Abstract:
Background
Manual therapy has been an approach in the management of patients with various disorders dating back to ancient times and continues to play a significant role in current health care.1 The meaning of manual therapy is widely varied, ranging from a hands-on technique, and a hands-on approach to a structured and skillful hands-on clinical management approach within a biopsychosocial framework.4 The future role of manual therapy in health care is an important area of research.1 Over the last decade, there has been an increased focus on and expansion of orthopedic manual physical therapy (OMPT) clinical practice and research.2 Along with this focus have come numerous research studies assessing the effectiveness of OMPT, a dramatic increase in the number of orthopedic residency and manual therapy fellowship programs, and an increased emphasis on OMPT in entry-level Physical Therapy academic programs.2 Orthopaedic manual therapy residence program has a positive influence on the residents’ ability to perform musculoskeletal examination and evaluation and to determine a treatment diagnosis.5 However, there are very few opportunities for long-term, comprehensive postgraduate clinical education in developing countries because of fiscal and human resource constraints.3 Therefore, physiotherapists have little opportunity to improve clinical reasoning and treatment skills.3


Rationale

We argue that Orthopaedic Manual Physiotherapy is one of the most important specializations in the physiotherapy profession for physiotherapists in low-resource settings with the potential to strengthen rehabilitation and support the healthcare system. However, very little is known about the development and advancement of Orthopaedic Manual Physiotherapy in low- and middle-income countries. There are questions about the implementation of Orthopaedic Manual physiotherapy in these countries including what does Orthopaedic manual therapy practice mean for low-resource settings? How are low-resourced Orthopaedic Manual Physiotherapy countries advancing their practice based on their local context (e.g., level of physiotherapy entry-to-practice education, availability of resources, and support from the healthcare system)? How can physiotherapists within low-resource countries support their healthcare system and strengthen rehabilitation by advancing their practice in different specialties?

Aims and Objectives
This debate/discussion aims to address these questions by providing practical examples of advancement in Orthopaedic Manual Physiotherapy practice in low-resource settings drawing on examples from Africa, Asia, and Parts of North America (the Caribbean). The specific objectives of this session are to:

1. Discuss what Orthopaedic Manual Physiotherapy practice means to countries with low resources and describe the importance of developing and advancing Orthopaedic Manual Physiotherapy practice as a specialization to strengthen physiotherapy and rehabilitation in developing countries.

2. Provide practical examples of how countries with low resources have developed and implemented Orthopaedic Manual Physiotherapy practice as a specialization to strengthen physiotherapy and rehabilitation within their countries with examples from Africa, Asia, and parts of North America (the Caribbean).

3. Stimulate discussion on the barriers, facilitators, and strategies for developing, implementing, and advancing Orthopaedic Manual Physiotherapy practice in developing countries and discuss the next steps.

Method
This session will use a combination of presentation and interactive discussion to engage with the audience. This Debate/discussion will present practical approaches to the implementation of OMPT practice in low-resource settings. This focused symposium will present important information that is currently not available in the literature and the practice of OMPT. The information will be additional valuable knowledge to OMPT practice.



Implications/conclusions
Orthopaedic Manual Physiotherapy practice is a specialization in the physiotherapy profession with the potential to strengthen physiotherapy and rehabilitation and improve healthcare systems in low-resource settings. This debate/discussion will enable the physiotherapy profession to better understand what Orthopaedic Manual Physiotherapy practice means in different contexts and the strategies for developing, implementing, and advancing OMPT in low-resource settings with examples from African, Asia, and parts of North American countries. The examples from this debate/discussion can be applied to many low-resource countries (the Caribbean) and have the potential to have a broader impact on the development, implementation, sustainability, and advancement of OMPT and on strengthening rehabilitation. The presentation and discussions from this session will be published in different formats (Conference publication and opinion paper). The outcome of the session will also lead to the formation of a team of researchers, clinicians, and physiotherapy leaders who will further design research projects to support OMPT in low-resource settings.

References
1. Manual Therapy: The Historical, Current, and Future Role in the Treatment of Pain A. Russell Smith, Jr. Department of Athletic Training and Physical Therapy, Brooks College of Health, University of North Florida, Jacksonville Received October 3, 2006; Revised December 11, 2006; Accepted December 11, 2006; Published February 2, 2007
2. Cristiana K. Collins, Michael Masaracchio & Jean-Michel Brismée (2017): The future of orthopedic manual therapy: what are we missing? Journal of Manual & Manipulative Therapy, DOI: 10.1080/10669817.2017.1358249
3. Shala Cunningham1, Richard Jackson2, Daniel Kangutu Muli3, McFelea4 The development of postgraduate Orthopaedic Manual Therapy Residency Program in Nairobi, Kenya: 1Department of Physical Therapy, Radford University, Roanoke, VA, United States2The Jackson Clinics Foundation, Inc., Middleburg, VA, United States3Department of Physiotherapy, Kenya Medical Training College, Nairobi, Kenya4Department of Physical Therapy, University of Evansville, Evansville, IN, United States. Published June, 2017
4. Chad E. Cook, Megan Donaldson & Elaine Lonnemann (2021) ‘Next steps’ for researching orthopedic manual therapy, Journal of Manual & Manipulative Therapy, 29:6, 333-336, DOI: 10.1080/10669817.2021.2008010
5. The Influence of an Orthopedic, Manual Therapy Residency Program on Improved Knowledge, Psychomotor Skills, and Clinical Reasoning in Nairobi, Kenya: Shala Cunningham1, Joni McFelea2 1Department of Physical Therapy, Radford University, Roanoke, VA, USA2Department of Physical Therapy, University of Evansville, Evansville, IN, USA. Published March, 2017