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Sheppard M, Johnson S, Quiroz V, Ward J. Interactions between the sex of the clinician grader and the sex of the chiropractic student intern on spinal manipulation assessment grade. THE JOURNAL OF CHIROPRACTIC EDUCATION 2023; 37:157-161. [PMID: 37655808 PMCID: PMC11095654 DOI: 10.7899/jce-22-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 01/08/2023] [Accepted: 07/03/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE The purpose of this project was to determine if there was any relationship between the sex of the clinician grader and the sex of the chiropractic student intern on student spinal manipulation assessment grades. METHODS Twelve thousand six hundred and thirty-one supervised patient adjustments by student interns were analyzed over a 3-year data collection window. Student interns were assessed by multiple male and female clinicians in a teaching clinic using a modified Dreyfus model scoring system on a 1-4 scale (1 = novice, 4 = proficient). A Mann-Whitney U test was used to compare the relationship between grader sex and student grade as well as student sex and student grade. RESULTS Sex of the grader had a statistically significant effect on spinal manipulation assessment grade, p < .001, with male clinician graders assigning average scores of 2.81 ± 0.39 (mean ± SD) and female clinician graders scores of 3.01 ± 0.52, r = .18. Sex of the student had a statistically significant but negligible (r = .08) effect on spinal manipulation assessment grade, p < .001, with male students averaging slightly higher scores (2.93 ± 0.47) than females (2.86 ± 0.44) on the modified Dreyfus scale. CONCLUSION Male clinicians tended to assign lower grades on spinal manipulation assessments than female clinicians. Male students on average received slightly higher scores than female students on spinal manipulation assessments.
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Russell BS, Owens EF, Hosek RS, Dever LL, Weiner MT. Assessment of forces during side-posture adjustment with the use of a table-embedded force plate: Reference values for education. THE JOURNAL OF CHIROPRACTIC EDUCATION 2023; 37:73-81. [PMID: 37721390 PMCID: PMC11095653 DOI: 10.7899/jce-22-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 01/26/2023] [Accepted: 03/18/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE Force-sensing treatment tables are becoming more commonly used by chiropractic educational institutions. However, when a table-embedded force platform is the sole measurement method, there is little information available about what force-time values instructors and students should expect for side-posture spinal manipulative thrusts. The purpose of this report is to provide force-time values recorded with such a system during side-posture manipulation with human recipients. METHODS Student volunteers were examined by and received lumbar or pelvic side-posture manipulation from experienced chiropractors who were diplomates of the Gonstead Clinical Studies Society. Forces were recorded using proprietary software of a Bertec force platform; force and time data were analyzed with a custom-programmed software tool in Excel. RESULTS Seven doctors of chiropractic performed 24 thrusts on 23 student recipients. Preload forces, averaging 69.7 N, and thrust loading duration, averaging 167 milliseconds, were similar to previous studies of side-posture manipulation. Peak loads were higher than previous studies, averaging 1010.9 N. Other variables included prethrust liftoff force, times from thrust onset to peak force and peak load to resolution of thrust, and average rates of force loading and unloading. CONCLUSION The values we found will be used for reference at our institution and may be useful to instructors at other chiropractic educational institutions, in the teaching of lumbar side-posture manipulation. A caveat is that the values of this study reflect multiple sources of applied force, not solely the force applied directly to the spine.
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Pasquier M, Memari S, Lardon A, Descarreaux M. Can self-assessment and augmented feedback improve performance and learning retention in manual therapy: results from an experimental study. Chiropr Man Therap 2023; 31:35. [PMID: 37700344 PMCID: PMC10498620 DOI: 10.1186/s12998-023-00505-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/31/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate how feedback and self-assessment strategies affect performance and retention of manual skills in a group of chiropractic students. METHODS Seventy-five students participated in two spinal manipulation (SM) learning sessions using a force-sensing table. They were recruited between May and November 2022 during HVLA technical courses. Students were randomly assigned into three different groups: participants in group 1 received visual feedback, those in group 2 received visual feedback after self-assessment, and participants in group 3 (C) received no feedback. During the first session, participants started with one block of 3 familiarization trials, followed by two blocks of 6 SM HVLA (high velocity low amplitude) posterior-to-anterior thoracic SM trials, with 3 trials performed with a target force of 450 N and 3 others at 800 N. They received feedback according to their group during the first block, but no feedback was provided during the second block. All participants were invited to participate in a second session for the retention test and to perform a new set SM without any form of feedback. RESULTS Results showed that visual feedback and visual feedback in addition to self-assessment did not improve short-term SM performance, nor did it improve performance at the one-week retention test. The group that received visual feedback and submitted to self-assessment increased the difference between the target force and the peak force applied, which can be considered a decrease in performance. CONCLUSION No learning effects between the three groups of students exposed to different feedback and self-assessment learning strategies were highlighted in the present study. However, future research on innovative motor learning strategies could explore the role of external focus of attention, self-motivation and autonomy in SM performance training.
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Affiliation(s)
- Mégane Pasquier
- Research Department, Institut Franco-Européen de Chiropraxie, 24 Boulevard Paul Vaillant Couturier, 94200, Ivry-Sur-Seine, France.
| | - Sahel Memari
- Research Department, Institut Franco-Européen de Chiropraxie, 24 Boulevard Paul Vaillant Couturier, 94200, Ivry-Sur-Seine, France
- Department of Human Kinetics, Université du Québec À Trois-Rivières, 3351 Bd Des Forges, Trois-Rivières, QC, G8Z 4M3, Canada
| | - Arnaud Lardon
- Research Department, Institut Franco-Européen de Chiropraxie, 24 Boulevard Paul Vaillant Couturier, 94200, Ivry-Sur-Seine, France
| | - Martin Descarreaux
- Research Department, Institut Franco-Européen de Chiropraxie, 24 Boulevard Paul Vaillant Couturier, 94200, Ivry-Sur-Seine, France
- Department of Human Kinetics, Université du Québec À Trois-Rivières, 3351 Bd Des Forges, Trois-Rivières, QC, G8Z 4M3, Canada
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Owens EF, Dever LL, Hosek RS, Russell BS, Dc SS. Development of a mannequin lab for clinical training in a chiropractic program. THE JOURNAL OF CHIROPRACTIC EDUCATION 2022; 36:147-152. [PMID: 35394042 PMCID: PMC9536233 DOI: 10.7899/jce-21-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/14/2021] [Accepted: 08/27/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Faced with COVID-19 safety protocols that severely limited the ability to conduct chiropractic technique instruction in the usual manner, our university invested the resources to develop a new mannequin lab for hands-on training, which would help supplement the loss of person-to-person contact. METHODS Training mannequins could enable student learning of palpation and adjustment skills while avoiding close human-human contact. The university had developed a mannequin over the previous 4 years consisting of a full-sized human torso with individually movable and palpable vertebrae, pelvis, and thighs. In the mannequin, 64 pressure sensors are attached to particular vertebral and skeletal landmarks and provide feedback on palpation location and level of force applied. We assembled 3 teams to produce 20 copies of that mannequin for student use. RESULTS Mannequins were produced in 7 weeks, and space was built out for a special lab. Faculty members are developing classroom procedures to introduce the mannequin to students, phase in the skills from static and motion palpation, and practice thrust performance. CONCLUSION The production run was successful, and the resulting equipment, well-received by students and faculty. In addition to helping teach manual skills, the lab serves as a platform for educational research to test the efficacy of mannequin-based training protocols. With the pressure sensors on known locations along the spine, future research may be able to test the ability of students to identify and contact specific target locations for adjustive thrusts.
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Weiner MT, Russell BS, Elkins LM, Hosek RS, Owens EF, Kelly G. Spinal Kinematic Assessment of Chiropractic Side-Posture Adjustments: Development of a Motion Capture System. J Manipulative Physiol Ther 2022; 45:298-314. [DOI: 10.1016/j.jmpt.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 06/06/2021] [Accepted: 07/13/2022] [Indexed: 10/14/2022]
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Hodgetts CJ, McLeish T, Thomas E, Walker BF. Association Between Chiropractic Students’ Hand-Eye Coordination or General Self-efficacy and Their Performance on a Spinal Manipulative Therapy Examination: A Cross-sectional Study. J Chiropr Med 2021; 20:183-190. [DOI: 10.1016/j.jcm.2021.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 12/17/2021] [Accepted: 12/17/2021] [Indexed: 10/18/2022] Open
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Effects of biomechanical parameters of spinal manipulation: A critical literature review. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2021; 20:4-12. [PMID: 34756673 DOI: 10.1016/j.joim.2021.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/10/2021] [Indexed: 11/23/2022]
Abstract
Spinal manipulation is a manual treatment technique that delivers a thrust, using specific biomechanical parameters to exert its therapeutic effects. These parameters have been shown to have a unique dose-response relationship with the physiological responses of the therapy. So far, however, there has not been a unified approach to standardize these biomechanical characteristics. In fact, it is still undetermined how they affect the observed clinical outcomes of spinal manipulation. This study, therefore, reviewed the current body of literature to explore these dosage parameters and evaluate their significance, with respect to physiological and clinical outcomes. From the experimental studies reviewed herein, it is evident that the modulation of manipulation's biomechanical parameters elicits transient physiological responses, including changes in neuronal activity, electromyographic responses, spinal stiffness, muscle spindle responses, paraspinal muscle activity, vertebral displacement, and segmental and intersegmental acceleration responses. However, to date, there have been few clinical trials that tested the therapeutic relevance of these changes. In addition, there were some inherent limitations in both human and animal models due to the use of mechanical devices to apply the thrust. Future studies evaluating the effects of varying biomechanical parameters of spinal manipulation should include clinicians to deliver the therapy in order to explore the true clinical significance of the dose-response relationship.
