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 tableimbedded 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 aidas assigned on a randomized basis. Student's t and χ2 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. (J Manipulative Physiol Ther 2002;25:353-61)