RESEARCH REPORT PLATFORM PRESENTATION

DEVELOPMENT OF A MOBILISATION DYNAMOMETER FOR APPLYING CONTROLLED FORCES IN THE MANUAL THERAPY CLINICAL SETTING. Lau G¹, Waddington G², Adams R¹; ¹School of Physiotherapy, University of Sydney, Sydney, AUSTRALIA. ²School of Health Sciences, University of Canberra, Canberra, AUSTRALIA

PURPOSE: To create a clinically suitable mobilising dynamometer (MobDyn) that generates force readouts that give control of applied force and enable treatment-to-treatment monitoring of changes in the amount of pressure needed for pain response. Further, an ergonomic grip on the device may reduce the risk of hand and wrist work-related musculoskeletal disorders (WMSD) in the practice of manual therapy. RELEVANCE: High volume of manual therapy work stresses the structures of the hands and wrists, and can lead to WMSD, and possibly to injuries that force therapists to leave their profession. Hence, a mobilising tool with instant force readout, that can reduce hand injury risk and provide a way of gauging patient progress between sessions, is needed. PARTICIPANTS: 36 healthy physiotherapy students who had passed courses on spinal mobilisation techniques. All subjects had no history of hand or back pain three months prior to testing, and were recruited via advertisements at University of Sydney, Faculty of Health Sciences. METHODS: All testing was performed in pairs, where one subject assumed the role of the simulated-therapist whilst the other was the simulated-patient. The independent variables were spinal segment (T6 and L3), method of force application (Pisiform grip and MobDyn), and grade of mobilisation (Grades I, II, and III). Posteroanterior mobilisation forces were standardised by use of a force plinth with force display for feedback. After each combination has been performed, both subjects rated their hand and back comfort respectively on a 10 cm visual analogue scale (VAS). ANALYSIS: A 2 x 2 x 3 analysis of variance was used to determine significance and interactions between the independent variables spinal segment, method of force application, and grade of mobilisation in terms of rated back comfort and hand comfort. RESULTS: Back comfort with tool mobilisation was significantly less comfortable than hand mobilisation (p < 0.001, mean = 14 mm, 95% CI 7.6–20.8 mm on a 100 mm VAS), and back comfort decreased as the grade of mobilisation increased from Grade I to Grade III (p < 0.001, mean = 27 mm, 95% CI 19.5–34.5 mm) regardless of the method of force application. Because the difference between the hands and the tool was approximately half the discomfort experienced as grade was increased from Grade I to Grade III, this difference in comfort was deemed to be acceptable. Hand comfort, also decreased as grade increased (p < 0.001, mean = 20, 95% CI 13.5–27.2 mm), but the method of force application was not significant (p = 0.199). CONCLUSIONS: The MobDyn has been found to be acceptably comfortable at the hands, with an acceptable level of patient comfort. It can now be used in research in physiotherapy clinics. IMPLICATIONS: The mobilising dynamometer warrants further testing regarding use in manual therapy for the prevention of hand and wrist WMSD. Further testing is necessary by therapists who are getting hand pain, and with patients experiencing back pain. KEYWORDS: Manual therapy, Tool. FUNDING ACKNOWLEDGEMENTS: Neither the candidate nor the supervisors on this research project have any financial interest involved. CONTACT: gordonhlau@gmail.com

ETHICS COMMITTEE: Human Research Ethics Committee, University of Sydney