title: Consistency and malleability of manipulation performance in experienced clinicians: a pre-post experimental design.
abstract: OBJECTIVE
  The purpose of this study was to sample the stability of spinal manipulation performance in peak impulse force development over time and the ability of clinicians to adapt to arbitrary target levels with short-duration training.
  
  
  METHODS
  A pre-post experimental design was used. Human analog mannequins provided standardized simulation for performance measures. A convenience sample was recruited consisting of 41 local doctors of chiropractic with 5 years of active clinical practice experience. Thoracic impulse force was measured among clinicians at baseline, after 4 months at pretraining, and again posttraining. Intraclass correlation coefficient values and within-subject variability defined consistency. Malleability was measured by reduction of error (paired t tests) in achieving arbitrary targeted levels of force development normalized to the individual's typical performance.
  
  
  RESULTS
  No difference was observed in subgroup vs baseline group characteristics. Good consistency was observed in force-time profiles (0.55 ≤ intraclass correlation coefficient ≤ 0.75) for force parameters over the 4-month interval. With short intervals of focused training, error rates in force delivery were reduced by 23% to 45%, depending on target. Within-subject variability was 1/3 to 1/2 that of between-subject variability. Load increases were directly related to rate of loading.
  
  
  CONCLUSIONS
  The findings of this study show that recalibration of spinal manipulation performance of experienced clinicians toward arbitrary target values in the thoracic spine is feasible. This study found that experienced clinicians are internally consistent in performance of procedures under standardized conditions and that focused training may help clinicians learn to modulate procedure characteristics.
authors.affiliation: Professor, Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada. Electronic address: jtriano@cmcc.ca.
authors.forename: John J
authors.initials: JJ
authors.lastname: Triano
authors.affiliation: Educational Coordinator, Simulation Laboratory, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
authors.forename: Dominic
authors.initials: D
authors.lastname: Giuliano
authors.affiliation: Clinical Sciences Resident, Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
authors.forename: Ismat
authors.initials: I
authors.lastname: Kanga
authors.affiliation: Instructor, Chiropractic Therapeutics, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Starmer
authors.affiliation: Student, Undergraduate Program, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Brazeau
authors.affiliation: Student, Undergraduate Program, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
authors.forename: C Elaine
authors.initials: CE
authors.lastname: Screaton
authors.affiliation: Student, Undergraduate Program, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
authors.forename: Curtis
authors.initials: C
authors.lastname: Semple
mesh_terms: D000328:Adult; D002170:Canada; D002684:Chiropractic / Q000193:education; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008297:Male; D008348:Manikins; D020393:Manipulation, Spinal / Q000379:methods*; D012107:Research Design; D013647:Task Performance and Analysis
keywords: Chiropractic; Clinical; Manipulation; Reliability of Results; Skills