BACKGROUND AND OBJECTIVE: High-velocity low-amplitude thrust spinal manipulation (SM) is a recommended and commonly used manual therapy intervention in physiotherapy. Beliefs surrounding the safety and effectiveness of SM have challenged its use, and even advocated for its abandonment. Our study aimed to investigate the knowledge and beliefs surrounding SM by Italian physiotherapists compared with similar practitioners in other countries.METHODS: An online survey with 41 questions was adapted from previous surveys and was distributed via a mailing list of the Italian Physiotherapists Association (March 22-26, 2020). The questionnaire was divided into 4 sections to capture information on participant demographics, utilization, potential barriers, and knowledge about SM. Questions were differentiated between spinal regions. Attitudes towards different spinal regions, attributes associated with beliefs, and the influence of previous educational background were each evaluated.RESULTS: Of the 7398 registered physiotherapists, 575 (7.8%) completed the survey and were included for analysis. The majority of respondents perceived SM as safe and effective when applied to the thoracic (74.1%) and lumbar (72.2%) spines; whereas, a smaller proportion viewed SM to the upper cervical spine (56.8%) as safe and effective. Respondents reported they were less likely to provide and feel comfortable with upper cervical SM (respectively, 27.5% and 48.5%) compared to the thoracic (respectively, 52.2% and 74.8%) and lumbar spines (respectively, 46.3% and 74.3%). Most physiotherapists (70.4%) agreed they would perform additional screening prior to upper cervical SM compared to other spinal regions. Respondents who were aware of clinical prediction rules were more likely to report being comfortable with SM (OR 2.38-3.69) and to perceive it as safe (OR 1.75-3.12). Finally, physiotherapists without musculoskeletal specialization, especially those with a traditional manual therapy background, were more likely to perform additional screening prior to SM, use SM less frequently, report being less comfortable performing SM, and report upper cervical SM as less safe (p < 0.001).DISCUSSION: The beliefs and attitudes of physiotherapists surrounding the use of SM are significantly different when comparing the upper cervical spine to other spinal regions. An educational background in traditional manual therapy significantly influences beliefs and attitudes. We propose an updated framework on evidence-based SM.
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Teacher beliefs have been shown to play a major role in shaping educational practice, especially in the area of grammar teaching―an area of language education that teachers have particularly strong views on. Traditional grammar education is regularly criticized for its focus on rules-of-thumb rather than on insights from modern linguistics, and for its focus on lower order thinking. A growing body of literature on grammar teaching promotes the opposite, arguing for more linguistic conceptual knowledge and reflective or higher order thinking in grammar pedagogy. In the Netherlands, this discussion plays an important role in the national development of a new curriculum. This study explores current Dutch teachers’ beliefs on the use of modern linguistic concepts and reflective judgment in grammar teaching. To this end, we conducted a questionnaire among 110 Dutch language teachers from secondary education and analyzed contemporary school textbooks likely to reflect existing teachers’ beliefs. Results indicate that teachers generally appear to favor stimulating reflective judgement in grammar teaching, although implementing activities aimed at fostering reflective thinking seems to be difficult for two reasons: (1) existing textbooks fail to implement sufficient concepts from modern linguistics, nor do they stimulate reflective thinking; (2) teachers lack sufficient conceptual knowledge from linguistics necessary to adequately address reflective thinking.
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L1 grammar teaching worldwide often takes the form of traditional grammar teaching with decontextualized parsing exercises and rules of thumb. Some researchers have proposed enriching such forms of grammar teaching by relating traditional grammatical concepts to underlying metaconcepts from linguistic theory. The merits of such an approach have become apparent in recent intervention studies, but the question remains how teachers perceive such forms of grammar teaching, which is of particular importance for curriculum development. The present study investigated Dutch teachers’ beliefs in focus groups and a national survey (N = 127). It is found that Dutch language teachers see important benefits of a metaconceptual approach to grammar teaching, particularly as a means to improve students’ grammatical understanding. However, results also indicate that while teachers may see clear pedagogical and conceptual advantages of working based on underlying metaconcepts, their own teaching practice appears to be much more traditional. This discrepancy is explained by assuming that contextual factors have a restraining effect on what teachers can or want to do in reality. Once such contextual factors no longer play a part, teachers’ views tend to be much more geared towards a metaconceptual approach. The paper concludes with some implications for future research.
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