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Standards DocumentThe Standards Document is the guideline document which IFOMT provides for groups of Manual Therapists who wish to seek membership through the creation of a Post-Registration/Post-graduate education program in Neuro-musculo-skeletal Manual Therapy management. The program must be submitted to the Standards Committee of IFOMT for scrutiny before membership of that group can be considered. The Standards Document is divided into two sections, Part A, Educational Standards Document (2000), and Part B, International Monitoring Document (2005). Below is the Educational Standards section, and if you wish to view the International Monitoring Document, click here. Deutsche Versionen:
EDUCATIONAL STANDARDS An educational curriculum referred to as the "STANDARDS" which was presented in 1977 at the IFOMT meeting in Vail, USA has been effective since ratification in Israel at WCPT in 1978. This doucment has been regularly updated, the latest version of which was ratified in Perth in November 2000. It covers the post-graduate training of physical therapists in Orthopaedic Manipulative (manual) Therapy (OMT). The educational standards of IFOMT extend the basic training received in OMT in physical therapy training programs so that orthopaedic manipulative physical therapists attain a high standard of patient care. The acceptance and implementation of the educational standards both theoretical and practical is a mandatory minimum requirement for countries seeking full membership in IFOMT. Of special note is that formal evaluations to prove competency are prerequisite for this membership status. These cover all aspects of theoretical, practical and clinical knowledge applied to neuro-muscular-articular dysfunction in the spine and the extremities in patients. The educational aims and objectives are not meant to be absolute but rather they serve as a detailed guide towards standards of education and training acceptable to IFOMT. IFOMT recognizes that there will be differences in strengths and emphases in different OMT courses around the world. These are necessary and encouraged by IFOMT for the future development of OMT. IFOMT also recognizes differences that will exist in methods and delivery of education in various countries. IFOMT has a commitment to research and recognizes the importance of proof of validity of OMT diagnosis and practice. It fosters enquiry and encourages physical therapists' involvement in a variety of ways such as experimental studies, single case studies, surveys and literature reviews.
BASIC SCIENCES
* To advance physical therapists' knowledge of the anatomy, physiology and biomechanics of the spinal and peripheral neuro-muscular-articular systems. * To enhance physical therapists' understanding of aberrations of functions of the neuro-muscular-articular system. * To provide further knowledge for clinical problem solving and for the understanding of the anatomical and physiological bases for techniques used to examine, diagnose and manage neuro-muscular-articular dysfunctions. * To enhance physical therapists' ability to scientifically evaluate established and new theories on mechanisms, pathogenesis and management of neuro-muscular-articular disorders.
On completion of the education program, the physical therapist shall be able to demonstrate: (i) Anatomy * a detailed understanding of the structure, function and relationships of the muscular, articular and nervous systems of the axial and appendicular skeleton including the temporo-mandibular joint. * an understanding of developmental and acquired anomalies in the osseous, articular and neural systems. * a detailed knowledge of the nature, ranges and interrelationships of spinal and peripheral joint movement. * an understanding of the organization of the central and peripheral nervous systems, the neurology of joints and the anatomical bases for somatic and neurotic pain. * an understanding of the structure, mechanics and movement of the central and peripheral nervous systems during normal body movements. * an understanding of the vascular system (course and blood supply) of the axial and appendicular structures.
* an understanding of the biomechanical properties of viscoelastic tissues of the neuro-muscular-articular system and understand the changes that occur with trauma, overuse, immobilization, age and during the repair process. * an understanding of how loads and forces are distributed and resisted by the neuro-muscular-articular structures in normal function. * an ability to analyze the stresses imparted to various structures during injurious activity and discuss how such stress may be involved in the pathogenesis of axial and appendicular neuro-muscular-articular pain and dysfunction. * an ability to critically evaluate and discuss the anatomical and biomechanical bases for physical examination and treatment techniques.
* an understanding and ability to evaluate current knowledge on physiological mechanisms of muscle control in normal and abnormal function. * an ability to discuss current knowledge on the neurophysiological mechanisms underlying pain production, perception and modulation. * an understanding of the functional organization of the sympathetic nervous system; the mechanisms of visceral and deep somatic pain; viscero-somatic and somato-visceral relationships; sympathetically maintained pain. * an understanding of current knowledge of biochemistry and microstructure of collagen, particularly as it pertains to the articular system including the intervertebral disc. * an understanding of the significance of biochemical reactions in trauma, immobilization, repair and aging to the clinical situation.
MEDICAL SCIENCES AIMS: * To advance physical therapists' knowledge of pathology and pathogenesis of disorders of the neuro-muscular-articular system and their clinical features. * To further knowledge on the clinical presentation of non-mechanical disorders of the neuro-muscular-articular system, their clinical recognition and differential diagnosis. * To further understanding of the investigative procedures available for differential diagnosis of neuro-muscular-articular pain states. * To further understanding of the indications for and the nature of surgical intervention for neuro-muscular-articular disorders. * To advance knowledge of the indications and effects of therapeutic drugs in the management of neuro-muscular-articular disorders.