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Kinematic consistency in the knee manipulation learning: A comparison between expert and beginner therapists. INT J OSTEOPATH MED 2021. [DOI: 10.1016/j.ijosm.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Schmiederer IS, Kearse LE, Lin DT, Anderson TN, Lau JN, Korndorffer JR. Isolating steps instead of learners: Use of deliberate practice and validity evidence in coronavirus disease (COVID)-era procedural assessment. Surgery 2021; 170:1652-1658. [PMID: 34272045 PMCID: PMC8276111 DOI: 10.1016/j.surg.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/25/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022]
Abstract
Background In surgical training, assessment tools based on strong validity evidence allow for standardized evaluation despite changing external circumstances. At a large academic institution, surgical interns undergo a multimodal curriculum for central line placement that uses a 31-item binary assessment at the start of each academic year. This study evaluated this practice within increased in-person learning restrictions. We hypothesized that external constraints would not affect resident performance nor assessment due to a robust curriculum and assessment checklist. Methods From 2018 to 2020, 81 residents completed central line training and assessment. In 2020, this curriculum was modified to conform to in-person restrictions and social distancing guidelines. Resident score reports were analyzed using multivariate analyses to compare performance, objective scoring parameters, and subjective assessments among “precoronavirus disease” years (2018 and 2019) and 2020. Results There were no significant differences in average scores or objective pass rates over 3 years. Significant differences between 2020 and precoronavirus disease years occurred in subjective pass rates and in first-time success for 4 checklist items: patient positioning, draping, sterile ultrasound probe cover placement, and needle positioning before venipuncture. Conclusion Modifications to procedural training within current restrictions did not adversely affect residents’ overall performance. However, our data suggest that in 2020, expert trainers may not have ensured learner acquisition of automated procedural steps. Additionally, although 2020 raters could have been influenced by logistical barriers leading to more lenient grading, the assessment tool ensured training and assessment integrity.
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Affiliation(s)
| | | | - Dana T Lin
- Department of Surgery, Stanford University Medical Center, CA
| | | | - James N Lau
- Department of Surgery, Loyola University Medical Center, Maywood, IL
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Pasquier M, Chéron C, Barbier G, Dugas C, Lardon A, Descarreaux M. Learning Spinal Manipulation: Objective and Subjective Assessment of Performance. J Manipulative Physiol Ther 2021; 43:189-196. [PMID: 32951767 DOI: 10.1016/j.jmpt.2019.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 12/22/2019] [Accepted: 12/23/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate associations between objective spinal manipulation therapy (SMT) biomechanical parameters and subjective assessments provided by patients, clinicians, and expert assessors. METHODS Chiropractic students (N = 137) and expert instructors (N = 14) were recruited. Students were asked to perform a thoracic SMT alternately on each other on a force-sensing table while being observed by an expert instructor. Students who performed (clinicians) and received (patients) SMT, and expert instructors, independently scored each SMT performance using visual analog scales. Correlations between these subjective scores and SMT biomechanical parameters were calculated. The following parameters were evaluated: peak force, preload force, thrust duration, and drop in preload force. Spinal manipulation therapy comfort was also assessed by patients, clinicians, and expert instructors. RESULTS Results of the study indicate that thrust duration assessed by instructors and patients was the only parameters significantly correlated with the table data (r = .37; P < .001 and r = .26; P = .002). Comfort assessed by clinicians was significantly correlated with their own assessments of thrust duration (r = .37; P < .001) and preload force (r = .23; P = .007), whereas comfort assessed by instructors was significantly correlated with their own assessment of thrust duration (r = .27; P = .002) and drop in preload force (r = -.34; P < .001). Objective biomechanical parameters of performance did not predict perceived comfort. CONCLUSIONS Overall, the results from the subjective assessments of SMT performance are weakly correlated with objective measures of SMT performance. Only the thrust duration evaluated by expert instructors and patients was associated with scores obtained from the table. Perceived comfort of the procedure seems to be associated mostly with perceived thrust duration and preload characteristics.
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Affiliation(s)
- Mégane Pasquier
- Institut Franco-Européen de Chiropraxie, Toulouse, France; Department of Anatomy, Université du Québec à Trois-Rivières, Trois Rivières, Québec, Canada.
| | | | - Gaëtan Barbier
- Institut Franco-Européen de Chiropraxie, Toulouse, France
| | - Claude Dugas
- Université du Québec à Trois-Rivières, Trois Rivières, Québec, Canada
| | - Arnaud Lardon
- Institut Franco-Européen de Chiropraxie, Toulouse, France; CIAMS, University of Paris-Sud, University of Paris-Saclay, France
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Owens EF, Hosek RS, Russell BS. Mechanical properties of a thoracic spine mannequin with variable stiffness control. THE JOURNAL OF CHIROPRACTIC EDUCATION 2021; 35:1-7. [PMID: 32930327 PMCID: PMC7958670 DOI: 10.7899/jce-19-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/07/2019] [Accepted: 12/24/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To test the posterior-to-anterior stiffness (PAS) of a new thoracic spine training simulator under different conditions of "fixation." METHODS We constructed a thoracic spine model using plastic bones and ribs mounted in a wooden box, with skin and soft tissue simulated by layers of silicone and foam. The spine segment could be stiffened with tension applied to cords running through the vertebrae and ribs. We tested PAS at 2 tension levels using a custom-built device to apply repetitive loads at the T6 spinous process (SP) and over adjacent soft tissue (TP) while measuring load and displacement. Stiffness was the slope of the force-displacement curve from 55 to 75 N. RESULTS Stiffness in the unconstrained (zero tension) condition over the SP averaged 11.98 N/mm and 6.72 N/mm over the TP. With tension applied, SP stiffness increased to 14.56 N/mm, and TP decreased to 6.15 N/mm. CONCLUSION Thoracic model compliance was similar to that reported for humans. The tension control system increased stiffness by 21.3% only over the SP. Stiffness over the TP was dominated by the lower stiffness of the thicker foam layer and did not change. The mannequin with these properties may be suitable for use in manual training of adjusting or PAS testing skills.
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de Luca K, McDonald M, Montgomery L, Sharp S, Young A, Vella S, Holmes MM, Aspinall S, Brousseau D, Burrell C, Byfield D, Dane D, Dewhurst P, Downie A, Engel R, Gleberzon B, Hollandsworth D, Nielsen AM, O'Connor L, Starmer D, Tunning M, Wanlass P, D French S. COVID-19: how has a global pandemic changed manual therapy technique education in chiropractic programs around the world? Chiropr Man Therap 2021; 29:7. [PMID: 33522933 PMCID: PMC7849220 DOI: 10.1186/s12998-021-00364-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background Manual therapy is a cornerstone of chiropractic education, whereby students work towards a level of skill and expertise that is regarded as competent to work within the field of chiropractic. Due to the COVID-19 pandemic, chiropractic programs in every region around the world had to make rapid changes to the delivery of manual therapy technique education, however what those changes looked like was unknown. Aims The aims of this study were to describe the immediate actions made by chiropractic programs to deliver education for manual therapy techniques and to summarise the experience of academics who teach manual therapy techniques during the initial outbreak of COVID-19 pandemic. Methods A qualitative descriptive approach was used to describe the immediate actions made by chiropractic programs to deliver manual therapy technique education during the COVID-19 pandemic. Chiropractic programs were identified from the webpages of the Councils on Chiropractic Education International and the Council on Chiropractic Education – USA. Between May and June 2020, a convenience sample of academics who lead or teach in manual therapy technique in those programs were invited via email to participate in an online survey with open-ended questions. Responses were entered into the NVivo software program and analysed using a reflexive thematic analysis by a qualitative researcher independent to the data collection. Results Data from 16 academics in 13 separate chiropractic programs revealed five, interconnected themes: Immediate response; Move to online delivery; Impact on learning and teaching; Additional challenges faced by educators; and Ongoing challenges post lockdown. Conclusion This study used a qualitative descriptive approach to describe how some chiropractic programs immediately responded to the initial outbreak of the COVID-19 pandemic in their teaching of manual therapy techniques. Chiropractic programs around the world provided their students with rapid, innovative learning strategies, in an attempt to maintain high standards of chiropractic education; however, challenges included maintaining student engagement in an online teaching environment, psychomotor skills acquisition and staff workload. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-021-00364-7.
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Affiliation(s)
- Katie de Luca
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia.
| | - Marcus McDonald
- Discipline of Chiropractic, RMIT University, Melbourne, Australia
| | - Laura Montgomery
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | - Stephen Sharp
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | - Anika Young
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | - Simon Vella
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | | | - Sasha Aspinall
- College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
| | - Danica Brousseau
- Department of Chiropractic, Université du Québec à Trois-Rivieres, Trois-Rivières, Canada
| | - Chris Burrell
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | - David Byfield
- Welsh Institute of Chiropractic, University of South Wales, Pontypridd, UK
| | - Dawn Dane
- Central Queensland University, Brisbane, Australia
| | - Philip Dewhurst
- School of Chiropractic, AECC University College, Bournemouth, UK
| | - Aron Downie
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | - Roger Engel
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | - Brian Gleberzon
- Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Canada
| | | | - Anne Molgaard Nielsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Laura O'Connor
- Department of Chiropracti, Durban University of Technology, Durban, KwaZulu-Natal, South Africa
| | - David Starmer
- Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Michael Tunning
- Associate Dean of Clinical Sciences, Palmer College of Chiropractic, Davenport, USA
| | - Paul Wanlass
- Interim Chair, Principles and Practice Department, Southern California University of Health Sciences, Los Angeles College of Chiropractic, Los Angeles, USA
| | - Simon D French
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
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Hunnisett AGW, Cunliffe C. A comparison of the academic outcome of chiropractic students on full-time and full-time equivalent chiropractic education routes. THE JOURNAL OF CHIROPRACTIC EDUCATION 2020; 34:140-146. [PMID: 31393748 PMCID: PMC7682644 DOI: 10.7899/jce-18-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 06/05/2018] [Accepted: 03/23/2018] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To compare the academic equivalence of full-time (FT) and full-time equivalent (FTE) delivery routes for chiropractic training and to assess nontraditional education delivery as a viable method for training chiropractors. METHODS A retrospective analysis of student summative assessment data was undertaken on a total of 196 FT and FTE students studying for the master's in chiropractic degree at a UK chiropractic college between 2009 and graduating by 2017. The analysis consisted of within-group comparison and between-group comparisons using the Kruskal-Wallis test and the Mann-Whitney U test. RESULTS The demographics of the 2 student groups varied in terms of gender and age distribution. The analysis of summative data indicated no differences between the 2 routes of delivery. There was also no difference in the distribution of final degree classification outcome between the 2 routes. CONCLUSIONS While it is possible that demographic differences influence the outcomes in each training route, this preliminary study indicates that, based only on analysis of overall achievement, there is no difference in either FT or FTE programs in training chiropractors, allowing them to register with the UK regulatory body. It suggests that a nontraditional mode of delivery is an achievable route to qualification as a chiropractor, enabling a greater number of students to consider chiropractic as a career choice while managing other life commitments.
