Quantitative feedback versus standard training for cervical and thoracic manipulation

Objective: To quantify elements of spinal manipulation therapy performance and to test the strategy of combined rehearsal and quantitative feedback as a means of enhancing student skill development for cervical and thoracic manipulative procedures. Design: Randomized, controlled study. Setting: Chiropractic college. Subjects: Thirty-nine chiropractic student volunteers entering the manipulation technique training course. Methods: Student performance of cervical and thoracic spinal manipulation therapies were quantified at the beginning, middle, and end of a trimester using a Leader 900 Z series manipulation table (Leader International, Port Orchard, Wash) embedded with an AMTI force plate. Passive loads acting through the targeted (C2 or T7) functional spinal units were estimated using inverse dynamics. Participating students rehearsed the index transverse (C2) and single pisiform-transverse (T7) procedures following either the standard curriculum alone or a modified curriculum adding the Dynadjust Instrument training aid (Labarge, Inc.), as assigned on a randomized basis. Student t and chi-square tests were used to explore and describe biomechanical parameter changes over time as the semester progressed. Results: Significant changes in performance between the standard curriculum and modified curriculum (with the Dynadjust) were observed for several, but different, biomechanical parameters of cervical and thoracic procedures. Conclusion: This project used a rehearsal program that provided quantitative feedback on an empirically defined schedule that was self-administered by the student. Results demonstrated significant changes in performance of spinal manipulation by students using the Dynadjust Instrument versus those who did not. Using quantitative feedback provided from training aids and biomechanical measurement systems, future training programs may be optimized and tested.