Paul E. Mintken

Manipulative therapy has long been a cornerstone of musculoskeletal treatment, primarily recognized for its efficacy in joint dysfunction and mobility restoration. The broader term manual therapy h...

To achieve international consensus on communication and education competencies and associated graduation milestones for Orthopedic Manual Physical Therapy (OMPT) fellowship training. A modified three-round Delphi process was conducted. This study was part of a larger project aimed at reaching consensus on competencies and graduation milestones across seven domains of expertise. A panel of content experts developed and approved proposed competencies in Round I. Rounds II and III involved stakeholders, identified as members of IFOMPT member organizations, who selected domains to rank and voted using a four-point Likert scale. Consensus was established beforehand at 80% agreement. Experts identified four competencies and 18 milestones for communication, and four competencies with nine milestones for education. In subsequent rounds, 124 participants from 12 countries evaluated communication competencies, and 135 participants from 15 countries evaluated education competencies. All competencies achieved consensus. Strong support was observed for person-centered communication, cultural humility, feedback and reflection, clinical teaching, and learner assessment. No significant differences were found between the ratings of Rounds II and III. This study provides the first internationally agreed-upon framework for communication and education competencies in OMPT fellowship training. These findings offer a foundation for curriculum design, assessment, and global standardization. Future research should validate assessment tools and expand consensus to additional domains.

Importance: This case report emphasizes the importance of recognizing and preventing adverse events, specifically pneumothorax related to dry needling (DN), particularly when using rib bracketing techniques in the intrascapular region. It highlights the need for greater clinician awareness to enhance patient safety and minimize the risk of complications during DN interventions. Objective: The objective of this case report was to describe the clinical presentation, progression, and outcome of a patient who developed a pneumothorax following DN, and to propose alternative methods for safer needling in the intrascapular musculature. Design: This case report presents a detailed account of a single patient’s clinical experience—including the adverse event, its management, and outcome—supplemented by expert commentary from a clinician specializing in DN. Setting: The setting of this case report was an outpatient physical therapy clinic. Participants: A 24-year-old woman undergoing physical therapy for chronic neck and shoulder pain. Intervention(s) or Exposure(s): The physical therapist administered DN to the left intrascapular muscles using a rib bracketing technique to treat trigger points. Main Outcome(s) and Measure(s): The primary outcome was the development of a pneumothorax, identified through clinical symptoms and confirmed by radiographic imaging. Outcomes included hospitalization, symptom resolution, and return to physical activity. Results: The patient experienced an unusually sharp pain during needle insertion. Over the following 2 days, she developed dyspnea, thoracic pain, dry cough, and chest discomfort. A radiograph confirmed a moderate left-sided pneumothorax, which was treated with chest tube reinflation and one night of hospitalization. Post-discharge, the patient had residual symptoms for 2 weeks but achieved complete recovery by 1 month, returning to activities like hiking and skiing. Conclusions: DN can result in serious complications such as pneumothorax. Early recognition and immediate treatment can lead to full recovery. This case raises concerns about the safety of the rib bracketing technique for DN in the thoracic intrascapular region. Relevance: Physical therapists should exercise caution when performing DN, especially in high-risk anatomical areas. Safer techniques should be considered, and vigilance is crucial to detect and manage adverse events promptly. Enhancing practitioner awareness can improve patient outcomes and safety during rehabilitation interventions.

Neurological testing is commonly used in outpatient physical therapy (PT) for patients with suspected neurological involvement. However, limited data exist on the prevalence of abnormal neurological findings in patients without a peripheral neuropathic pain (PNP) diagnosis. Understanding the frequency of these findings may help refine screening practices and improve patient care. This study aimed to determine the prevalence of abnormal neurological findings in patients attending PT without a clinical PNP diagnosis. This observational study included 104 adult patients attending PT for upper or lower quadrant pain. Each patient underwent a series of clinical neurologic tests (strength, sensation, and reflexes) and neurodynamic (ND) tests. Patients were categorized as having either a clinical PNP diagnosis or a non-PNP diagnosis based on physician and/or physical therapist assessment. Of the participants, 22% had a clinical PNP diagnosis. Among those without a PNP diagnosis, clinical neurologic test abnormalities were common, with 50.6% exhibiting abnormal reflexes, 48.1% showing strength deficits, and 21% having sensory impairments. ND test abnormalities were less frequent in this group, with 18.5% experiencing symptom reproduction during testing. These findings suggest that abnormal neurological test results are not exclusive to patients with a clinical PNP diagnosis. The high prevalence of clinical neurologic test abnormalities in patients without a PNP diagnosis raises questions about the sensitivity of current screening approaches. Neurological abnormalities may be overlooked when screening is based solely on clinical diagnosis or reported symptoms. Expanding neurological testing to a broader patient population may enhance diagnostic accuracy and treatment planning. Further research is needed to determine the clinical significance of these findings and the potential benefits of routine neurological screening in outpatient PT.

