title: Clinician proficiency in delivering manual treatment for neck pain within specified force ranges.
abstract: BACKGROUND
  Neck pain is a common musculoskeletal complaint responsive to manual therapies. Doctors of chiropractic commonly use manual cervical distraction, a mobilization procedure, to treat neck pain patients. However, it is unknown if clinicians can consistently apply standardized cervical traction forces, a critical step toward identifying an optimal therapeutic dose.
  
  
  OBJECTIVE
  To assess clinicians' proficiency in delivering manually applied traction forces within specified ranges to neck pain patients.
  
  
  METHODS
  An observational study nested within a randomized clinical trial.
  
  
  METHODS
  Two research clinicians provided study interventions to 48 participants with neck pain.
  
  
  METHODS
  Clinician proficiency in delivering cervical traction forces within three specified ranges (low force, less than 20 N; medium force, 21-50 N; and high force 51-100 N).
  
  
  METHODS
  Participants were randomly allocated to three force-based treatment groups. Participants received five manual cervical distraction treatments over 2 weeks while lying prone on a treatment table instrumented with force sensors. Two clinicians delivered manual traction forces according to treatment groups. Clinicians treated participants first without real-time visual feedback displaying traction force and then with visual feedback. Peak traction force data were extracted and descriptively analyzed.
  
  
  RESULTS
  Clinicians delivered manual cervical distraction treatments within the prescribed traction force ranges 75% of the time without visual feedback and 97% of the time with visual feedback.
  
  
  CONCLUSIONS
  This study demonstrates that doctors of chiropractic can successfully deliver prescribed traction forces while treating neck pain patients, enabling the capability to conduct force-based dose response clinical studies.
authors.affiliation: Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, Davenport, IA 52803, USA. Electronic address: Gudavalli_r@palmer.edu.
authors.forename: Maruti Ram
authors.initials: MR
authors.lastname: Gudavalli
authors.affiliation: Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, Davenport, IA 52803, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Vining
authors.affiliation: Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, Davenport, IA 52803, USA.
authors.forename: Stacie A
authors.initials: SA
authors.lastname: Salsbury
authors.affiliation: Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, Davenport, IA 52803, USA.
authors.forename: Lance G
authors.initials: LG
authors.lastname: Corber
authors.affiliation: Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, Davenport, IA 52803, USA.
authors.forename: Cynthia R
authors.initials: CR
authors.lastname: Long
authors.affiliation: Department of Orthopaedic Surgery & Rehab, Loyola University Stritch School of Medicine, 2160 S. First Avenue, Maywood, IL 06153, USA.
authors.forename: Avinash G
authors.initials: AG
authors.lastname: Patwardhan
authors.affiliation: Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, Davenport, IA 52803, USA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Goertz
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D001696:Biomechanical Phenomena; D026882:Manipulation, Chiropractic / Q000379:methods / Q000592:standards; D020393:Manipulation, Spinal / Q000379:methods / Q000592:standards; D019547:Neck Pain / Q000628:therapy; D010820:Physicians / Q000592:standards; D016032:Randomized Controlled Trials as Topic
keywords: Biomechanics; Chiropractic; Clinician training; Dose; Manual therapy; Mobilization; Neck pain; Traction forces