On completion of the education program, the physical therapist shall be able to: (i) Orthopaedics * discuss current knowledge of the aetiology, pathomechanics, pathogenesis and pathologies of benign mechanical and degenerative disorders of the vertebral column and the extremities. * discuss congenital and acquired anomalies of the vertebral column and their possible role in spinal pain syndromes. * discuss the problems and presentations of instability of spinal and peripheral joints. * demonstrate a knowledge of clinical presentations of orthopaedic conditions where a referral for possible surgical intervention is indicated.
* discuss the pathology, pathogenesis and clinical features of degenerative and inflammatory arthropathies. * discuss the pathology, pathogenesis and clinical features of inflammatory, viral and metabolic disorders affecting connective tissues including bone and fascia. * display a basic knowledge of the laboratory investigations used to diagnose rheumatic disease. * discuss the type of therapeutic drugs used in the management of degenerative and rheumatic disorders.
* discuss the clinical and differential diagnostic features of conditions and diseases which may mimic musculoskeletal pain, with particular reference to cardiovascular and visceral disease. (i) Neurology * discuss the nature, early signs and symptoms and differential diagnosis of tumours and other causes of spinal cord compression. * discuss the clinical presentation and differential diagnosis of vascular disorders mimicking musculoskeletal pain. * discuss vertebrobasilar insufficiency, disorders with similar presentations and differential diagnosis. * demonstrate an understanding of the classification and various causes of headache and to identify those which may have a neuro-muscular-articular cause or component. * discuss the pathology and neurophysiology of nerve entrapment neuropathies. * demonstrate an understanding of the aetiology, pathology and differential diagnosis of diseases of nerve roots and peripheral nerves.
* display a knowledge of the current methods of radiological investigation for disorders of the spinal column and peripheral joints.
* discuss disorders of the craniomandibular complex and the dental approach to management. * demonstrate an understanding of the roles of the dentist and the physical therapist in the management of craniomandibular dysfunction.
BEHAVIOURAL SCIENCES AIMS: * To enhance physical therapists' communication and interactive skills. * To enhance physical therapists' awareness of the global aspects of pain, psychological factors and stress management strategies.
On completion of the education program, the physical therapist shall be able to: * demonstrate effective communication skills for patient assessment, instruction and counselling. * demonstrate an understanding of the global reactions of pain and disability and strategies that the physical therapist may use to assist the patient in total rehabilitation. * understand the problems of chronic pain, the team approach to management and management strategies.
* To advance physical therapists' knowledge of the physical therapy theory of assessment, diagnosis and management of neuro-muscular-articular disorders. * To assist physical therapists to integrate knowledge from the basic, medical and behavioural sciences in the clinical setting. * To develop a high level of clinical skill in the assessment, physical diagnosis and management of patients with neuro-muscular-articular disorders. * To develop a high level of expertise in the selection and application of orthopaedic manipulative therapy techniques. * To develop outcome measures to evaluate the effectiveness of OMT. * To enhance knowledge of the theory of manipulative therapy practice and encourage critical review of its scientific merit. * To ensure that physical therapists have a comprehensive knowledge of the indications and contra-indications for manipulative therapy practice. * To enhance the physical therapists' expertise in preventative programs for neuro-muscular-articular disorders. * To enhance physical therapists' knowledge of professional issues relevant to the practice of manipulative therapy. * To encourage physical therapists to critically review the recent literature of the basic and applied sciences relevant to neuro-muscular-articular disorders, to draw inferences for orthopaedic manipulative therapy practice and present material logically in both verbal and written forms.
