Study Aim: This study examined the item difficulty and item discrimination scores for the HRFK PE Metrics cognitive assessment tool for 5th-grade students.

Materials and Methods: Ten elementary physical education teachers volunteered to participate. Based on convenience, participating teachers selected two 5th grade physical education classes. Teachers then gave students (N = 633) a 28-question paper and pencil HRFK exam using PE Metrics Standards 3 and 4. Item difficulty and discrimination analysis and Rasch Modeling were used data to determine underperforming items.

Results: Analysis suggests that at least three items are problematic. The Rasch Model confirmed this result and identified similar items with high outfit mean square values and low Point Biserial correlation values.

Conclusions: Teachers are in need of valid and reliable HRFK assessment tools. Without the removal of three items in the PE Metrics HRFK exam for 5th-grade students, complete use of the exam could offer incorrect conclusions.

Manual therapy has long been a component of physical rehabilitation programs, especially to treat those in pain. The mechanisms of manual therapy, however, are not fully understood, and it has been suggested that its pain modulatory effects are of neurophysiological origin and may be mediated by the descending modulatory circuit. Therefore, the purpose of this review is to examine the neurophysiological response to different types of manual therapy, in order to better understand the neurophysiological mechanisms behind each therapy’s analgesic effects. It is concluded that different forms of manual therapy elicit analgesic effects via different mechanisms, and nearly all therapies appear to be at least partially mediated by descending modulation. Additionally, future avenues of mechanistic research pertaining to manual therapy are discussed.