Motor Control in Musculoskeletal Physiotherapy: A Concept Analysis

A few people have contacted me with regards to my recent poster presentation that I gave at IFOMPT 2016 in Glasgow.  Below is the content of the poster, please feel free to ask questions or post comments in the comment section or via Twitter @MattLowPT.

Motor Control in Musculoskeletal Physiotherapy: A Concept Analysis

by Matthew Low, Dr. Nicola J. Petty, Dr. Clair Hebron
University of Brighton, School of Health Sciences, Eastbourne, United Kingdom

Background

The term motor control is used commonly in physiotherapy research and clinical practice however the meaning of the term is unclear. A systematic review of the literature revealed variation in the use of the concept of motor control within and between the specialties of the physiotherapy profession. In addition, the literature identified that motor control is used interchangeably with terms such as neuromotor control and core stability. The ambiguity of the term may cause miscommunication and misunderstanding in physiotherapy education, research and clinical practice.

Purpose

To clarify the concept of motor control and its use in musculoskeletal (MSK) physiotherapy practice.

Method

The evolutionary method of concept analysis was used to investigate the socially constructed concept of motor control. Literature between 2009 to 2014 was selected from CINAHL, AMED and Medline databases to provide contemporary, peer reviewed and relevant data on the concept.

Two hundred and ten abstracts were reviewed from which 50 studies were included in the analysis due to their relevance to physiotherapy practice (figure 1). An inductive process of analysis was used to collect the attributes, antecedent theoretical models, consequences and related terms of the concept of motor control.

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Document-3-page001Results

Forty-one different attributes of motor control were identified in the literature across the musculoskeletal, neurological and paediatric physiotherapy specialty areas. The highest prevalence of research articles that used the concept of motor control was within the musculoskeletal literature (n=35).

The term motor control was used interchangeably with neuromuscular control, neuromotor control and core stability (table 1).

Four clusters of attributes were interpreted from the literature; movement performance, structural, equilibrium and cognitive/perceptual attributes. The musculoskeletal literature had a greater number of attributes within the movement performance (57%) and equilibrium clusters (23%). The neurological literature had a high number of movement performance attributes (70%) with the paediatric literature having an even spread of movement performance (35%) and equilibrium (25%) attributes but the greatest proportion of cognitive/perceptual attributes (45%). Both the neurological and paediatric speciality areas had no structural cluster of attributes referenced in the literature (see figures 2, 3 and 4).

The MSK literature tended to focus on the balance between movement performance and movement stability with a greater focus on structure whereas the neurological physiotherapy literature tended to focus on the function and purpose of movement. The paediatric physiotherapy literature had a tendency to focus on individuals’ interactions with the environment to provide developmental learning opportunities.

The results reflect the underpinning antecedent theoretical models of motor control in each of the specialty areas. The neurological and paediatric literature were based upon the neurodevelopmental and motor learning theoretical models.

The majority of the MSK literature focused on spinal rehabilitation (n=26/35). Eighteen of the 26 spinal rehabilitation research papers used Panjabi’s spinal stability model as a fundamental theoretical basis for this research. The consequence of this facilitated the development of the surrogate conceptual term ‘core stability’.

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Figure 2. A word cloud representation of the attributes of motor control in the Musculoskeletal Physiotherapy literature.

 

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Figure 3. A word cloud representation of the attributes of motor control in the Neurological Physiotherapy literature.

 

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Figure 4. A word cloud representation of the attributes of motor control in the Paediatric Physiotherapy literature.

Conclusion

Motor control is a broad, vague and ambiguous concept that is open to interpretation. There is inconsistency in its meaning within and between physiotherapy specialities. The use of the concept of motor control is determined by the context in which it is delivered, including its underlying theoretical model and the time in which the research was conducted.

Implications

The lack of clarity of the concept of motor control could be problematic in clinical practice, education and research resulting in an inappropriate application or interpretation of the concept. A recommendation from this research paper is that a Delphi study may be helpful to bring consensus to the concept of motor control within physiotherapy, which in turn, could inform future theoretical model(s) to be developed.

Key-Words: Concept Analysis; Motor Control; Physiotherapy Theory

Funding acknowledgements: Not applicable

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