The clinical decision making process in the use of mobilisation with movement – A Delphi survey

R.Baeske, M.F.Silva, T.Hall

A B S T R A C T

Background: Mobilisation with movement (MWM) is a method of treating musculoskeletal disorders. Although widely used clinically and with increasing research investigation, little is known about the decision making process for its utilization.

Objectives: To understand the factors experts believe important for utilization of MWM when assessing a patient, predicting responses to its delivery, responsive body areas, and expected outcomes to MWM.

Design: A web-based Delphi study of experts in the use of MWM.

Methods: Round one contained five open-ended questions regarding assessment strategies, prediction of successful and unsuccessful outcomes, body areas most responsive, and common outcome measures observed. Rounds 2 and 3 were quantitative and aimed at establishing consensus.

Results: Thirty-seven experts participated in the study and took part in round 1, thirty-two in round 2, and twenty-eight in round 3. The exclusion of red flags and impairment in range of motion (ROM), obtained the highest level of consensus for the item assessment strategies. Patients presenting with a variety of issues on movement, in addition to mild to moderate levels of severity and immediately responsive to a trial MWM, were believed to respond favourably to MWM. Patients with predominant inflammatory pain, with high levels of psychosocial factors, increased central sensitization and not improving after a trial of MWM, were recognized as non-responders.

Improvement of different aspects of movement (e.g. ROM, less fear) are the most common outcomes observed.

Conclusions: This study provides factors believed to be important in the decision-making process when using

MWM clinically.

June 2020

Musculoskeletal Science and Practice 49:102212

DOI:10.1016/j.msksp.2020.102212

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