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Shannon ZK, Vining RD, Gudavalli MR, Boesch RJ. High-velocity, low-amplitude spinal manipulation training of prescribed forces and thrust duration: A pilot study. THE JOURNAL OF CHIROPRACTIC EDUCATION 2020; 34:107-115. [PMID: 30951380 PMCID: PMC7682642 DOI: 10.7899/jce-18-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/18/2018] [Accepted: 11/20/2018] [Indexed: 05/14/2023]
Abstract
OBJECTIVE High-velocity, low-amplitude spinal manipulation (HVLA-SM) may generate different therapeutic effects depending on force and duration characteristics. Variability among clinicians suggests training to target specific thrust duration and force levels is necessary to standardize dosing. This pilot study assessed an HVLA-SM training program using prescribed force and thrust characteristics. METHODS Over 4 weeks, chiropractors and students at a chiropractic college delivered thoracic region HVLA-SM to a prone mannequin in six training sessions, each 30 minutes in duration. Force plates embedded in a treatment table were used to measure force over time. Training goals were 350 and 550 Newtons (N) for peak force and ≤150 ms for thrust duration. Verbal and visual feedback was provided after each training thrust. Assessments included 10 consecutive thrusts for each force target without feedback. Mixed-model regression was used to analyze assessments measured before, immediately following, and 1, 4, and 8 weeks after training. RESULTS Error from peak force target, expressed as adjusted mean constant error (standard deviation), went from 107 N (127) at baseline, to 0.2 N (41) immediately after training, and 32 N (53) 8 weeks after training for the 350 N target, and 63 N (148), -6 N (58), and 9 N (87) for the 550 N target. Student median values met thrust duration target, but doctors' were >150 ms immediately after training. CONCLUSION After participation in an HVLA-SM training program, participants more accurately delivered two prescribed peak forces, but accuracy decreased 1 week afterwards. Future HVLA-SM training research should include follow-up of 1 week or more to assess skill retention.
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Derian JM, Smith JA, Wang Y, Lam W, Kulig K. Biomechanical characteristics of lumbar manipulation performed by expert, resident, and student physical therapists. Musculoskelet Sci Pract 2020; 48:102150. [PMID: 32217304 DOI: 10.1016/j.msksp.2020.102150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/16/2019] [Accepted: 03/08/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Lumbar manipulation is a commonly used treatment for low back pain, but little research evidence exists regarding practitioner biomechanics during manipulation. Most existing evidence describes rate of force production through the hands into instrumented manikins and it is unclear how the practitioner moves their body and legs to generate this force. OBJECTIVES To identify and characterize important kinetic and kinematic factors in practitioners of varying experience performing lumbar manipulation in order to identify which factors distinguish experts from less experienced practitioners. STUDY DESIGN This was a cohort observational laboratory study. METHODS 43 male physical therapists (PT) and PT students (4 experts, 11 residents, 13 third year, and 15 first year students) performed 4 manipulations each on asymptomatic patient models. Angular and linear kinematics of the pelvis were measured using motion capture, and ground reaction forces were measured with force plates under the practitioner's feet. RESULTS Peak pelvic angular velocity was greater and in the opposite direction in experts compared to other groups in the frontal plane (p = 0.020) and transverse plane (p = 0.000). Experts had greater downward pelvic linear velocity than third year students and first year students (p = 0.000). Experts also demonstrated faster rate of vertical ground reaction force unloading during the manipulation (p = 0.002). CONCLUSIONS Expert performance of manipulation was characterized by increased speed of linear and angular pelvic motion, and increased modulation of vertical ground reaction force. These results help to inform educators and practitioners that teach and use this complex manual skill.
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Affiliation(s)
- Joseph M Derian
- University of Southern California, Division of Biokinesiology and Physical Therapy. Los Angeles, CA, USA
| | - Jo Armour Smith
- University of Southern California, Division of Biokinesiology and Physical Therapy. Los Angeles, CA, USA; Chapman University, Crean College of Health and Behavioral Sciences, Irvine, CA, USA.
| | - Yue Wang
- University of Southern California, Division of Biokinesiology and Physical Therapy. Los Angeles, CA, USA
| | - Wilson Lam
- University of Southern California, Division of Biokinesiology and Physical Therapy. Los Angeles, CA, USA
| | - Kornelia Kulig
- University of Southern California, Division of Biokinesiology and Physical Therapy. Los Angeles, CA, USA
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Petersen EJ, Thurmond SM, Buchanan SI, Chun DH, Richey AM, Nealon LP. The effect of real-time feedback on learning lumbar spine joint mobilization by entry-level doctor of physical therapy students: a randomized, controlled, crossover trial. J Man Manip Ther 2019; 28:201-211. [PMID: 31593528 DOI: 10.1080/10669817.2019.1673953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To examine the effects of real-time, objective feedback on learning lumbar spine joint mobilization techniques by entry-level Doctor of Physical Therapy (DPT) students. METHODS A randomized, controlled, crossover design was used. Twenty-four 1st Year DPT students were randomized into two groups. Group 1 (n = 12) practiced with the real-time feedback device first and then without it, while Group 2 (n = 12) practiced without the device first and then with it. Both practice periods with and without the device were 4 weeks long. Data were collected at Baseline, 5 weeks, 11 weeks, and 16 weeks. The crossover period was 5 weeks long, during which neither group practiced with or without the device. Eight force parameters were measured: R1 force; R2 force; Grade III and Grade IV mean peak force, frequency, and amplitude. RESULTS When students practiced with the real-time feedback device, they more closely matched the reference standard for two outcomes: 1) the mean difference in R2 force between student and reference standard was better with device (38.0 ± 26.7 N) than without it (51.0 ± 38.5 N); P = .013; and 2) the mean difference in Grade III peak to peak amplitude force was also better with device (8.9 ± 9.3 N) than without it (11.8 ± 11.0); P = .026. All other force parameters improved when students practiced with the real-time feedback device, however, the differences between when they practiced without the device were not statistically significant. DISCUSSION Real-time, objective feedback using a direct force measurement device improved learning for some aspects of lumbar spine joint mobilization by entry-level physical therapy students. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Evan J Petersen
- School of Physical Therapy, University of the Incarnate Word , San Antonio, TX, USA
| | - Stephanie M Thurmond
- School of Physical Therapy, University of the Incarnate Word , San Antonio, TX, USA
| | - Sydney I Buchanan
- School of Physical Therapy, University of the Incarnate Word , San Antonio, TX, USA
| | - Diana H Chun
- School of Physical Therapy, University of the Incarnate Word , San Antonio, TX, USA
| | - Ashley M Richey
- School of Physical Therapy, University of the Incarnate Word , San Antonio, TX, USA
| | - Lauren P Nealon
- School of Physical Therapy, University of the Incarnate Word , San Antonio, TX, USA
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Lardon A, Pasquier M, Audo Y, Barbier-Cazorla F, Descarreaux M. Effects of an 8-week physical exercise program on spinal manipulation biomechanical parameters in a group of 1st-year chiropractic students. THE JOURNAL OF CHIROPRACTIC EDUCATION 2019; 33:118-124. [PMID: 30951379 PMCID: PMC6759008 DOI: 10.7899/jce-18-15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To determine the effects of a physical exercise program on spinal manipulation (SM) performance in 1st-year chiropractic students. METHODS One hundred and thirteen students from 2 chiropractic schools were assigned to 1 of 2 groups: exercise group (EG) for campus A students or control group (CG) (no training) for campus B students. All participated in 2 1-hour experimental training sessions that were added to the usual technique curriculum. At the beginning and at the end of each session, SM thrust duration and preload force release were recorded as dependent variables in 5 trials performed on a force-sensing table for a total of 10 recorded trials per session. The session consisted of several drills during which augmented feedback was provided to students to improve their skills. The EG performed physical exercises (push-ups, core stabilization, and speeder board exercises) 3 times per week for an 8-week period between the 2 training sessions. RESULTS The mean thrust duration increased between the 2 sessions [+0.8 ms (±15.6)]. No difference between groups was found using a t test for independent samples (p = .94). The mean preload force release decreased between the 2 sessions (-6.1 N [±17.1]). Differences between groups were found using a t test for independent samples (p = .03); the results showed a reduction of preload force release in the participants in the EG group compared to those in the CG group (-8.1 N [±16.9] vs -0.3 N [±16.5]). CONCLUSION A physical exercise program seems to be beneficial in the SM learning process; chiropractic students should therefore be encouraged to do home physical exercises to develop their physical capabilities and improve SM delivery.
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Passmore SR, Gelley GM, Malone Q, MacNeil BJ. Tactile Perception of Pressure and Volitional Thrust Intensity Modulate Spinal Manipulation Dose Characteristics. J Manipulative Physiol Ther 2019; 42:335-342. [PMID: 31272711 DOI: 10.1016/j.jmpt.2018.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 10/25/2018] [Accepted: 11/15/2018] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purpose of this study was to examine clinicians' ability to modulate spinal manipulation (SM) thrust characteristics based on their tactile perception of pressure and volitional intensity. METHODS In a cross-sectional, within-participants design, 13 doctors of chiropractic delivered SM thrusts of perceived least, appropriate, or greatest intensity of their perceived safe output level for an SM thrust on low-fidelity thoracic spine models of 4 different pressure levels. The participants performed SM over the course of 96 trials in a randomized order on combinations of thrust intensity and pressure. Dependent variables included normalized preload force, thrust force, thrust duration, peak acceleration, time to peak acceleration, and displacement. For all dependent measures, 2-factor within-participants analysis of variance models with repeated measures on both factors were performed. RESULTS Preload force increased with intensity (F2,24 = 9.72; P < .001) and model pressure (F3,36 = 4.27; P = .011). Participants modulated thrust force and displacement as each also increased with intensity escalation (F2,24 = 22.53, P < .001; F2,18 = 45.20, P < .001). The highest accelerations were observed during the greatest intensity. Increased thrust force was delivered at higher model pressures (F3,36 = 6.43; P < .001). A significant interaction demonstrated that as volitional thrust intensity increased, greater displacement was attained, particularly on low pressure models (F6,54 = 11.06; P < .001). Thrust duration and time to peak acceleration yielded no significant differences. CONCLUSION Spinal manipulation thrust dosage was modulated by the chiropractors' tactile perception of pressure and volitional intensity.
