Developing skilled performance of lumbar spine 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.


METHODS
Randomized, controlled study.


METHODS
Chiropractic college.


METHODS
Thirty-nine chiropractic student volunteers entering the manipulation technique training course participated after providing informed consent.


METHODS
Student performance of lumbar spinal manipulation therapy was quantified at the beginning, middle, and end of a trimester with a manipulation table imbedded with an AMTI force plate. Loads acting passing through the L5/S1 functional spinal unit were estimated by inverse dynamics. Participating students rehearsed the mamillary push, diversified procedure following either the standard curriculum alone or a modified curriculum adding a training aid as assigned on a randomized basis. Student's t and chi(2) 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 were observed in several biomechanical parameters.


CONCLUSIONS
The reported project used a rehearsal program defined empirically and was self-administered in practice by the student. Results demonstrated significant changes in performance of spinal manipulation by students using the training aid instrument versus those who did not. With quantitative training aids and biomechanical measurement systems, future training programs may be optimized and tested.
University of Texas, Southwestern and Arlington Joint Biomedical Engineering Program and Texas Back Institute, Plano, Texas 75093, USA.
John J
JJ
Triano
Carolyn M
CM
Rogers
Sarah
S
Combs
David
D
Potts
Kenneth
K
Sorrels
D000328:Adult; D001696:Biomechanical Phenomena; D002684:Chiropractic / Q000193:education* / Q000592:standards; D002983:Clinical Competence / Q000592:standards*; D003479:Curriculum / Q000592:standards*; D004504:Education, Medical, Undergraduate / Q000592:standards*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008159:Lumbar Vertebrae; D008297:Male; D026882:Manipulation, Chiropractic / Q000379:methods* / Q000592:standards*; D015397:Program Evaluation; D013337:Students, Medical / Q000523:psychology; D013663:Teaching / Q000379:methods; D013781:Texas