Manipulative Therapy logo Joint mobilization forces and therapist reliability in subjects with knee osteoarthritis

The authors of this study determined biomechanical force parameters and reliability in the community of clinicians performing knee joint mobilizations. Sixteen patients with knee osteoarthritis and six clinicians were used for 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. 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.

The authors found that 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 outstanding for all biomechanical parameters and inter-clinician reliability for dosage, the main variable of clinical interest, was moderate. This study quantified the applied forces of more than one clinician, which may assist in the determination of the best dosage and standardize care.

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Nice to a study with good intertester reliability since other parts of the body typically a hit! I llok forward to reading the whole study and discerning the amount of force applied. I prefer to mobilize the knee with a grade VI OR GRADE VII not a standard grade though I will present a talk on this at AAOMPT 2013 IN October. I like to take up the slack and sustain the force at the knee for 5 minutes versus grades I-V. In addition to that, I use a fulcrum for greater leverage and greater isolation. I submit that the forces are greater compared to the forces in the study. In restoring the typical loss of end-range extension my bet is that the knee does NOT obey convex/concave rules, because I treat both femur distally and if need be (less often) the proximal tibia; both in posterior glide with knee at its end range of extension. Thank you for posting the topic and posting the study. Interested in your thoughts on testing and treating IR/ER at end-range. Best Regards, Jerry Hesch HESCH INSTITUTE

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