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Affiliation(s)
- Steven R Passmore
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Canada; Health, Leisure, and Human Performance Research Institute, University of Manitoba, Winnipeg, Canada; College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada; Research Department, New York Chiropractic College, Seneca Falls, New York.
| | - Geoffrey M Gelley
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Quinn Malone
- Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, Canada
| | - Brian J MacNeil
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
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Pasquier M, Barbier-Cazorla F, Audo Y, Descarreaux M, Lardon A. Learning spinal manipulation: Gender and expertise differences in biomechanical parameters, accuracy, and variability. THE JOURNAL OF CHIROPRACTIC EDUCATION 2019; 33:1-7. [PMID: 30408423 PMCID: PMC6417869 DOI: 10.7899/jce-18-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 06/23/2018] [Accepted: 07/21/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE: The purpose of this study was to investigate gender differences and expertise effects on biomechanical parameters as well as force accuracy and variability for students learning spinal manipulation. METHODS: A total of 137 fourth- and fifth-year students were recruited for the study. Biomechanical parameters (preload, time to peak force, peak force, rate of force), as well as accuracy and variability of thoracic spine manipulation performance, were evaluated during 5 consecutive trials using a force-sensing table and a target force of 450 N. Gender, expertise differences on biomechanical parameters, as well as constant, variable, and absolute error were assessed using 2-way analysis of variance. RESULTS: Analyses showed significant gender differences for several biomechanical parameters, as well as significant gender differences in accuracy and variability. Although women showed lower time to peak force and rate of force values, they were more precise and showed less variability than men when performing thoracic spine manipulations. Students with clinical expertise (fifth-year students) used less force and were more precise. CONCLUSION: Our results showed that gender differences in spinal manipulation performance exist and that these differences seem to be mainly explained by alternative motor strategies. To develop gender-specific teaching methods, future studies should explore why men and women approach spinal manipulation tasks differently.
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Marchand AA, Mendoza L, Dugas C, Descarreaux M, Pagé I. Effects of practice variability on spinal manipulation learning. THE JOURNAL OF CHIROPRACTIC EDUCATION 2017; 31:90-95. [PMID: 28121458 PMCID: PMC5656152 DOI: 10.7899/jce-16-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate the effects of practice variability on chiropractic students' capacity to deliver spinal manipulations (SMs) of a targeted peak force. METHODS Forty students participated in an experimental session including either a variable or a constant practice protocol of 45 SMs. SMs were delivered on a computer-connected device that recorded force-time profiles. Ten SMs with a target peak force of 350-N were performed before practice, immediately following practice, and 2 days later. Mixed-design analyses of variance were used to assess the effect of practice type on SM biomechanical parameters and on the constant, the absolute error (AE), and the variable error (VE). RESULTS The practice period led to significantly more accurate (FAE[2,76] = 6.17, p < .01) and consistent (FVE[2,76] = 3.90, p = .02) performances at the postintervention assessment regardless of practice type. Among biomechanical parameters, preload force was higher at the retention assessment than at baseline (F[2,76] = 6.53, p < .01), while rate of force application significantly decreased between the baseline and the retention assessment (F[2,76] = 4.10, p = .02). CONCLUSION This experimental study showed that 1 session of SM practice including feedback leads to an increase in SM peak force accuracy and consistency, whether or not the practice period included variable practice. The current results confirmed that short practice periods with feedback should be included in the chiropractic curriculum.
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Pasquier M, Cheron C, Dugas C, Lardon A, Descarreaux M. The Effect of Augmented Feedback and Expertise on Spinal Manipulation Skills: An Experimental Study. J Manipulative Physiol Ther 2017; 40:404-410. [DOI: 10.1016/j.jmpt.2017.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/17/2017] [Accepted: 03/14/2017] [Indexed: 11/24/2022]
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Owens EF, Russell BS, Hosek RS, Sullivan SGB, Dever LL, Mullin L. Changes in adjustment force, speed, and direction factors in chiropractic students after 10 weeks undergoing standard technique training. THE JOURNAL OF CHIROPRACTIC EDUCATION 2017; 32:3-9. [PMID: 28768115 PMCID: PMC5834298 DOI: 10.7899/jce-173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess the force profiles of high-velocity low-amplitude thrusts delivered to a mannequin on a force platform by novice students given only verbal instructions. METHODS Student volunteers untrained in adjusting delivered a series of adjustments to a mannequin on a force platform. Participants performed 3 light, 3 normal, and 3 heavy thrusts on 5 listings specifying contact point, hand, and direction. Force profiles were analyzed for speed and amplitude, consistency, and force discrimination. Two recording sessions occurred 10 weeks apart. RESULTS Sixteen participants (11 females, 5 male) completed the study. Peak forces ranged from 880 to 202 N for heavy thrusts and 322- to 66 N for light thrusts. Thrust rate was from 8.1 to 1.8 Newtons per millisecond. Average coefficients of variability (CV = STD/mean) at each load level (initial/final) were heavy: 17%/15%; normal: 16%/15%; and light: 20%/20%, with 0 as ideal. A force ratio measured students' abilities to distinguish thrust magnitude. The heavy/normal ratio (initial/final) was 1.35/1.39, and the light/normal ratio was 0.70/0.67. CONCLUSIONS At this point, without force feedback being used in the classroom, novice students can produce thrusts that look like those of their teachers and of experienced practitioners, but they may not produce similar speed and force values. They are consistent within and between sessions and can discriminate between light and heavy loads. A natural next step in our educational research will be to measure adjustment factors on more experienced cohorts of students with and without the presence of force-feedback training apparatus.
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Tissue loading created during spinal manipulation in comparison to loading created by passive spinal movements. Sci Rep 2016; 6:38107. [PMID: 27905508 PMCID: PMC5131487 DOI: 10.1038/srep38107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 11/03/2016] [Indexed: 11/08/2022] Open
Abstract
Spinal manipulative therapy (SMT) creates health benefits for some while for others, no benefit or even adverse events. Understanding these differential responses is important to optimize patient care and safety. Toward this, characterizing how loads created by SMT relate to those created by typical motions is fundamental. Using robotic testing, it is now possible to make these comparisons to determine if SMT generates unique loading scenarios. In 12 porcine cadavers, SMT and passive motions were applied to the L3/L4 segment and the resulting kinematics tracked. The L3/L4 segment was removed, mounted in a parallel robot and kinematics of SMT and passive movements replayed robotically. The resulting forces experienced by L3/L4 were collected. Overall, SMT created both significantly greater and smaller loads compared to passive motions, with SMT generating greater anterioposterior peak force (the direction of force application) compared to all passive motions. In some comparisons, SMT did not create significantly different loads in the intact specimen, but did so in specific spinal tissues. Despite methodological differences between studies, SMT forces and loading rates fell below published injury values. Future studies are warranted to understand if loading scenarios unique to SMT confer its differential therapeutic effects.
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Gradl-Dietsch G, Lübke C, Horst K, Simon M, Modabber A, Sönmez TT, Münker R, Nebelung S, Knobe M. Peyton's four-step approach for teaching complex spinal manipulation techniques - a prospective randomized trial. BMC MEDICAL EDUCATION 2016; 16:284. [PMID: 27809905 PMCID: PMC5094089 DOI: 10.1186/s12909-016-0804-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 10/21/2016] [Indexed: 05/15/2023]
Abstract
BACKGROUND The objectives of this prospective randomized trial were to assess the impact of Peyton's four-step approach on the acquisition of complex psychomotor skills and to examine the influence of gender on learning outcomes. METHODS We randomly assigned 95 third to fifth year medical students to an intervention group which received instructions according to Peyton (PG) or a control group, which received conventional teaching (CG). Both groups attended four sessions on the principles of manual therapy and specific manipulative and diagnostic techniques for the spine. We assessed differences in theoretical knowledge (multiple choice (MC) exam) and practical skills (Objective Structured Practical Examination (OSPE)) with respect to type of intervention and gender. Participants took a second OSPE 6 months after completion of the course. RESULTS There were no differences between groups with respect to the MC exam. Students in the PG group scored significantly higher in the OSPE. Gender had no additional impact. Results of the second OSPE showed a significant decline in competency regardless of gender and type of intervention. CONCLUSIONS Peyton's approach is superior to standard instruction for teaching complex spinal manipulation skills regardless of gender. Skills retention was equally low for both techniques.
