Developing skilled performance of lumbar spine manipulation.

OBJECTIVE

To quantify elements of spinal manipulation therapy performance and to test the strategy of combined rehearsal and quantitative feedback as a means of enhancing student skill development.

DESIGN

Randomized, controlled study.

SETTING

Chiropractic college.

SUBJECTS

Thirty-nine chiropractic student volunteers entering the manipulation technique training course participated after providing informed consent.

METHODS

Student performance of lumbar spinal manipulation therapy was quantified at the beginning, middle, and end of a trimester with a manipulation table imbedded with an AMTI force plate. Loads acting passing through the L5/S1 functional spinal unit were estimated by inverse dynamics. Participating students rehearsed the mamillary push, diversified procedure following either the standard curriculum alone or a modified curriculum adding a training aid as assigned on a randomized basis. Student's t and chi(2) tests were used to explore and describe biomechanical parameter changes over time as the semester progressed.

RESULTS

Significant changes in performance between the standard curriculum and modified curriculum were observed in several biomechanical parameters.

CONCLUSION

The reported project used a rehearsal program defined empirically and was self-administered in practice by the student. Results demonstrated significant changes in performance of spinal manipulation by students using the training aid instrument versus those who did not. With quantitative training aids and biomechanical measurement systems, future training programs may be optimized and tested.