Joint Mobilization Forces and Therapist Reliability in Subjects with Knee Osteoarthritis

Overview

Journal J Man Manip Ther

Specialty Rehabilitation Medicine

Date 2014 Jan 15

PMID 24421632

Citations 7

Authors

Bradley S Tragord

Norman W Gill

Jason L Silvernail

Deydre S Teyhen

Stephen C Allison

Affiliations

Soon will be listed here.

Abstract

Objectives: This study determined biomechanical force parameters and reliability among clinicians performing knee joint mobilizations.

Methods: Sixteen subjects with knee osteoarthritis and six therapists participated in the study. Forces were recorded using a capacitive-based pressure mat for three techniques at two grades of mobilization, each with two trials of 15 seconds. Dosage (force-time integral), amplitude, and frequency were also calculated. Analysis of variance was used to analyze grade differences, intraclass correlation coefficients determined reliability, and correlations assessed force associations with subject and rater variables.

Results: Grade IV mobilizations produced higher mean forces (P<0.001) and higher dosage (P<0.001), while grade III produced higher maximum forces (P = 0.001). Grade III forces (Newtons) by technique (mean, maximum) were: extension 48, 81; flexion 41, 68; and medial glide 21, 34. Grade IV forces (Newtons) by technique (mean, maximum) were: extension 58, 78; flexion 44, 60; and medial glide 22, 30. Frequency (Hertz) ranged between 0.9-1.1 (grade III) and 1.4-1.6 (grade IV). Intra-clinician reliability was excellent (>0.90). Inter-clinician reliability was moderate for force and dosage, and poor for amplitude and frequency.

Discussion: Force measurements were consistent with previously reported ranges and clinical constructs. Grade III and grade IV mobilizations can be distinguished from each other with differences for force and frequency being small, and dosage and amplitude being large. Intra-clinician reliability was excellent for all biomechanical parameters and inter-clinician reliability for dosage, the main variable of clinical interest, was moderate. This study quantified the applied forces among multiple clinicians, which may help determine optimal dosage and standardize care.

Citing Articles

Reliability and accuracy of an expert physical therapist as a reference standard for a manual therapy joint mobilization trial.

Petersen E, Thurmond S, Shaw C, Miller K, Lee T, Koborsi J J Man Manip Ther. 2020; 29(3):189-195.

PMID: 33234048 PMC: 8183505. DOI: 10.1080/10669817.2020.1844853.

The effect of real-time feedback on learning lumbar spine joint mobilization by entry-level doctor of physical therapy students: a randomized, controlled, crossover trial.

Petersen E, Thurmond S, Buchanan S, Chun D, Richey A, Nealon L J Man Manip Ther. 2019; 28(4):201-211.

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Quantifying performance metrics of cervical spine mobilization for improved education and clinical outcomes: Early experience with a novel wearable device.

Kope R, OBrien J, Sadi J, Walton D, Ferreira L J Rehabil Assist Technol Eng. 2019; 5:2055668318765396.

PMID: 31191931 PMC: 6453047. DOI: 10.1177/2055668318765396.

Effect of joint mobilization techniques for primary total knee arthroplasty: Study protocol for a randomized controlled trial.

Xu J, Zhang J, Wang X, Wang X, Wu Y, Chen C Medicine (Baltimore). 2017; 96(49):e8827.

PMID: 29245244 PMC: 5728859. DOI: 10.1097/MD.0000000000008827.

The intra-rater reliability of a revised 3-point grading system for accessory joint mobilizations.

Ward J, Hebron C, Petty N J Man Manip Ther. 2017; 25(4):201-207.

PMID: 28912632 PMC: 5592344. DOI: 10.1080/10669817.2016.1235246.

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