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Affiliation(s)
- Gertraud Gradl-Dietsch
- Department of Orthopaedic Trauma, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, 52074 Aachen, Germany
| | - Cavan Lübke
- Department of Orthopaedic Trauma, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, 52074 Aachen, Germany
| | - Klemens Horst
- Department of Orthopaedic Trauma, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, 52074 Aachen, Germany
| | - Melanie Simon
- Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, 52074 Aachen, Germany
| | - Ali Modabber
- Department of Oral and Maxillofacial and Plastic Facial Surgery, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, 52074 Aachen, Germany
| | - Tolga T. Sönmez
- Department of Oral and Maxillofacial and Plastic Facial Surgery, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, 52074 Aachen, Germany
| | - Ralf Münker
- Department of Orthopaedics and Trauma Surgery, Bethlehem Hospital Stolberg, 5 Steinfeldstreet, 52222 Stolberg, (Rheinland) Germany
| | - Sven Nebelung
- Department of Radiology, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, 52074 Aachen, Germany
| | - Matthias Knobe
- Department of Orthopaedic Trauma, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, 52074 Aachen, Germany
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González-Sánchez M, Ruiz-Muñoz M, Ávila-Bolívar AB, Cuesta-Vargas AI. Kinematic real-time feedback is more effective than traditional teaching method in learning ankle joint mobilisation: a randomised controlled trial. BMC MEDICAL EDUCATION 2016; 16:261. [PMID: 27716215 PMCID: PMC5054622 DOI: 10.1186/s12909-016-0789-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 09/30/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND To analyse the effect of real-time kinematic feedback (KRTF) when learning two ankle joint mobilisation techniques comparing the results with the traditional teaching method. METHODS Double-blind randomized trial. SETTINGS Faculty of Health Sciences. PARTICIPANTS undergraduate students with no experience in manual therapy. Each student practised intensely for 90 min (45 min for each mobilisation) according to the random methodology assigned (G1: traditional method group and G2: KRTF group). G1: an expert professor supervising the student's practice, the professorstudent ratio was 1:8. G2: placed in front of a station where, while they performed the manoeuvre, they received a KRTF on a laptop. OUTCOME MEASURES total time of mobilisation, time to reach maximum amplitude, maximum angular displacement in the three axes, maximum and average velocity to reach the maximum angular displacement, average velocity during the mobilisation. RESULTS Among the pre-post intervention measurements, there were significant differences within the two groups for all outcome variables, however, G2 (KRTF) achieved significantly greater improvements in kinematic parameters for the two mobilisations (significant increase in displacement, velocity and significant reduction in the mobilisations runtime) than G1. Ankle plantar flexion: G1's measurement stability (post-intervention) ranged between 0.491 and 0.687, while G2's measurement stability ranged between 0.899 and 0.984. Ankle dorsal flexion mobilisation: G1 the measurement stability (post-intervention) ranged from 0.543 and 0.684 while G2 ranged between 0.899 and 0.974. CONCLUSION KRTF was proven to be more effective tool than traditional teaching method in the teaching - learning process of two joint mobilisation techniques. TRIAL REGISTRATION NCT02504710.
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Affiliation(s)
- Manuel González-Sánchez
- Departamento de Fisioterapia, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Arquitecto Francisco Peñalosa s/n. (ampliación Campus Teatinos), 29071 Málaga, Spain
| | - Maria Ruiz-Muñoz
- Departamento de Enfermería y Podología, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | | | - Antonio I. Cuesta-Vargas
- Departamento de Fisioterapia, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Arquitecto Francisco Peñalosa s/n. (ampliación Campus Teatinos), 29071 Málaga, Spain
- School of Clinical Sciences at Queensland University, Brisbane, Australia
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Stainsby BE, Clarke MCS, Egonia JR. Learning spinal manipulation: A best-evidence synthesis of teaching methods. THE JOURNAL OF CHIROPRACTIC EDUCATION 2016; 30:138-151. [PMID: 26998630 PMCID: PMC5067123 DOI: 10.7899/jce-15-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effectiveness of different reported methods used to teach spinal manipulative therapy to chiropractic students. METHODS For this best-evidence literature synthesis, 5 electronic databases were searched from 1900 to 2015. Eligible studies were critically appraised using the criteria of the Scottish Intercollegiate Guidelines Network. Scientifically admissible studies were synthesized following best-evidence synthesis principles. RESULTS Twenty articles were critically appraised, including 9 randomized clinical trials, 9 cohort studies, and 2 systematic reviews/meta-analyses. Eleven articles were accepted as scientifically admissible. The type of teaching method aids included a Thrust in Motion cervical manikin, instrumented cardiopulmonary reanimation manikin, padded contact with a load cell, instrumented treatment table with force sensor/transducer, and Dynadjust instrument. CONCLUSIONS Several different methods exist in the literature for teaching spinal manipulative therapy techniques; however, future research in this developing area of chiropractic education is proposed. It is suggested that various teaching methods be included in the regular curricula of chiropractic colleges to aid in developing manipulation skills, efficiency, and knowledge of performance.
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Hu MT, Hsu AT, Su FC. Kinematic Analyses of the Thumb during Simulated Posteroanterior Glide Mobilization. PLoS One 2016; 11:e0161624. [PMID: 27583407 PMCID: PMC5008622 DOI: 10.1371/journal.pone.0161624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 08/09/2016] [Indexed: 11/20/2022] Open
Abstract
Objective Thumb problems are common in some health professionals such as physical therapists. The purpose of this case-control study is to investigate the influence of clinical experience and different mobilization techniques on the kinematics of the thumb. Methods Twenty-three participants without exposure to manual techniques (the Novice Group) and fifteen physical therapists with at least 3 years of orthopedic experience (the Experienced Group) participated. The kinematics of the thumb while performing 3 different simulated posteroanterior (PA) glide mobilization techniques on a load cell was monitored. These 3 techniques were: 1) unsupported, 2) with digital support and 3) with thumb interphalangeal joint supported by the index finger. The amount of forces exerted were 25% to 100% of maximum effort at 25% increments. The main effects of experience and technique on thumb kinematics were assessed. Results Both experience and technique had main effects on the flexion/extension angles of the thumb joints. Experienced participants assumed a more flexed position at the carpometacarpal (CMC) joint, and the novice participants performed with angles closer to the neutral position (F = 7.593, p = 0.010). Participants’ metacarpophalangeal (MCP) joints were in a more flexed position while performing PA glide with thumb interphalangeal (IP) joint supported by the index as compared to the other two techniques (p < .001). Conclusions Negative correlations were generally obtained between the sagittal plane angles of adjacent thumb joints during mobilization/manipulation. Therapists are recommended to treat patient with more stable PA glide mobilization techniques, such as PA glide with thumb interphalangeal joint supported by the index finger, to prevent potential mobilization-related thumb disorders.
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Affiliation(s)
- Meng-Tzu Hu
- Institute of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
- Department of Physical Therapy, Tzu Hui Institute of Technology, Ping Tung, Taiwan
| | - Ar-Tyan Hsu
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Fong-Chin Su
- Institute of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
- * E-mail:
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O'Donnell M, Smith JA, Abzug A, Kulig K. How should we teach lumbar manipulation? A consensus study. ACTA ACUST UNITED AC 2016; 25:1-10. [PMID: 27422591 DOI: 10.1016/j.math.2016.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/16/2016] [Accepted: 05/20/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Spinal manipulation is an effective intervention for low back pain, yet there is little consistency in how this skill is taught. OBJECTIVES The purpose of this study was to identify what educators and clinicians believe are important characteristics of the patient and operator position prior to side-lying lumbar manipulation and the patient position and operator motion during the manipulative thrust. DESIGN A multi-disciplinary correspondence-based Delphi method. METHODS Three rounds of questionnaires were sent to physical therapists, osteopaths and chiropractors. Consensus was established in Round 3 if at least 75% of respondents identified a characteristic as very important/extremely important on a 5-point Likert scale. RESULTS 265 educators and clinicians completed the three rounds of questioning. There was consensus that localization to target segment, patient comfort, table height, and logrolling the patient towards the operator are important characteristics of patient position during the preparatory phase. During the manipulation phase, respondents agreed that it is important to maintain localization to the segment and rotate the patient's pelvis and lumbar spine. For the operator characteristics, consensus was reached for the following items; moving up and over the patient, maintaining contact using forearms, and close contact between the operator and patient (preparatory phase); generating force through the body and legs, dropping the body downwards, maintaining localization, and providing a high-velocity and low-amplitude thrust (manipulation phase). CONCLUSIONS This Delphi study successfully identified key characteristics of patient position and operator position and motion for effective delivery of side-lying lumbar spine manipulations.
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Affiliation(s)
- Michael O'Donnell
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 East Alcazar Street, CHP-155, Los Angeles, CA 90089, USA
| | - Jo Armour Smith
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 East Alcazar Street, CHP-155, Los Angeles, CA 90089, USA; Department of Physical Therapy, Chapman University, Irvine, CA, USA.
| | - Alex Abzug
- Paulseth and Associates Physical Therapy, Los Angeles, CA, USA
| | - Kornelia Kulig
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 East Alcazar Street, CHP-155, Los Angeles, CA 90089, USA
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Todd AJ, Carroll MT, Mitchell EKL. Forces of Commonly Used Chiropractic Techniques for Children: A Review of the Literature. J Manipulative Physiol Ther 2016; 39:401-410. [PMID: 27346861 DOI: 10.1016/j.jmpt.2016.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 06/11/2015] [Accepted: 06/15/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this study is to review the available literature that describes forces of the most commonly used chiropractic techniques for children. METHODS Review of the English-language literature using search terms Chiropract* and technique, protocol, or approach in databases PubMed, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine, and Index to Chiropractic Literature and direct contact with authors of articles and book chapters. RESULTS Eleven articles that discussed the 7 most commonly used pediatric chiropractic techniques and the forces applied were identified. Chiropractic techniques reviewed described forces that were modified based on the age of the patient. Force data for mechanically assisted devices were varied, with the minimum force settings for some devices outside the age-specific safe range recommended in the literature when not modified in some way. CONCLUSION This review found that technique selection and application by chiropractors treating infants and young children are typically modified in force and speed to suit the age and development of the child.
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Affiliation(s)
| | - Matthew T Carroll
- School of Rural Health-Churchill, Monash University, Churchill, Australia
| | - Eleanor K L Mitchell
- Department of Rural and Indigenous Health, School of Rural Health, Monash University, Moe, Australia; School of Rural Health-East Gippsland, Monash University, Bairnsdale, Australia
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Nougarou F, Pagé I, Loranger M, Dugas C, Descarreaux M. Neuromechanical response to spinal manipulation therapy: effects of a constant rate of force application. Altern Ther Health Med 2016; 16:161. [PMID: 27249939 PMCID: PMC4890324 DOI: 10.1186/s12906-016-1153-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 05/28/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Neuromechanical responses to spinal manipulation therapy (SMT) have been shown to be modulated through the variation of SMT biomechanical parameters: peak force, time to peak force, and preload force. Although rate of force application was modulated by the variation of these parameters, the assumption that neuromuscular responses are modulated by the rate of force application remains to be confirmed. Therefore, the purpose of the present study was to evaluate the effect of a constant rate of force application in neuromechanical responses to SMT in healthy adults. METHODS Four SMT force-time profiles presenting different time to peak force and peak force, but with a constant rate of force application were applied on 25 healthy participants' T7 transverse processes. Muscular responses were recorded through surface electromyography electrodes (T6 and T8 levels), while vertebral displacements were assessed through pasted kinematic markers on T6 to T8 spinous processes. Effects of SMT force-time profiles on neuromechanical responses were assessed using repeated-measures ANOVAs. RESULTS There was no main effect of SMT force-time profile modulation on muscular responses (ps > .05) except for the left T8 (F (3, 72) = 3.23, p = .03) and left T6 (F (3, 72) = 2.94, p = .04). Muscular responses were significantly lower for the lowest peak force condition than the highest (for T8) or second highest (for T6). Analysis showed that increasing the SMT peak force (and concomitantly time to peak force) led to a significant vertebral displacement increase for the contacted vertebra (F T7 (1, 17) = 354.80, p < .001) and both adjacent vertebras (F T6 (1, 12) = 104.71, p < .001 and F T8 (1, 19) = 468.68, p < .001). CONCLUSION This study showed that peak force modulation using constant rate of force application leads to similar neuromuscular responses. Coupled with previous investigations of SMT peak force and duration effects, the results suggest that neuromuscular responses to SMT are mostly influenced by the rate of force application, while peak force modulation yields changes in the vertebral displacement. Rate of force application should therefore be defined in future studies. Clinical implications of various SMT dosages in patients with spine related pain should also be investigated. TRIAL REGISTRATION ClinicalTrials.gov NCT02550132 . Registered 8 September 2015.
