Learning lumbar spine mobilization: the effects of frequency and self-control of feedback.
METHODS
Controlled laboratory study, longitudinal.


OBJECTIVE
To investigate the effects of frequency and self-control of feedback on physiotherapy students learning lumbar spinal mobilization.


BACKGROUND
Posterior-to-anterior mobilization is included in most physiotherapy curricula. However, force application varies between therapists and the optimal feedback for learning is unknown.


METHODS
Sixty-two physiotherapy students were randomized to 3 feedback groups: constant (100% of practice trials), intermittent (33%), and self-controlled (varied according to student choice) feedback. Students performed 12 practice trials of grade II posterior-to-anterior mobilization to the third lumbar vertebra while receiving real-time feedback. The differences between students' force parameters (mean peak force [N], force amplitude [N], and oscillation frequency [Hz]) and those of a physiotherapist expert were compared between groups posttest and at a follow-up of 5 to 7 days using analysis of covariance. Students completed a survey regarding their perceptions of feedback.


RESULTS
Students in the self-controlled group applied mean peak force (mean difference between student and expert, 6.7 N; 95% confidence interval [CI]: 4.4, 9.0) and force amplitude (6.3 N; 95% CI: 4.2, 8.4) that more closely matched the expert's than those applied by the constant group (13.7 N; 95% CI: 8.7, 18.6; P = .021, and 13.1 N; 95% CI: 8.9, 17.4; P = .028) at posttest, with similar results at follow-up for force amplitude only (self-controlled, 9.5 N; 95% CI: 5.8, 18.1; constant, 21.0 N; 95% CI: 13.3, 28.7; P = .018). There were no other significant differences. All students reported a better understanding of manual force application, but feedback preferences varied.


CONCLUSIONS
Self-controlled feedback appears to be more beneficial than constant feedback for students learning to apply forces during lumbar mobilization.
Physiotherapist, Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, Callaghan, NSW, Australia. Emma.Sheaves@uon.edu.au
Emma G
EG
Sheaves
Suzanne J
SJ
Snodgrass
Darren A
DA
Rivett
D005246:Feedback; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008161:Lumbosacral Region / Q000503:physiopathology*; D009048:Motor Skills; D026201:Musculoskeletal Manipulations / Q000193:education*; D026761:Physical Therapy Specialty / Q000193:education* / Q000379:methods