Effects of Visual Feedback on Manipulation Performance and Patient Ratings
Received 18 January 2005; received in revised form 9 January 2006
Abstract
Objective
This study examined the explicit targeted outcome (a criterion standard) and visual feedback on the immediate change in and the short-term retention of performance by novice operators for a high-velocity, low-amplitude procedure under realistic conditions.
Methods
This study used a single-blind randomized experimental design. Forty healthy male (n = 26) and female (n = 14) chiropractic student volunteers with no formal training in spinal manipulative therapy participated. Biomechanical parameters of an L4 mammillary push spinal manipulation procedure performed by novice operators were quantified. Participants were randomly assigned to 2 groups and paired. One group received visual feedback from load-time histories of their performance compared with a criterion standard before a repeat performance. Participants then performed a 10-minute distractive exercise consisting of National Board of Chiropractic Examiners review questions. The second group received no feedback. An independent rating of performance was conducted for each participant by his/her partner. Results were analyzed separately for biomechanical parameters for partner ratings using the Student t test with levels of significance (P < .01) adjusted for repeated testing.
Results
Expressed in percent change for each individual, visual feedback was associated with change in the biomechanical performance of group 2, a minimum of 14% and a maximum of 32%. Statistical analysis rating of the performance favored the feedback group on 4 of the parameters (fast, P < .0008; force, P < .0056; precision, P < .0034; and composite, P < .0016).
Conclusion
Quantitative feedback, based on a tangible conceptualization of the target performance, resulted in immediate and significant improvement in all measured parameters. Newly developed skills were retained at least over short intervals even after distractive tasks. Learning what to do with feedback on one's own performance may be more important than the classic teaching of how to do it.
aQuality Improvement and Outcomes Coordinator, Texas Back Institute, Plano, Tex; Research Professor, University of Texas, Arlington, Tex; and Associate Dean of Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
bSouthern California University of Health Sciences, Whittier, Calif
cSouthern California University of Health Sciences, Whittier, Calif
dTexas Back Institute, Plano, Tex; and Innovative Spinal Technologies, Mansfield, Mass
Submit requests for reprints to: John J. Triano, DC, PhD, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, Canada M2H 3J1.
ABSTRACT