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Lardon A, Cheron C, Pagé I, Dugas C, Descarreaux M. Systematic Augmented Feedback and Dependency in Spinal Manipulation Learning: a Randomized Comparative Study. J Manipulative Physiol Ther 2016; 39:185-91. [DOI: 10.1016/j.jmpt.2016.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 11/19/2015] [Accepted: 01/20/2016] [Indexed: 10/22/2022]
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Loranger M, Treboz J, Boucher JA, Nougarou F, Dugas C, Descarreaux M. Correlation of expertise with error detection skills of force application during spinal manipulation learning. THE JOURNAL OF CHIROPRACTIC EDUCATION 2016; 30:1-6. [PMID: 26270897 PMCID: PMC4770989 DOI: 10.7899/jce-15-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Most studies on spinal manipulation learning demonstrate the relevance of including motor learning strategies in chiropractic curricula. Two outcomes of practice are the production of movement in an efficient manner and the improved capability of learners to evaluate their own motor performance. The goals of this study were to evaluate if expertise is associated with increased spinal manipulation proficiency and if error detection skills of force application during a high-velocity low-amplitude spinal manipulation are related to expertise. METHODS Three groups of students and 1 group of expert chiropractors completed 10 thoracic spine manipulations on an instrumented device with the specific goal of reaching a maximum peak force of 300 N after a brief period of practice. After each trial, participants were asked to give an estimate of their maximal peak force. Force-time profiles were analyzed to determine the biomechanical parameters of each participant and the participant's capacity to estimate his or her own performance. RESULTS Significant between-group differences were found for each biomechanical parameter. No significant difference was found between groups for the error detection variables (p > .05). The lack of significant effects related to the error detection capabilities with expertise could be related to the specificity of the task and how the training process was structured. CONCLUSION This study confirms that improvements in biomechanical parameters of spinal manipulation are related to expertise. Feedback based on error detection could be implemented in chiropractic curricula to improve trainee abilities in detecting motor execution errors.
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Engell S, Triano JJ, Fox JR, Langevin HM, Konofagou EE. Differential displacement of soft tissue layers from manual therapy loading. Clin Biomech (Bristol, Avon) 2016; 33:66-72. [PMID: 26954891 DOI: 10.1016/j.clinbiomech.2016.02.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 01/05/2016] [Accepted: 02/17/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Understanding the biomechanics of spinal manipulative therapy requires knowing how loads are transmitted to deeper structures. This investigation monitored displacement at sequential depths in thoracic paraspinal tissues parallel with surface load directions. METHODS Participants were prone and a typical preload maneuver was applied to thoracic tissues. Ultrasound speckle tracking synchronously monitored displacement and shear deformation of tissue layers in a region of interest adjacent to load application to a depth of 4 cm. Cumulative and shearing displacements along with myoelectric activity were quantitatively estimated adjacent to loading site. FINDINGS The cephalocaudal cumulative displacement in layers parallel to the surface were, in order of depth, 1.27 (SD=0.03), 1.18 (SD=0.02), and 1.06 (SD=0.01) mm (P<0.000), respectively. The superficial/intermediate shear was 2.1 ± 2.3% whereas the intermediate/deep shear was 4.4% (SE=3.7, P=0.014). Correlation of tissue layers was stronger with application site displacement at the surface (0.87<r<0.89) than with muscle activation (0.65<r<0.67). INTERPRETATION Surface loading of the torso in combined posteroanterior and caudocephalic directions result in both displacement of tissues anteriorly and in shearing between tissue layers in the plane of the tissues strata to depths that could plausibly affect spinal tissues. Displacements of tissues more likely arise passively, consistent with load transmitted by the retinacula cutis and epimuscular force pathways. Displacements are similar in magnitude to those known to evoke biologically relevant responses in both animal and human studies.
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Affiliation(s)
- Shawn Engell
- Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - John J Triano
- Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
| | - James R Fox
- Department of Neurological Sciences, College of Medicine, University of Vermont, Burlington, VT, USA
| | - Helene M Langevin
- Department of Neurological Sciences, College of Medicine, University of Vermont, Burlington, VT, USA; Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - Elisa E Konofagou
- Biomedical Engineering and Radiology, Columbia University, New York, NY, USA
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Chapman PD, Stomski NJ, Losco B, Walker BF. The simulated early learning of cervical spine manipulation technique utilising mannequins. Chiropr Man Therap 2015; 23:23. [PMID: 26240752 PMCID: PMC4522963 DOI: 10.1186/s12998-015-0067-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 06/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trivial pain or minor soreness commonly follows neck manipulation and has been estimated at one in three treatments. In addition, rare catastrophic events can occur. Some of these incidents have been ascribed to poor technique where the neck is rotated too far. The aims of this study were to design an instrument to measure competency of neck manipulation in beginning students when using a simulation mannequin, and then examine the suitability of using a simulation mannequin to teach the early psychomotor skills for neck chiropractic manipulative therapy. METHODS We developed an initial set of questionnaire items and then used an expert panel to assess an instrument for neck manipulation competency among chiropractic students. The study sample comprised all 41 fourth year 2014 chiropractic students at Murdoch University. Students were randomly allocated into either a usual learning or mannequin group. All participants crossed over to undertake the alternative learning method after four weeks. A chi-square test was used to examine differences between groups in the proportion of students achieving an overall pass mark at baseline, four weeks, and eight weeks. RESULTS This study was conducted between January and March 2014. We successfully developed an instrument of measurement to assess neck manipulation competency in chiropractic students. We then randomised 41 participants to first undertake either "usual learning" (n = 19) or "mannequin learning" (n = 22) for early neck manipulation training. There were no significant differences between groups in the overall pass rate at baseline (χ(2) = 0.10, p = 0.75), four weeks (χ(2) = 0.40, p = 0.53), and eight weeks (χ(2) = 0.07, p = 0.79). CONCLUSIONS This study demonstrates that the use of a mannequin does not affect the manipulation competency grades of early learning students at short term follow up. Our findings have potentially important safety implications as the results indicate that students could initially gain competence in neck manipulation by using mannequins before proceeding to perform neck manipulation on each other.
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Affiliation(s)
| | - Norman J Stomski
- />School of Health Professions, Murdoch University, 90 South St, Murdoch, 6150 WA Australia
| | - Barrett Losco
- />Discipline of Chiropractic, School of Health Professions, Murdoch University, 90 South St, Murdoch, 6150 WA Australia
| | - Bruce F Walker
- />Discipline of Chiropractic, School of Health Professions, Murdoch University, 90 South St, Murdoch, 6150 WA Australia
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Cuesta-Vargas AI, González-Sánchez M, Lenfant Y. Inertial Sensors as Real-Time Feedback Improve Learning Posterior-Anterior Thoracic Manipulation: A Randomized Controlled Trial. J Manipulative Physiol Ther 2015. [DOI: 10.1016/j.jmpt.2015.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Consistency and Malleability of Manipulation Performance in Experienced Clinicians: A Pre-Post Experimental Design. J Manipulative Physiol Ther 2015. [DOI: 10.1016/j.jmpt.2015.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Descarreaux M, Dugas C, Treboz J, Cheron C, Nougarou F. Learning spinal manipulation: the effect of expertise on transfer capability. J Manipulative Physiol Ther 2015; 38:269-74. [PMID: 25925020 DOI: 10.1016/j.jmpt.2015.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/04/2015] [Accepted: 02/18/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Transfer capability represents the changes in performance in one task that result from practice or experience in other related tasks. Increased transfer capability has been associated with expertise in several motor tasks. The purpose of this study was to investigate if expertise in spinal manipulation therapy, assessed in groups of trainees and experienced chiropractors, is associated with increased transfer capabilities. METHODS Forty-nine chiropractic students (fifth- and sixth-year students) and experienced chiropractors were asked to perform blocks of 10 thoracic spine manipulations in 3 different conditions: preferred position and table setting, increased table height, and unstable support surface. Spinal manipulations were performed on a computer-connected device developed to emulate a prone thoracic spine manipulation. Thrust duration, thrust force rate of force application, and preload force were obtained for each trial and compared across groups and conditions. RESULTS Results indicated that both expertise and performance conditions modulated the biomechanical parameters of spinal manipulation. Decreased thrust duration and increased rate of force application were observed in experienced clinicians, whereas thrust force and thrust rate of force application were significantly decreased when task difficulty was increased. Increasing task difficulty also led to significant increases in performance variability. CONCLUSION Overall, this study suggests that when instructed to perform spinal manipulation in a challenging context, trainees and experts choose to modulate force to optimize thrust duration, a characteristic feature of high-velocity, low-amplitude spinal manipulation. Given its known association with motor proficiency, transfer capability assessments should be considered in spinal manipulative therapy training.
