A model for teaching and learning spinal thrust manipulation and its effect on participant confidence in technique performance

Abstract

Background: Despite emerging evidence to support the use of high velocity thrust manipulation in the management of lumbar spinal conditions, utilization of thrust manipulation among clinicians remains relatively low. One reason for the underutilization of these procedures may be related to disparity in training in the performance of these techniques at the professional and post professional levels. Purpose: To assess the effect of using a new model of active learning on participant confidence in the performance of spinal thrust manipulation and the implications for its use in the professional and postprofessional training of physical therapists. Methods: A cohort of 15 DPT students in their final semester of entry-level professional training participated in an active training session emphasizing a sequential partial task practice (SPTP) strategy in which participants engaged in partial task practice over several repetitions with different partners. Participants' level of confidence in the performance of these techniques was determined through comparison of preand post-training session surveys and a post-session open-ended interview. Results: The increase in scores across all items of the individual pre-and post-session surveys suggests that this model was effective in changing overall participant perception regarding the effectiveness and safety of these techniques and in increasing student confidence in their performance. Interviews revealed that participants greatly preferred the SPTP strategy, which enhanced their confidence in technique performance. Conclusion: Results indicate that this new model of psychomotor training may be effective at improving confidence in the performance of spinal thrust manipulation and, subsequently, may be useful for encouraging the future use of these techniques in the care of individuals with impairments of the spine. Inasmuch, this method of instruction may be useful for training of physical therapists at both the professional and post-professional levels.

The evolution of manual therapy education: what are we waiting for?

“…Finally, teaching MT should not be so homogeneous across educational institutions, reflecting a single perspective based on the lens and experiences of a single educator. Although early learners need more guided direction and rules to develop clinical decision-making, build confidence in psychomotor skills [28], and gain mastery, it is important to provide students with multiple MT perspectives and tools which, in the spirit of graded exposure principles, foster the creativity to treat each individual patient differently and, more importantly, based on their unique biopsychosocial context.…”

Investigation of reaction force magnitude and orientation during supine thoracic thrust manipulation applied to intervertebral and costovertebral regions.

“…orientation and shape), thrust direction and force might be important characteristics for determining success of manipulation techniques (Evans and Breen, 2006;Herzog, 2010), however assessment of reaction force orientation is lacking in the literature. Characterizing such biomechanical features may be useful for teaching and learning supine thoracic thrust manipulation to clinicians for both students and professionals (Wise et al, 2016).…”

High-velocity, low-amplitude spinal manipulation training of prescribed forces and thrust duration: A pilot study

“…2,3 Strategies used to provide feedback include partial practice, which includes doctor-patient positioning without a manipulative thrust, and complete practice, which includes delivering a manipulative thrust. [4][5][6] Students participating in complete practice are able to deliver HVLA-SM thrusts more like those of experienced clinicians when comparing rate of force production. 5 However, repeated practice of dynamic thrusts with human, simulated patients raises safety concerns.…”

“…Complete HVLA-SM practice can be accomplished with force-sensing technology incorporated into hand-interface devices or platform systems measuring thrust characteristics delivered to devices, humans, or mannequins functioning as simulated patients. [2][3][4] Using mannequins removes injury risk to patients 7,8 and provides additional training components compared to devices alone. Other potential benefits of using mannequins and force-sensing equipment include faster motor skill development, likely due to the greater potential for repeated practice, 5,9 and higher student confidence 4 and satisfaction.…”

“…[2][3][4] Using mannequins removes injury risk to patients 7,8 and provides additional training components compared to devices alone. Other potential benefits of using mannequins and force-sensing equipment include faster motor skill development, likely due to the greater potential for repeated practice, 5,9 and higher student confidence 4 and satisfaction. 10 Differing HVLA-SM characteristics have the potential to affect physiology, including vertebral movement and neuromuscular responses.…”