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… Show more
“…3,6 Some work has been done to describe how loads differ when applied to various regions of the spine. 11 Efforts are now underway to use force feedback in training to help standardize the delivery of adjustments in clinical trials 12,13 and in education. Early chiropractic education, where students are taught first to deliver manual thrusts, has been revolutionized by the addition of force and speed feedback and training devices.…”
These faculty members delivered a range of thrusts, not unlike those seen in the literature for high velocity, low amplitude manipulation. We have established at least minimum force and speed targets for student performance, but more work must be done to create a normative adjustment to guide refinement of student learning.
“…3,6 Some work has been done to describe how loads differ when applied to various regions of the spine. 11 Efforts are now underway to use force feedback in training to help standardize the delivery of adjustments in clinical trials 12,13 and in education. Early chiropractic education, where students are taught first to deliver manual thrusts, has been revolutionized by the addition of force and speed feedback and training devices.…”
These faculty members delivered a range of thrusts, not unlike those seen in the literature for high velocity, low amplitude manipulation. We have established at least minimum force and speed targets for student performance, but more work must be done to create a normative adjustment to guide refinement of student learning.
“…24 Future studies may address this gap by assessing skill retention over time with additional instruction, such as instructor feedback, video feedback, a comparative reference for visual feedback, or modifying the number and frequency of practice thrusts and training sessions. Gudavalli et al [17][18][19] demonstrated that the recertification of ability to deliver prespecified forces using a low velocity manipulation may be necessary to maintain skill over time, which may generalize to HVLA-SM performance.…”
Section: Discussionmentioning
confidence: 99%
“…The ability to deliver prescribed manipulative forces consistently also is necessary to address some questions related to treatment dosing, which can be answered only by applying standardized manipulative forces and loading rates. [17][18][19] Force-sensing technology has been used to train participants to deliver prescribed forces within wide ranges, 20 as a percentage of the clinician's maximum force, 21 and doubling or halving a clinician's typical force. 14 These training methods appear to decrease intraclinician variability, but they do not address the problem of inconsistent force delivery among clinicians.…”
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), À6 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.
“…Dosing was limited to three sets of five repetitions with contact over the C5 cervical vertebra and three sets of five repetitions with contact on the occiput. To insure inter- and intra-clinician proficiency in treatment implementation [ 46 ], we conducted pre-trial training sessions and monthly clinician recertification on traction force delivery using a process described elsewhere [ 43 ]. Fig.…”
Section: Methodsmentioning
confidence: 99%
“…Based on the results of these preliminary studies, we concluded that developing a low-force minimal intervention will be a better choice than a sham treatment. We next developed a force feedback technology [ 42 ] to allow clinicians to deliver MCD within distinct traction force ranges, and tested a training and certification process using this technology [ 43 ]. These data led us to conclude that MCD could be delivered consistently within three different traction force ranges [ 44 ].…”
BackgroundManual cervical distraction (MCD) is a traction-based therapy performed with a manual contact over the cervical region producing repeating cycles while patients lie prone. This study evaluated a traction force-based minimal intervention for use as an attention-touch control in clinical trials of MCD for patients with chronic neck pain.MethodsWe conducted a mixed-methods, pilot randomized clinical trial in adults with chronic neck pain. Participants were allocated to three traction force ranges of MCD: low force/minimal intervention (0-20 N), medium force (21-50 N), or high force (51-100 N). Clinicians delivered five treatments over two weeks consisting of three sets of five cycles of MCD at the C5 vertebra and occiput. Traction forces were measured at each treatment. Patient-reported outcomes included a pain visual analogue scale (VAS), Neck Disability Index (NDI), Credibility and Expectancy Questionnaire (CEQ), and adverse effects. A qualitative interview evaluated treatment group allocation perceptions.ResultsWe randomized 48 participants, allocating an average of five each month. Forty-five participants completed the trial with three participants lost to follow-up. Most participants were women (65 %) and white (92 %) with a mean (SD) age of 46.8 (12.5) years. Mean traction force values were within the prescribed force ranges for each group at the C5 and occiput levels. Neck pain VAS demonstrated a benefit for high traction force MCD compared to the low force group [adjusted mean difference 15.6; 95 % confidence interval (CI) 1.6 to 29.7]. Participants in the medium traction force group demonstrated improvements in NDI compared to the low force group (adjusted mean difference 3.0; 95 % CI 0.1 to 5.9), as did participants in the high traction force group (adjusted mean difference 2.7; 95 % CI -0.1 to 5.6). CEQ favored the high force group. Most low force participants correctly identified their treatment allocation in the qualitative interview. No serious adverse events were documented.ConclusionsThis pilot study demonstrated the feasibility of a clinical trial protocol and the utility of a traction-based, minimal intervention as an attention-touch control for future efficacy trials of MCD for patients with neck pain.Trial registrationClinicalTrials.gov NCT01765751 (Registration Date 30 May 2012)
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