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Affiliation(s)
- Martin Descarreaux
- Full Professor, Département des sciences de l'activité physique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec.
| | - Claude Dugas
- Full Professor, Département des sciences de l'activité physique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec
| | - Julien Treboz
- Enseignant, Domaine des sciences cliniques et examens du patient, Institut Franco-Européen de Chiropratique (IFEC), Toulouse, France
| | - Charlène Cheron
- Enseignant, Domaine d'intégration des savoirs et savoirs faire en chiropraxie, Institut Franco-Européen de Chiropratique (IFEC), Toulouse, France
| | - François Nougarou
- Postdoctoral Fellow, Département des sciences de l'activité physique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec
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Gudavalli MR, Vining RD, Salsbury SA, Corber L, Long CR, Patwardhan AG, Goertz CM. Clinician proficiency in delivering manual treatment for neck pain within specified force ranges. Spine J 2015; 15:570-6. [PMID: 25452013 PMCID: PMC4375060 DOI: 10.1016/j.spinee.2014.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 07/23/2014] [Accepted: 10/16/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Neck pain is a common musculoskeletal complaint responsive to manual therapies. Doctors of chiropractic commonly use manual cervical distraction, a mobilization procedure, to treat neck pain patients. However, it is unknown if clinicians can consistently apply standardized cervical traction forces, a critical step toward identifying an optimal therapeutic dose. PURPOSE To assess clinicians' proficiency in delivering manually applied traction forces within specified ranges to neck pain patients. STUDY DESIGN An observational study nested within a randomized clinical trial. SAMPLE Two research clinicians provided study interventions to 48 participants with neck pain. OUTCOME MEASURES Clinician proficiency in delivering cervical traction forces within three specified ranges (low force, less than 20 N; medium force, 21-50 N; and high force 51-100 N). METHODS Participants were randomly allocated to three force-based treatment groups. Participants received five manual cervical distraction treatments over 2 weeks while lying prone on a treatment table instrumented with force sensors. Two clinicians delivered manual traction forces according to treatment groups. Clinicians treated participants first without real-time visual feedback displaying traction force and then with visual feedback. Peak traction force data were extracted and descriptively analyzed. RESULTS Clinicians delivered manual cervical distraction treatments within the prescribed traction force ranges 75% of the time without visual feedback and 97% of the time with visual feedback. CONCLUSIONS This study demonstrates that doctors of chiropractic can successfully deliver prescribed traction forces while treating neck pain patients, enabling the capability to conduct force-based dose response clinical studies.
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Affiliation(s)
- Maruti Ram Gudavalli
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, Davenport, IA 52803, USA.
| | | | | | - Lance Corber
- Palmer Center for Chiropractic Research, Davenport, IA, USA
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Gudavalli MR. Instantaneous rate of loading during manual high-velocity, low-amplitude spinal manipulations. J Manipulative Physiol Ther 2015; 37:294-9. [PMID: 24928638 DOI: 10.1016/j.jmpt.2014.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 01/09/2014] [Accepted: 01/09/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to determine the instantaneous rate of loading during manual high-velocity, low-amplitude spinal manipulations (HVLA SMs) in the lumbar and thoracic regions and compare to the average rates of loading. METHODS Force-time profiles were recorded using a hand force transducer placed between the hand of a doctor of chiropractic and the subject's back during 14 HVLA SM thrusts on asymptomatic volunteers while 3 doctors of chiropractic delivered the spinal manipulations. Doctors also delivered 36 posterior to anterior thoracic manipulations on a mannequin. Data were collected at a sampling rate of 1000 Hz using Motion Monitor software. Force-time profile data were differentiated to obtain instantaneous rates of loading. The data were reduced using a custom-written MathCad program and analyzed descriptively. RESULTS The instantaneous rates of loading were 1.7 to 1.8 times higher than average rates of loading, and instantaneous rates of unloading were 2.1 to 2.6 times the average rates of unloading during HVLA SMs. Maximum instantaneous rates of loading occurred 102 to 111 milliseconds prior to peak load. Maximum instantaneous rates of unloading occurred 121 to 154 milliseconds after the peak load. These data may be useful for further understanding of HVLA SMs. CONCLUSIONS The instantaneous rates of loading and where they occurred may be useful data for understanding and describing HVLA SMs.
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Gudavalli MR, Vining RD, Salsbury SA, Goertz CM. Training and certification of doctors of chiropractic in delivering manual cervical traction forces: Results of a longitudinal observational study. THE JOURNAL OF CHIROPRACTIC EDUCATION 2014; 28:130-8. [PMID: 25237767 PMCID: PMC4211585 DOI: 10.7899/jce-14-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/03/2014] [Accepted: 07/19/2014] [Indexed: 05/27/2023]
Abstract
Objective : Doctors of chiropractic (DCs) use manual cervical distraction to treat patients with neck pain. Previous research demonstrates variability in traction forces generated by different DCs. This article reports on a training protocol and monthly certification process using bioengineering technology to standardize cervical traction force delivery among clinicians. Methods : This longitudinal observational study evaluated a training and certification process for DCs who provided force-based manual cervical distraction during a randomized clinical trial. The DCs completed a 7-week initial training that included instructional lectures, observation, and guided practice by a clinical expert, followed by 3 hours of weekly practice sessions delivering the technique to asymptomatic volunteers who served as simulated patients. An instrument-modified table and computer software provided the DCs with real-time audible and visual feedback on the traction forces they generated and graphical displays of the magnitude of traction forces as a function of time immediately after the delivery of the treatment. The DCs completed monthly certifications on traction force delivery throughout the trial. Descriptive accounts of certification attempts are provided. Results : Two DCs achieved certification in traction force delivery over 10 consecutive months. No certification required more than 3 attempts at C5 and occiput contacts for 3 force ranges (0-20 N, 21-50 N, and 51-100 N). Conclusions : This study demonstrates the feasibility of a training protocol and certification process using bioengineering technology for training DCs to deliver manual cervical distraction within specified traction force ranges over a 10-month period.
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Snider EJ, Pamperin K, Johnson JC, Shurtz NR, Degenhardt BF. Assessing palpation thresholds of osteopathic medical students using static models of the lumbar spine. J Osteopath Med 2014; 114:460-9. [PMID: 24917633 DOI: 10.7556/jaoa.2014.096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Although spinal somatic dysfunction diagnosis is taught at all colleges of osteopathic medicine, few objective measures have been used to evaluate student accuracy. OBJECTIVE To assess the palpatory skills of osteopathic medical students in evaluating positional asymmetry in the transverse plane using static block transverse process and lumbar spine models. METHODS For this observational study, first-year osteopathic medical students completed 3 palpatory assessments using uncovered and covered block transverse process and lumbar spine models to simulate a range of positional asymmetries of the transverse processes. With use of logistic regression, 80%, 90%, and 95% thresholds were defined as the magnitude of asymmetry for which the predicted probability of students correctly determining the direction of asymmetry exceeded a specified amount (.80, .90, or .95). RESULTS A total of 346 students completed the assessments. For the uncovered block transverse process model (assessment 1), students correctly identified the direction of asymmetry with .89 probability at 1 mm of asymmetry (80% threshold), .94 probability at 2 mm (90% threshold), and .95 probability at 3 mm (95% threshold). For the covered block transverse process model, students correctly identified the direction of asymmetry with .80 probability at 1 mm (80% threshold), .92 probability at 2 mm (90% threshold), and .98 probability at 3 mm (95% threshold) by the third assessment. For the uncovered lumbar spine model (assessment 2), students correctly identified the direction of asymmetry with .93 probability at 2 mm (80% and 90% thresholds) and .95 probability at 3 mm (95% threshold). For the covered lumbar spine model (assessments 2 and 3), students correctly identified the direction of asymmetry with .87 probability at 4 mm (80% threshold); 90% and 95% thresholds were not reached with the range of asymmetries tested. CONCLUSION Most first-year osteopathic medical students were able to discern the direction of positional asymmetry of transverse processes on static models. Depending on the model type, student performance improved (block transverse process models) or declined (lumbar spine models) over time. Future studies should evaluate whether accuracy of palpating lumbar spine models translates to accuracy of palpating human lumbar spines.
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Affiliation(s)
- Eric J Snider
- From the Department of Neurobehavioral Sciences at the A.T. Still University-Kirksville College of Osteopathic Medicine (Dr Snider); the A.T. Still Research Institute at A.T. Still University (Drs Snider and Degenhardt and Ms Johnson); and Research Support at A.T. Still University (Mr Pamperin, Ms Johnson, and Ms Shurtz), all in Kirksville, Missouri
| | - Kenneth Pamperin
- From the Department of Neurobehavioral Sciences at the A.T. Still University-Kirksville College of Osteopathic Medicine (Dr Snider); the A.T. Still Research Institute at A.T. Still University (Drs Snider and Degenhardt and Ms Johnson); and Research Support at A.T. Still University (Mr Pamperin, Ms Johnson, and Ms Shurtz), all in Kirksville, Missouri
| | - Jane C Johnson
- From the Department of Neurobehavioral Sciences at the A.T. Still University-Kirksville College of Osteopathic Medicine (Dr Snider); the A.T. Still Research Institute at A.T. Still University (Drs Snider and Degenhardt and Ms Johnson); and Research Support at A.T. Still University (Mr Pamperin, Ms Johnson, and Ms Shurtz), all in Kirksville, Missouri
| | - Natalie R Shurtz
- From the Department of Neurobehavioral Sciences at the A.T. Still University-Kirksville College of Osteopathic Medicine (Dr Snider); the A.T. Still Research Institute at A.T. Still University (Drs Snider and Degenhardt and Ms Johnson); and Research Support at A.T. Still University (Mr Pamperin, Ms Johnson, and Ms Shurtz), all in Kirksville, Missouri
| | - Brian F Degenhardt
- From the Department of Neurobehavioral Sciences at the A.T. Still University-Kirksville College of Osteopathic Medicine (Dr Snider); the A.T. Still Research Institute at A.T. Still University (Drs Snider and Degenhardt and Ms Johnson); and Research Support at A.T. Still University (Mr Pamperin, Ms Johnson, and Ms Shurtz), all in Kirksville, Missouri
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The Role of Preload Forces in Spinal Manipulation: Experimental Investigation of Kinematic and Electromyographic Responses in Healthy Adults. J Manipulative Physiol Ther 2014; 37:287-93. [DOI: 10.1016/j.jmpt.2014.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 04/14/2014] [Accepted: 04/29/2014] [Indexed: 11/18/2022]
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Williams JM, Cuesta-Vargas A. Quantification of Prone Thoracic Manipulation Using Inertial Sensor–Derived Accelerations. J Manipulative Physiol Ther 2014; 37:230-5. [DOI: 10.1016/j.jmpt.2014.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 01/04/2014] [Accepted: 01/09/2014] [Indexed: 10/25/2022]
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Triano JJ, McGregor M, Dinulos M, Tran S. Staging the use of teaching aids in the development of manipulation skill. ACTA ACUST UNITED AC 2014; 19:184-9. [PMID: 24503216 DOI: 10.1016/j.math.2014.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 01/06/2014] [Accepted: 01/13/2014] [Indexed: 10/25/2022]
Abstract
Skill development in manual therapies is influenced by a number of factors. The effects of the training program organization, mentor coaching, feedback in various forms, and electromechanical training aids are factors that have been studied. A significant gap exists in understanding when teaching aids might be most effective within a defined curriculum structure. This project used the ratio of instructional theory and laboratory practice to define the learning context. An electromechanical training aid (Dynadjust™) was introduced at different stages (year 2 and year 4) of training for high-velocity, low-amplitude (HVLA) manipulation. Learners were assigned to either the Aid group or the NoAid group. Independent assessment of skill was evaluated before and after 6 weeks by means of recording force-time profiles of HVLA performance. Repeated measures analysis of variance (ANOVA) evaluated change scores in the force amplitude and rate of rise in force. Program features were dominated by a low ratio of laboratory practice to didactic foundational education components. Use of the aid was not associated with any measurable gains for participants when used in year 2. Later participation in year 4 suggested enhanced development in rate of rise for force (p < 0.0597) and for peak force (p < 0.0303). Careful attention should be given to the sequencing of content and laboratory work in designing curricula for training programs. For programs using lower ratios of laboratory contact hours, teaching aids to augment practice may result in better performance gains when introduced later than if added early in the curriculum.
