowledge is power. The world of academia, regardless of the area of study, should be filled with the visionaries, the thinkers, the people that are prepared to be on the cutting edge of thought in their discipline. Research is important, but integration of the research into practice is perhaps even more so.

Professional education should be no different. Chiropractors, physical therapists, and physicians please take note.

Professional education is defined by accreditation standards. In the physical therapy world, CAPTE – the Commission on Accreditation in Physical Therapy Education – “grants specialized accreditation status to qualified entry-level education programs for physical therapists and physical therapist assistants.”

Somehow, we have managed to run into an unfortunate and ugly symbiotic yet dysfunctional relationship between research, education and accreditation, and subsequently clinical practice – and our academic and clinical worlds suffer because of it.

Before we go any further, I will repeat once again: this problem is not exclusive to physical therapists. This topic is relevant to chiropractors, physicians, and many other health care professions. Since I am a physical therapist and educator, I will speak to that specific aspect of this topic.

In my last post on this topic, I presented certain conclusions about the educational curricula underlying spinal evaluation techniques:

“Of course, we could choose to learn from this experience, or we can simply continue to do what we have done. The latter is the path of least academic and professional resistance. The former would require changing our perceptions regarding what we teach, what we utilize clinically, and what we believe our role to be with patients. That will require a vigilant effort from educators, professionals, and professional associations like the APTA.”

Let’s use palpation-based spinal evaluation techniques as but one example. There are countless research studies that have indicated that palpation-based spinal evaluation techniques have poor inter-rater reliability. The vast majority of accredited PT and PTA programs put a great teaching emphasis on these evaluation techniques. Accreditation standards put great emphasis on these evaluation techniques academically and in terms of licensure. Graduates enter clinical practice with a whole host of spinal evaluation techniques that have poor inter-rater reliability and thus poor clinical utility.

Now, imagine a world in which the researchers were producing research that was not only being read by the academic and accreditation communities, but was being utilized in creating better academic and accreditation standards. If we have the research currently available to discount many of these spinal evaluation techniques (especially those that are palpation-based), and clinical guidelines that simply don’t support the use of these techniques, then why is that not reflected in the accreditation standards? And, better yet, why are students continuing to be exposed to “currently accepted standards of educational curricula” circa 1997?

This is not a debate over what is right or wrong to teach as much as it is a reflection on the hypocrisy involved in doing so. If you have research to the contrary, then the challenge is to integrate it into the sum total of knowledge and education. Do not just ignore it, hope it goes away, and just continue to do what you have done.

Here’s a thought: how about simply providing students with good clinical reasoning skills with a foundation of functional anatomy and physiology and biomechanics? Teach them how to think, and stop being concerned about putting “more tools in their toolbox” when they haven’t mastered the most important one – their own thoughts and perceptions. Teach them what the research and clinical guidelines support – and forget the rest. And while we’re at it, let’s have accreditation standards that reflect the same.

Clinicians should be graduating with clinical reasoning skills and a knowledge base that reflects what is current in our profession - and not just licensure-exam-passing test-taking skills.

Photo credits: Jim Callender