On completion of the education program, the physical therapist shall be able to: * critically evaluate the theory and science of orthopaedic manipulative therapy practice. * demonstrate an ability to interpret information from the basic, medical and behavioural sciences and apply it to the problem solving process of the clinical examination of neuro-muscular-articular disorders. * demonstrate a depth of knowledge of the interrelationship of the neuro-muscular-articular structures in normal function and musculoskeletal pain syndromes. * demonstrate effective communication skills to gain comprehensive information about the type and nature of the patient's complaint. To be able to interpret information towards physical diagnosis and the indications for and contra-indications to manipulative therapy management. * demonstrate a high level of skill in performing appropriate and effective physical examinations of patients with neuro-muscular-articular injuries or disorders of the axial or appendicular skeleton. Skills will be demonstrated in: * Analysis of static and dynamic posture * Analysis of the active and passive movements of the articular system * Clinical examination of the nervous system - for conductivity and neural mechanics * Analysis and specific tests for functional status of the muscular system * Special tests for the safety of practice of orthopaedic manipulative therapy. * interpret the findings of the physical examination in an accurate manner and relate such findings to any other medical diagnostic tests to make a physical diagnosis. * plan and implement appropriate management strategies which reflect the total needs of the patient. * perform manipulative therapy techniques effectively and accurately, demonstrating high levels of skill in the performance of passive movements (under the control of the patient) and passive movements with impulse (quick controlled manipulation). * demonstrate a high level of skill in other manual and physical therapy techniques required to mobilize the articular, muscular or neural systems. * apply current electrophysical modalities to enhance rehabilitation of neuro-muscular-articular dysfunction. * demonstrate a high level of skill in implementing and instructing patients in appropriate therapeutic rehabilitation exercise programs. * demonstrate knowledge of appropriate ergonomic strategies and advice. * demonstrate the ability to evaluate the results of treatment accurately on the basis of outcome measures and modify and progress treatment as required. * keep clear and accurate clinical records and write appropriate reports for medical and legal consultations. * demonstrate an ability to integrate and apply scientific and clinical data in the presentation of health promotion and preventative care programs. * demonstrate a knowledge of various manipulative therapy approaches as practised within physical therapy, medicine, osteopathy and chiropractic.
RESEARCH PROJECT
* To foster enquiry and critical analysis of orthopaedic manipulative therapy practice and its related sciences. * To extend physical therapists' interests, skill and commitment to research. * To enhance the physical therapists' ability to identify and pose a research question, to make a critical analysis of the literature relevant to the project, to design and conduct an investigation satisfactorily, to analyze and present results accurately and concisely and to draw logical and valid conclusions.
On completion of the education program, the physical therapist shall be able to: * present a research project which satisfies the examiners of the physical therapist's ability to undertake and present a research study.
FOOTNOTE: Research has many components which include, for example, critical evaluation of the literature on a nominated topic, population surveys, single case patient studies, evaluation of outcome measures, clinical trials and experimental studies.
APPENDIX 1 SCOPE OF PRACTICE OF OMT
Orthopaedic manipulative therapists work within the orthodox medical system in close liaison with medical practitioners. They are responsible for making a clinical physical diagnosis and for deciding on the suitability of a patient for treatment by observing precautions and recognizing contra-indications. The application of OMT is based on a thorough examination of the neuro-muscular-articular system. This examination serves to define, in physical terms, the presenting dysfunction in the articular, muscular and nervous systems. Equally, the examination aims to distinguish those conditions which contra-indicate management by OMT or those where anatomical anomalies or pathological processes limit or direct the use of OMT procedures. The main goal of OMT is to restore maximal and painfree function to the neuro-musculo-articular systems. This is achieved through several possible methods.1 * relief of pain and muscle spasm. * restoration of normal tissue fluid exchange, soft tissue pliability and extensibility, normal joint relationship and mobility. * correction of muscle weakness and imbalance. * restoration of adequate control of motion. * stabilization of unstable segments. * relief from chronic postural or occupational stress. * functional reablement of the patient. * prevention of recurrence. * restoration of confidence and self reliance.
In more specific terms, OMT means the use of passive movement applied manually or mechanically to help restore normal neuro-musculo-articular function. Application of passive movement can involve manipulation - passive movement with thrust (high velocity low amplitude) and mobilization - passive movement which is graded, the force, speed and amplitude being directed by the pain/range/spasm relationship in the joint (end feel). OMT is an extension of an extensive repertoire of physical therapy skills. The following represents a summary of OMT treatment strategies:
1. Immobilization: (i) General: bed rest in antalgic positions. (ii) Local: corsets, collars, casts, braces, taping. 2. Special passive movement procedures applied prior to the tissue resistance barrier being encountered (i) Optimal amplitude motion in pain-free ranges. (ii) 3-dimensional traction - distraction in the most pain free combination of joint positions. (iii) Inhibitory pressures. 1. The application of electrophysical agents.
1. Soft tissue (i) Massage: classical, connective tissue, deep transverse frictions. (ii) Muscle relaxation techniques based on specific reflex procedures: post isometric relaxation, reciprocal inhibition (iii) Specific muscle lengthening procedures to obtain muscle and connective tissue extensibility. (iv) Exercise to maintain or increase in soft tissue extensibility. (i) PASSIVE MOBILIZATION Passive mobilization is the application of specific passive movements to a joint, either manually or mechanically applied, which are performed at a slow and rhythmical speed such that the patient can prevent the movement if he so chooses. The rhythm can be oscillatory or a sustained stretch. Passive mobilization may encompass: All movements are graded with respect to their amplitude and position in range and are directed by the presence of pain, quality of tissue resistance through range and the joint end feel. (i) MANIPULATION Manipulation is a small amplitude of movement applied, with quick impulse, to a joint showing a suitable end feel to effect joint separation and to restore translatoric glide. Orthopaedic manipulative therapists recognize that this is not a benign procedure. Implicit in this document is acceptance that this must be thoroughly learned. Orthopaedic manipulative therapists have developed some unique procedures which eliminate rotary stresses and emphasize glide and distraction movements. Rotation and extension are recognized as being movements which can provide a hazard especially when applied to the cranio-vertebral region. 1. Neural tissues (i) Neuraxis mobilization. (ii) Nerve root, trunk and peripheral nerve mobilization.
