The Utilization of Spinal Thrust Manipulation by Physical Therapists in New York State
Authors: Walsh Laurie , Bicheler Hanna , Guillermo Kayla , Wolfley Bryan , Brown Michael , Schenk Ron , Ross Michael 
Published: June 2019

Introduction.
The purpose of this study was to evaluate the utilization of spinal thrust manipulation in the management of patients with low back pain (LBP) among physical therapists from New York State (NYS), as well as to evaluate physical therapist knowledge of a lumbar spine manipulation clinical prediction rule (CPR) and whether their NYS physical therapy practice act allows for spinal thrust manipulation to be performed.

Materials and Methods.
We invited the 300 physical therapy clinics from NYS who serve as clinical instruction sites for the Department of Physical Therapy at Daemen College in Amherst, NY, to participate in this survey-based study. One hundred fifty physical therapists completed the survey and were included in the analysis (54% were female and 45.3% were male; 1 respondent did not answer); the mean number of years of physical therapy practice of the participants was 13.3 ± 9.9 years (range, 1–44 years). Participants were invited to complete a survey that was comprised of questions relative to demographics, the use of thrust manipulation in the treatment of patients with LBP, their knowledge of a manipulation CPR, and the NYS physical therapy practice act and its ability to allow physical therapists to perform thrust manipulation. Chi-square tests, 1-way analyses of variance, and t tests were used for analyses.

Results.
Of the sample population, 41.3% reported performing spinal thrust manipulation, and the majority of those physical therapists (77.4%) use the intervention between 0% and 25% of the time. Thirty-seven percent of clinicians who reported manipulating patients with LBP reported using a CPR to determine candidates for manipulation; the remainder of the respondents (63%) did not provide an answer or were unsure. Of the sample population, 63.9% correctly answered the survey question regarding the NYS physical therapy practice act and an ability to legally perform thrust manipulation. Physical therapists who are board certified in orthopedics through the American Physical Therapist Association (P = .005) or residency/fellowship trained in manual physical therapy (P = .03) are significantly more likely to perform thrust manipulation than those who are not. Physical therapists who understand the NYS physical therapy practice act (P = .014), attend continuing education regarding the management of patients with LBP (P = .007), and are male (P < .00001) are also significantly more likely to perform thrust manipulation for patients with LBP.

Conclusions.
Despite emerging evidence to support the use of thrust manipulation in the management of patients with LBP, utilization of thrust manipulation among physical therapists still remains relatively low. Physical therapists who are board certified in orthopedics and/or residency/fellowship trained, attend continuing education, and better understand the NYS physical therapy practice act are more likely to perform thrust manipulation. The results of this study may have implications for professional development and educational efforts regarding the training of physical therapists in the utilization of thrust manipulation.