title: Learning spinal manipulation: the importance of augmented feedback relating to various kinetic parameters.
abstract: BACKGROUND
  Spinal manipulation is a widely accepted therapeutic approach in the treatment of back pain. In standard training programs, feedback on student performances is provided by an instructor based on teaching and clinical experience. Systematic study of the type of augmented feedback provided and skill learning is lacking in the literature.
  
  
  OBJECTIVE
  The goal of this investigation is to compare the performance of two groups of chiropractic students, one receiving traditional training from experienced instructors, and the other, augmented feedback on specific biomechanical aspects of spinal manipulation therapy using an instrumented manikin.
  
  
  METHODS
  Randomized controlled study.
  
  
  METHODS
  Thirty-one fourth-year students from the Department of Chiropractic of Université du Québec à Trois-Rivières participated in this study.
  
  
  METHODS
  Kinetic parameters (force-time curves) of spinal manipulation were evaluated.
  
  
  METHODS
  Spinal manipulation parameters were measured before and after a 5-week training period in which one group received standard chiropractic training while a second group received augmented feedback about specific biomechanical parameters of spinal manipulation. For both groups, practice scheduling and time duration were similar and consisted of a weekly practice session of 90 minutes for five consecutive weeks. Both groups had to practice thoracic spine manipulation throughout the training period.
  
  
  RESULTS
  Both groups showed a decrease in peak force applied, with a diminution in the number of trials where a downward incisural point was present in preload force. Participants in the feedback training group significantly reduced their peak force variability and significantly increased their preload force. No significant difference was observed for time to peak force.
  
  
  CONCLUSIONS
  The results of this study highlight the merits of practicing with an instrumented manikin or other instrumented training aids. Such a device can provide specific feedback on specific parameters of the task during learning; it can also serve as a tool to assess the progress of students and eliminate the risks relating to repetitive spinal manipulative therapy practice on student colleagues.
authors.affiliation: Département de Chiropratique, Université du Québec à Trois-Rivières, 3351 boul, Des Forges, Trois-Rivières, Qc, Canada G9A 5H7. Martin_descarreaux@uqtr.ca
authors.forename: Martin
authors.initials: M
authors.lastname: Descarreaux
authors.forename: Claude
authors.initials: C
authors.lastname: Dugas
authors.forename: Kim
authors.initials: K
authors.lastname: Lalanne
authors.forename: Mireille
authors.initials: M
authors.lastname: Vincelette
authors.forename: Martin C
authors.initials: MC
authors.lastname: Normand
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D002684:Chiropractic / Q000193:education*; D002983:Clinical Competence; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005246:Feedback; D005260:Female; D006801:Humans; D007721:Knowledge of Results, Psychological; D007858:Learning; D008297:Male; D008348:Manikins; D026882:Manipulation, Chiropractic; D015397:Program Evaluation; D011897:Random Allocation