CONTROL OF MOVEMENT - STABILISATION (i) External support e.g. braces, collars, taping. (ii) Enhance intrinsic joint support and reduce unwanted movement by retraining the activation and motor programming of muscles, both segmentally and regionally, which have a primary stabilizing function.
(i) Exercises (muscle strength, endurance and coordination) (ii) Correction of resting, working, sports postures etc. (iii) Job analysis and ergonomic retraining. (iv) Prophylactic procedures (ADL handling, lifting retraining and advice).
GUIDELINES FOR FORMULATING O.M.T. PROGRAMS
Fulltime training with supervised clinical work is vital in the long term development of OMT training. Training based on attendance of a sequence of short courses whilst successful in the past must only be considered an interim measure.
Comprehensive theoretical knowledge is required in the basic and clinical sciences for the development of high level skills in physical diagnosis and clinical management. Students' theoretical learning can be optimized by careful course planning. Courses are ideally structured so that theoretical instruction complements preclinical and clinical OMT subjects. This assists students' understanding of the relevance of the theory and helps them to integrate and apply it immediately to their clinical practice. Courses should include a variety of teaching formats and learning strategies. Formats that encourage and extend student problem solving, clinical reasoning skills will enhance their performance in clinical practice. It is expected that OMT educational programs will contain a minimum of 200 hours of theoretical instruction.
The preclinical courses in OMT must emphasize the development of students' clinical reasoning skills to prepare them for clinical practice. The examination and management of articular dysfunction should be learnt in conjunction with that of muscle and nervous systems so that total patient management is emphasized. A thorough understanding of the basic examination techniques for physical diagnosis of neuro-muscular-articular dysfunction is essential. Manual examination skills must be developed so that students can display competency in: * Recognizing possible positional faults, joint hypermobility and joint hypomobility through the use of specific techniques for testing passive joint movement. * Recognizing the reactivity of the local problem by analysis of local discrete muscle spasm. Students should understand the meaning of graded passive movement so that the appropriate amount of movement can be applied to the joint related to the pain/range/resistance findings. It is recommended that the teaching of manipulative therapy procedures (i.e. passive mobilizations and manipulations) follow a progressive plan. The recommended sequence for learning procedures is: * mobilization procedures for peripheral joints * mobilization procedures for spinal joints Once competency is demonstrated in preclinical and clinical situations in these procedures, * manipulation procedures for peripheral joints * manipulation procedures for spinal joints. The application of peripheral and spinal manipulations should be supervised in the preclinical and clinical environments. It is expected that a minimum of 150 hours will be spent in the preclinical instruction of OMT treatment procedures.
Supervised clinical practice is an essential part of the OMT educational program. Physical therapists in an OMT training program will undertake clinical practice under the direct supervision of an OMT instructor. It is recommended that the supervised clinical work should be undertaken with a ratio of no more than four (4) students to one (1) OMT instructor. It is recommended that a minimum of 150 hours of clinical instruction be undertaken. This should be distributed throughout the course of theoretical and preclinical instruction to give students the maximum opportunity to develop their clinical skills.
Proof of competency by formal evaluation is mandatory and should be based on knowledge of broad principles set out in the standards document. Competency should be demonstrated in: * the basic, medical and behavioural sciences underlying the use of manipulative therapy. * the theory and science of manipulative therapy. * the clinical examination, physical diagnosis and management of patients. * techniques of examination and treatment both to peripheral and spinal joints on a model and/or patients. * patient case presentation. * research principles and design. The physical therapist should demonstrate a breadth of knowledge obtained from a wide reading of the literature.
APPENDIX 3
THE PRACTICE OF MANIPULATION
The scope of practice of the orthopaedic manipulative therapists includes a full spectrum of OMT treatment procedures. including specific mobilization and manipulation applied to peripheral and spinal joints. In the event that manipulation (thrust techniques) applied to the spine is prohibited by government legislation this would not preclude the OMT group of that country obtaining membership provided manipulation be taught and practised as it can be applied to peripheral joints. Even if thrust techniques cannot be applied to patients with spinal problems, training in the theory and technique should be undertaken as this could be used to change government policy. If a country states that there is a legal restriction to manipulation, the details of such legislation should be produced with application for membership. © 2003-2008 International Federation Orthopaedic Manipulative Therapists (IFOMT). All rights reserved. |
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