Maiers Michele J, Sundin Alexander R, Oster Ryan J, Kreul Steven, Malone Quinn, Passmore Steven R
Northwestern Health Sciences University, Bloomington, MN, USA.
RAND Research Across Complementary and Integrative Health Institutions (REACH) Center, Santa Monica, CA, USA.
Chiropr Man Therap. 2025 May 21;33(1):20. doi: 10.1186/s12998-025-00584-1.
Contextual factors influence clinicians' delivery of force-based manipulation (FBM), like spinal manipulative therapy (SMT). It is particularly important to discern how contextual factors interact with therapeutic forces delivered to an older adult population, to minimize risk and identify ideal dosage. This study aimed to determine whether contextual factors pertaining to aging result in the modulation of kinetic and kinematic parameters used by experienced clinicians when delivering SMT.
Participants were randomly presented with a series of 12 AI-generated patient vignettes, featuring both visual and auditory content and representing varying age-related contextual factors. Factors included chronological (35-, 65- and 85-year-old), pathological ("healthy" vs degenerative spine), and felt (perceived as "young" vs. "old") age. Participants delivered SMT to a human analogue manikin based on each vignette, presented six times in randomized order. Kinetic and kinematic parameters were collected and analyzed for differences between "young" and "old" contextual factors of age, using a 3-way repeated measures ANOVA model.
Sixteen licensed chiropractors (8 female, 8 male) participated, with an average age of 45.4 (SD = 9.7, range 34-64) years and 18.3 (SD = 10.8, range 5-39) years of experience. A main effect in peak force was found for both chronological (F() = 26.18; p <.001, η = 0.636) and pathological age (F() = 11.58; p =.004, η = 0.436), following a stepwise progression of decreased force with increased age and with pathology. No statistically significant differences were found in peak force based on felt age, or in time to peak force for any factor. A main effect was found for chronological age with peak acceleration (F() = 9.50; p <.001, η = 0.487) and peak velocity (F() = 7.20; p =.004, η = 0.419), but not for pathological or felt age. There was a significant difference in time to peak velocity for felt age (F() = 12.23; p =.006, η = 0.550), with a shorter time to peak velocity in response to vignettes with older felt age.
Contextual factors of aging modulated certain kinetic and kinematic characteristics when delivering SMT. This provides evidence that practitioners differentially discern aspects of aging to inform how they deliver FBM dosage. Future research is needed to identify ideal kinetic and kinematic characteristics based on considerations of aging.
情境因素会影响临床医生实施基于力的手法治疗（FBM），如脊柱手法治疗（SMT）。辨别情境因素如何与施加于老年人群的治疗力相互作用，以将风险降至最低并确定理想剂量尤为重要。本研究旨在确定与衰老相关的情境因素是否会调节经验丰富的临床医生在实施SMT时所使用的动力学和运动学参数。
参与者被随机呈现一系列12个由人工智能生成的患者案例，这些案例具有视觉和听觉内容，并代表不同的与年龄相关的情境因素。因素包括实际年龄（35岁、65岁和85岁）、病理状况（“健康”与脊柱退变）以及感觉年龄（被感知为“年轻”与“年老”）。参与者根据每个案例对一个人体模拟模型进行SMT，案例以随机顺序呈现六次。收集并分析动力学和运动学参数，以使用三因素重复测量方差分析模型比较年龄的“年轻”和“年老”情境因素之间的差异。
16名有执照的脊椎按摩师（8名女性，8名男性）参与了研究，平均年龄为45.4岁（标准差=9.7，范围34 - 64岁），平均从业经验为18.3年（标准差=10.8，范围5 - 39年）。发现实际年龄（F() = 26.18；p <.001，η = 0.636）和病理年龄（F() = 11.58；p =.004，η = 0.436）对峰值力均有主效应，随着年龄增长和病理状况的出现，力呈逐步下降趋势。基于感觉年龄的峰值力或任何因素的峰值力到达时间均未发现统计学上的显著差异。发现实际年龄对峰值加速度（F() = 9.50；p <.001，η = 0.487）和峰值速度（F() = 7.20；p =.004，η = 0.419）有主效应，但病理年龄或感觉年龄无此效应。感觉年龄的峰值速度到达时间存在显著差异（F() = 12.23；p =.006，η = 0.550），对于感觉年龄较大案例的反应，峰值速度到达时间较短。
衰老的情境因素在实施SMT时调节了某些动力学和运动学特征。这提供了证据表明从业者会以不同方式辨别衰老的各个方面，从而为他们如何实施FBM剂量提供依据。未来需要开展研究，基于对衰老的考虑来确定理想的动力学和运动学特征。
