Shannon Zacariah K, Vining Robert D, Gudavalli Maruti Ram, Boesch Ron J
J Chiropr Educ. 2020 Oct 1;34(2):107-115. doi: 10.7899/JCE-18-19.
High-velocity, low-amplitude spinal manipulation (HVLA-SM) may generate different therapeutic effects depending on force and duration characteristics. Variability among clinicians suggests training to target specific thrust duration and force levels is necessary to standardize dosing. This pilot study assessed an HVLA-SM training program using prescribed force and thrust characteristics.
Over 4 weeks, chiropractors and students at a chiropractic college delivered thoracic region HVLA-SM to a prone mannequin in six training sessions, each 30 minutes in duration. Force plates embedded in a treatment table were used to measure force over time. Training goals were 350 and 550 Newtons (N) for peak force and ≤150 ms for thrust duration. Verbal and visual feedback was provided after each training thrust. Assessments included 10 consecutive thrusts for each force target without feedback. Mixed-model regression was used to analyze assessments measured before, immediately following, and 1, 4, and 8 weeks after training.
Error from peak force target, expressed as adjusted mean constant error (standard deviation), went from 107 N (127) at baseline, to 0.2 N (41) immediately after training, and 32 N (53) 8 weeks after training for the 350 N target, and 63 N (148), -6 N (58), and 9 N (87) for the 550 N target. Student median values met thrust duration target, but doctors' were >150 ms immediately after training.
After participation in an HVLA-SM training program, participants more accurately delivered two prescribed peak forces, but accuracy decreased 1 week afterwards. Future HVLA-SM training research should include follow-up of 1 week or more to assess skill retention.
高速低幅脊柱整复术（HVLA-SM）可能会根据力和持续时间特性产生不同的治疗效果。临床医生之间的差异表明，针对特定的推力持续时间和力水平进行培训对于标准化剂量是必要的。这项初步研究评估了一个使用规定的力和推力特性的HVLA-SM培训项目。
在4周的时间里，一所脊椎按摩疗法学院的脊椎按摩师和学生在六次培训课程中对一个俯卧的人体模型进行胸部区域的HVLA-SM，每次课程持续30分钟。嵌入治疗台的测力板用于测量随时间变化的力。训练目标是峰值力为350和550牛顿（N），推力持续时间≤150毫秒。每次训练推力后提供言语和视觉反馈。评估包括在没有反馈的情况下针对每个力目标进行10次连续推力。使用混合模型回归分析在训练前、训练后立即以及训练后1、4和8周测量的评估结果。
峰值力目标的误差，以调整后的平均常数误差（标准差）表示，对于350 N目标，从基线时的107 N（127），训练后立即降至0.2 N（41），训练后8周降至32 N（53）；对于550 N目标，分别为63 N（148）、-6 N（58）和9 N（87）。学生的中位数达到了推力持续时间目标，但医生在训练后立即超过了150毫秒。
参与HVLA-SM培训项目后，参与者更准确地施加了两个规定的峰值力，但1周后准确性下降。未来的HVLA-SM培训研究应包括1周或更长时间的随访，以评估技能保持情况。
