Role and reliability of passive joint motion assessment: Towards multivariable diagnostics and decision-making in manual therapy

Manual therapists strongly rely on passive intervertebral motion (PIVM) assessment for making decisions about spinal joint mobilisation and thrust manipulation in patients with neck or low-back pain. However, uncertainty exists about the use and the value of this physical examination procedure within clinical diagnostics and decision-making in manual therapy. The two main objectives of the research reported in this thesis were: (1) to evaluate the inter-examiner reliability of passive joint motion assessment of the spine and the extremities and (2) to examine the role and position of PIVM assessment within the process of clinical reasoning and decision-making in clinical practice in manual therapy in patients with spine-related disorders. From three systematic reviews, we concluded that the inter-examiner reliability of the tactile and visual judgements by therapists during passive motion assessment of joints of the spine and the extremities is unacceptably low. Two further studies showed that Dutch manual therapists are highly consistent in reporting their use, interpretation, and related perceptions regarding PIVM assessment and we found that PIVM assessment is positioned, albeit more or less routinely, as an ‘add-on’ test after history taking, visual inspection, and active and regional passive motion examination. Our research supports a multivariable, biopsychosocial, hypothesis-oriented approach to evaluating clinical diagnostics and decision-making in manual therapy as opposed to continuing investigating the value of single tests. We propose methods to incorporate such an approach into reliability studies and randomised controlled trials with the aim to, eventually, better identify those patients responding (or not) to spinal manual therapy.