Triano John J, Lester Steven, Starmer David, Hewitt Elise G
Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
J Manipulative Physiol Ther. 2017 Mar-Apr;40(3):139-146. doi: 10.1016/j.jmpt.2017.01.001. Epub 2017 Mar 6.
The purpose of this work was to create an exploratory database of manipulation treatment force variability as a function of the intent of an experienced clinician sub-specializing in the care of children to match treatment to childhood category. Data of this type are necessary for realistic planning of dose-response and safety studies on therapeutic benefit.
The project evaluated the transmitted peak forces of procedures applied to mannequins of different stature for younger and older children. Common procedures for the cervical, thoracic, and lumbar spine and sacroiliac joint were administered to estimate variability by a single experienced practitioner and educator in pediatric manipulation attempting to modulate for childhood category. Results described for peak components in the cardinal axes and for peak total forces were cataloged and compared with consensus estimates of force from the literature.
Mean force values for both components and total force peaks monotonically increased with childhood category analogous to consensus expectations. However, a mismatch was observed between peak values measured and consensus predictions that ranged by a factor of 2 to 3.5, particularly in the upper categories. Quantitative data permit a first estimate of effect size for future clinical studies.
The findings of this study indicate that recalibration of spinal manipulation performance of experienced clinicians toward arbitrary target values similar to consensus estimates is feasible. What is unclear from the literature or these results is the identity of legitimate target values that are both safe and clinically effective based on childhood categories in actual practice.
本研究旨在创建一个探索性数据库，记录从事儿童护理的经验丰富的临床专科医生根据儿童类别进行治疗时手法治疗力的变异性。这类数据对于治疗益处的剂量反应和安全性研究的实际规划是必要的。
该项目评估了应用于不同身高儿童人体模型的手法所传递的峰值力。由一名经验丰富的儿科手法治疗从业者和教育者对颈椎、胸椎、腰椎和骶髂关节的常见手法进行操作，以估计变异性，并尝试根据儿童类别进行调整。记录了主要轴向上的峰值分量和峰值总力的结果，并与文献中的力的共识估计值进行比较。
分量和总力峰值的平均力值均随儿童类别单调增加，与共识预期一致。然而，观察到测量的峰值与共识预测之间存在不匹配，相差2至3.5倍，特别是在较高类别中。定量数据可为未来的临床研究提供效应大小的初步估计。
本研究结果表明，将经验丰富的临床医生的脊柱手法操作重新校准到与共识估计相似的任意目标值是可行的。从文献或这些结果中尚不清楚的是，在实际实践中基于儿童类别既安全又具有临床疗效的合理目标值的具体情况。