Neck pain is a common musculoskeletal disorder, with a prevalence rate (age-standardized) of 27.0 per 1000 in 2019. Approximately 50-85% of individuals with acute neck pain do not experience complete resolution of symptoms, experiencing chronic pain. Manual therapy is a widely employed treatment approach for nonspecific neck pain (NSNP), cervical radiculopathy (CR) and cervicogenic headaches (CGH). This umbrella review synthesized systematic reviews examining manual physical therapy for individuals with cervical disorders. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed with Prospero registration (CRD42022327434). Four databases were searched from January 2016 to May 2023 for systematic reviews with or without meta-analysis examining manual therapy for individuals with neck pain of any stage. Interventions included any manual physical therapy of the cervical or thoracic spine as well as neuromobilization of the upper quarter. Primary outcomes included pain and disability. Two reviewers screened for eligibility and completed data extraction. Methodological quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR 2) tool. A total of 35 SRs were included: 15 NSNP, 7 cervical radiculopathy, 9 CGH and 4 samples with combined diagnoses. AMSTAR 2 ratings of the SRs support high confidence in results for 10 reviews, moderate confidence in 12 reviews and low to critically low confidence in 13 reviews. For NSNP, there was high confidence in the results showing manual therapy combined with exercise was superior to either treatment in isolation. In cervical radiculopathy, neural mobilization, distraction, soft tissue treatment and mobilization/manipulation to cervical and thoracic spine were supported with moderate confidence in results. For CGH, there was high confidence in the results supporting the use of cervical spine mobilization/manipulation, soft tissue mobilization, and manual therapy combined with exercise. Original authors of SRs reported varying quality of primary studies with lack of consistent high quality/low risk of bias designs. Manual therapy plus exercise, cervical or thoracic mobilization and manipulation, neuromobilization, and other types of manual therapy were supported as effective interventions in the management of pain and disability for individuals with NSNP, CGH, or CR in the short-term.

Purpose: This study investigated the prevalence of burnout in physical therapists in the United States and the relationships between burnout and education, mentorship, and self-efficacy.Methods: This was a cross-sectional survey study. An electronic survey was distributed to practicing physical therapists across the United States over a 6-week period from December 2020 to January 2021. The survey was completed by 2,813 physical therapists from all states. The majority were female (68.72%), White or Caucasian (80.13%), and employed full-time (77.14%). Respondents completed questions on demographics, education, mentorship, self-efficacy, and burnout. The Burnout Clinical Subtypes Questionnaire 12 (BCSQ-12) and self-reports were used to quantify burnout, and the General Self-Efficacy Scale (GSES) was used to measure self-efficacy. Descriptive and inferential analyses were performed.Results: Respondents from home health (median BCSQ-12=42.00) and skilled nursing facility settings (median BCSQ-12=42.00) displayed the highest burnout scores. Burnout was significantly lower among those who provided formal mentorship (median BCSQ-12=39.00, P=0.0001) compared to no mentorship (median BCSQ-12=41.00). Respondents who received formal mentorship (median BCSQ-12=38.00, P=0.0028) displayed significantly lower burnout than those who received no mentorship (median BCSQ-12=41.00). A moderate negative correlation (rho=-0.49) was observed between the GSES and burnout scores. A strong positive correlation was found between self-reported burnout status and burnout scores (rrb=0.61).Conclusion: Burnout is prevalent in the physical therapy profession, as almost half of respondents (49.34%) reported burnout. Providing or receiving mentorship and higher self-efficacy were associated with lower burnout. Organizations should consider measuring burnout levels, investing in mentorship programs, and implementing strategies to improve self-efficacy.

Purpose: The purpose of this study was to deliver pain neuroscience education (PNE) to participants in grades 3 to 8 to determine whether participants in these grades had positive shifts in pain knowledge and beliefs. Methods: Three hundred twenty participants, grades 3 to 8, received a 1-time, 30-minute PNE lecture. The Neurophysiology of Pain Questionnaire and the Health Care Provider's Pain and Impairment Relationship Scale were administered before and after the PNE lecture. Results: All grades improved in pain knowledge and beliefs. Higher-grade school participants (sixth to eighth grades) experienced larger shifts in pain knowledge and attitudes and beliefs than lower-grade (third to fifth grades) participants. Conclusion: PNE results in changes in pain knowledge and beliefs in school participants in grades 3 to 8.

The preferences a person has for care are associated with outcomes for patients presenting with musculoskeletal pain conditions. These include preferences for differing levels of involvement in the decision-making process, preferences for the provider attributes, and preferences for particular interventions. In this paper, we discuss these various forms of preference, as well as how they influence clinical care within shared decision-making frameworks. We also present a conceptual framing for how patient preferences can be incorporated in clinical decision-making by orthopedic manual physical therapists. Finally, research implications for interpreting findings from clinical studies are discussed.

To determine if thoracic spine manipulation (TSM) improves pain and disability in individuals with cervicogenic headache (CeH).A randomized controlled crossover trial was conducted on 48 participan...