title: Can a rescuer or simulated patient accurately assess motion during cervical spine stabilization practice sessions?
abstract: BACKGROUND
  Health care providers must be prepared to manage all potential spine injuries as if they are unstable. Therefore, most sport teams devote resources to training for sideline cervical spine (C-spine) emergencies.
  
  
  OBJECTIVE
  To determine (1) how accurately rescuers and simulated patients can assess motion during C-spine stabilization practice and (2) whether providing performance feedback to rescuers influences their choice of stabilization technique.
  
  
  METHODS
  Crossover study.
  
  
  METHODS
  Training studio.
  
  
  METHODS
  Athletic trainers, athletic therapists, and physiotherapists experienced at managing suspected C-spine injuries.
  
  
  METHODS
  Twelve lead rescuers (at the patient's head) performed both the head-squeeze and trap-squeeze C-spine stabilization maneuvers during 4 test scenarios: lift-and-slide and log-roll placement on a spine board and confused patient trying to sit up or rotate the head.
  
  
  METHODS
  Interrater reliability between rescuer and simulated patient quality scores for subjective evaluation of C-spine stabilization during trials (O = best, 10 = worst), correlation between rescuers' quality scores and objective measures of motion with inertial measurement units, and frequency of change in preference for the head-squeeze versus trap-squeeze maneuver.
  
  
  RESULTS
  Although the weighted κ value for interrater reliability was acceptable (0.71-0.74), scores varied by 2 points or more between rescuers and simulated patients for approximately 10% to 15% of trials. Rescuers' scores correlated with objective measures, but variability was large: 38% of trials scored as 0 or 1 by the rescuer involved more than 10° of motion in at least 1 direction. Feedback did not affect the preference for the lift-and-slide placement. For the log-roll placement, 6 of 8 participants who preferred the head squeeze at baseline preferred the trap squeeze after feedback. For the confused patient, 5 of 5 participants initially preferred the head squeeze but preferred the trap squeeze after feedback.
  
  
  CONCLUSIONS
  Rescuers and simulated patients could not adequately assess performance during C-spine stabilization maneuvers without objective measures. Providing immediate feedback in this context is a promising tool for changing behavior preferences and improving training.
authors.affiliation: Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, McGill University, Montreal, QC, Canada.
authors.forename: Ian
authors.initials: I
authors.lastname: Shrier
authors.forename: Patrick
authors.initials: P
authors.lastname: Boissy
authors.forename: Simon
authors.initials: S
authors.lastname: Brière
authors.forename: Jay
authors.initials: J
authors.lastname: Mellette
authors.forename: Luc
authors.initials: L
authors.lastname: Fecteau
authors.forename: Gordon O
authors.initials: GO
authors.lastname: Matheson
authors.forename: Daniel
authors.initials: D
authors.lastname: Garza
authors.forename: Willem H
authors.initials: WH
authors.lastname: Meeuwisse
authors.forename: Eli
authors.initials: E
authors.lastname: Segal
authors.forename: John
authors.initials: J
authors.lastname: Boulay
authors.forename: Russell J
authors.initials: RJ
authors.lastname: Steele
mesh_terms: D001265:Athletic Injuries; D002574:Cervical Vertebrae / Q000293:injuries; D018592:Cross-Over Studies; D019416:Head Movements; D006801:Humans; D007103:Immobilization; D009038:Motion; D019838:Neck Injuries; D018635:Rescue Work; D057566:Self Report; D013124:Spinal Injuries; D013131:Spine; D058254:Stretchers