Integrating person-centered concepts and modern manual therapy

Review written by Dr Jarod Hall info

Key Points

  1. Complexities in evidence-based healthcare arise as clinical practice guidelines and clinical trials are meant to assist in guiding clinical practice; however, both tools focus on treatment of the “average” patient and give guidance only on how averages of population respond to a treatment.
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BACKGROUND & OBJECTIVE

Person-centered care and person-focused care have been proposed as integral components of musculoskeletal pain care and are described as an approach that places the whole patient at the center of the assessment and treatment plan (1-3). This includes an appreciation of the biological, psychological, and social contributors to the patient’s status, use of shared decision-making to arrive at a feasible, person-centered care plan, and planning beyond the clinical encounter.

Whilst person-centered care has been trending among musculoskeletal pain care, the application of this concept in a management plan that incorporates manual therapy (MT) has yet to be explored.

Traditionally, MT has involved a practitioner leading the treatment session and providing the technique; however, recent advances in the MT literature and training are more reflective of a person-centered care model.

The objectives of this clinical commentary were to outline a vision of person-centered MT, including support on why and how it should be applied by answering the following questions: “What is person-centered manual therapy?”, “Why should person-centered manual therapy be adopted?”, and “How should person centered manual therapy be utilized.”

Person-centered care includes an appreciation of the biological, psychological, and social contributors to the patient’s status and use of shared decision-making to plan beyond the clinical encounter.
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If response to treatment is dictated largely by patient specific factors, it is likely time to put the patient at the center of the care plan when making decisions about the best treatment approaches.

WHAT IS PERSON-CENTERED MANUAL THERAPY?

Person-centered MT is a patient specific intervention chosen based on structure and function limitations (joint mobility, range of motion, palpation) identified during an objective exam. Historical models have emphasized these components as the primary rationale for MT treatment; however, these

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