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Affiliation(s)
- John J Triano
- Graduate Education and Research Program, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, Canada M2H J1.
| | - Marion McGregor
- Graduate Education and Research Program, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, Canada M2H J1
| | - Maricelle Dinulos
- Graduate Education and Research Program, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, Canada M2H J1
| | - Steven Tran
- Biomechanics and Elastography Laboratory, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, Canada M2H J1
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Quesnele JJ, Triano JJ, Noseworthy MD, Wells GD. Changes in vertebral artery blood flow following various head positions and cervical spine manipulation. J Manipulative Physiol Ther 2013; 37:22-31. [PMID: 24239451 DOI: 10.1016/j.jmpt.2013.07.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 07/12/2013] [Accepted: 07/31/2013] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The objective of the study was to investigate the cerebrovascular hemodynamic response of cervical spine positions including rotation and cervical spine manipulation in vivo using magnetic resonance imaging technology on the vertebral artery (VA). METHODS This pilot study was conducted as a blinded examiner cohort with 4 randomized clinical tasks. Ten healthy male participants aged 24 to 30 years (mean, 26.8 years) volunteered to participate in the study. None of the participants had a history of disabling neck, arm, or headache pain within the last 6 months. They did not have any current or history of neurologic symptoms. In a neutral head position, physiologic measures of VA blood flow and velocity at the C1-2 spinal level were obtained using phase-contrast magnetic resonance imaging after 3 different head positions and a chiropractic upper cervical spinal manipulation. A total of 30 flow-encoded phase-contrast images were collected over the cardiac cycle, in each of the 4 conditions, and were used to provide a blood flow profile for one complete cardiac cycle. Differences between flow (in milliliters per second) and velocity (in centimeters per second) variables were evaluated using repeated-measures analysis of variance. RESULTS The side-to-side difference between ipsilateral and contralateral VA velocities was not significant for either velocities (P = .14) or flows (P = .19) throughout the conditions. There were no other interactions or trends toward a difference for any of the other blood flow or velocity variables. CONCLUSIONS There were no significant changes in blood flow or velocity in the vertebral arteries of healthy young male adults after various head positions and cervical spine manipulations.
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Affiliation(s)
- Jairus J Quesnele
- Chiropractor, Private Practice, Division of Graduate Studies, Clinical Sciences, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada..
| | - John J Triano
- Professor, Dean of Graduate Studies and Research, Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Michael D Noseworthy
- Associate Professor, Electrical and Computer Engineering School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada; Director, Imaging Research Centre, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Greg D Wells
- Assistant Professor, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
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Nougarou F, Dugas C, Deslauriers C, Pagé I, Descarreaux M. Physiological responses to spinal manipulation therapy: investigation of the relationship between electromyographic responses and peak force. J Manipulative Physiol Ther 2013; 36:557-63. [PMID: 24161387 DOI: 10.1016/j.jmpt.2013.08.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 08/12/2013] [Accepted: 08/14/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE It is believed that systematic modulation of spinal manipulative therapy (SMT) parameters should yield varying levels of physiological responses and eventually a range of clinical responses. However, investigation of SMT dose-physiological response relationship is recent and has mostly been conducted using animal or cadaveric models. The main objective of the present study is to investigate SMT dose-physiological response relation in humans by determining how different levels of force can modify electromyographic (EMG) responses to spinal manipulation. METHODS Twenty-six participants were subjected to 2 trials of 4 different SMT force-time profiles using a servo-controlled linear actuator motor. Normalized EMG activity of paraspinal muscles (left and right muscles at level T6 and T8) was recorded during and after SMT, and EMG values were compared across the varying levels of force. RESULTS Increasing the level of force yielded an increase in paraspinal muscle EMG activity during the thrust phase of SMT but also in the two 250-millisecond time windows after the spinal manipulation impulse. These muscle activations quickly attenuated (500 milliseconds after spinal manipulation impulse). CONCLUSION The study confirmed the presence of a local paraspinal EMG response after SMT and highlighted the linear relationship between the SMT peak force and paraspinal muscle activation.
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Affiliation(s)
- François Nougarou
- Postdoctoral Fellowship, Département de Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
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Force-Time Profile Differences in the Delivery of Simulated Toggle-Recoil Spinal Manipulation by Students, Instructors, and Field Doctors of Chiropractic. J Manipulative Physiol Ther 2013; 36:342-8. [DOI: 10.1016/j.jmpt.2013.05.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 04/19/2013] [Accepted: 05/17/2013] [Indexed: 11/22/2022]
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Effect of sampling rates on the quantification of forces, durations, and rates of loading of simulated side posture high-velocity, low-amplitude lumbar spine manipulation. J Manipulative Physiol Ther 2013; 36:261-6. [PMID: 23790603 DOI: 10.1016/j.jmpt.2013.05.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 12/21/2012] [Accepted: 01/18/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Quantification of chiropractic high-velocity, low-amplitude spinal manipulation (HVLA-SM) may require biomechanical equipment capable of sampling data at high rates. However, there are few studies reported in the literature regarding the minimal sampling rate required to record the HVLA-SM force-time profile data accurately and precisely. The purpose of this study was to investigate the effect of different sampling rates on the quantification of forces, durations, and rates of loading of simulated side posture lumbar spine HVLA-SM delivered by doctors of chiropractic. METHODS Five doctors of chiropractic (DCs) and 5 asymptomatic participants were recruited for this study. Force-time profiles were recorded during (i) 52 simulated HVLA-SM thrusts to a force transducer placed on a force plate by 2 DCs and (ii) 12 lumbar side posture HVLA-SM on 5 participants by 3 DCs. Data sampling rate of the force plate remained the same at 1000 Hz, whereas the sampling rate of the force transducer varied at 50, 100, 200, and 500 Hz. The data were reduced using custom-written MATLAB (Mathworks, Inc, Natick, MA) and MathCad (version 15; Parametric Technologies, Natick, MA) programs and analyzed descriptively. RESULTS The average differences in the computed durations and rates of loading are smaller than 5% between 50 and 1000 Hz sampling rates. The differences in the computed preloads and peak loads are smaller than 3%. CONCLUSIONS The small differences observed in the characteristics of force-time profiles of simulated manual HVLA-SM thrusts measured using various sampling rates suggest that a sampling rate as low as 50 to 100 Hz may be sufficient. The results are applicable to the manipulation performed in this study: manual side posture lumbar spine HVLA-SM.
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Entwicklung und Relevanz biomechanischer Parameter einer Manipulationstechnik. MANUELLE MEDIZIN 2013. [DOI: 10.1007/s00337-013-1033-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Myers CA, Enebo BA, Davidson BS. Optimized prediction of contact force application during side-lying lumbar manipulation. J Manipulative Physiol Ther 2013. [PMID: 23206961 DOI: 10.1016/j.jmpt.2012.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The purposes of this study included the following: (1) to predict L3 contact force during side-lying lumbar manipulation by combining direct and indirect measurements into a single mathematical framework and (2) to assess the accuracy and confidence of predicting L3 contact force using common least squares (CLS) and weighted least squares (WLS) methods. METHODS Five participants with no history of lumbar pain underwent 10 high-velocity, low-amplitude lumbar spinal manipulations at L3 in a side-lying position. Data from 5 low-force criterion standard trials where the L3 contact force was directly measured were used to generate participant-specific force prediction algorithms. These algorithms were used to predict L3 contact force in 5 experimental trials performed at therapeutic levels. The accuracy and effectiveness of CLS and WLS methods were compared. RESULTS Differences between the CLS-predicted forces and the criterion standard-measured forces were 621.0 ± 193.5 N. Differences between the WLS-predicted forces and the criterion standard-measured forces were -3.6 ± 9.1 N. The 95% limits of agreement ranged from 234.0 to 1008.0 N for the CLS and -21.9 to 14.7 N for the WLS. During both the criterion standard and experimental trials, the CLS overestimated contact forces with larger variance than the WLS. CONCLUSION This novel method to predict spinal contact force combines direct and indirect measurements into a single framework and preserves clinically relevant practitioner-participant contacts. As advanced instrumentation becomes available, this framework will enable advancements in training and high-quality research on mechanisms of spinal manipulative therapy.
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Affiliation(s)
- Casey A Myers
- Mechanical and Materials Engineering, University of Denver, Denver, CO, USA
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