Attributes of Expert and Novice Clinicians: A Brief Review and Investigation of the Differences in Peripheral Sympathetic Nervous System Activity Elicited During Thoracic Mobilization

Abstract

The clinical attributes that distinguish expert from novice clinicians have become a topic of great interest. To date, the majority of the literature has investigated the differences that exist in the clinical reasoning process. Despite the reported importance of joint mobilization techniques in orthopaedic practice, many of these studies have admittedly omitted the movement component (manual skills) of clinical practice from their analysis. The purpose of this study was to investigate the differences, in peripheral sympathetic nervous system activity elicited with thoracic mobilizations, between an expert and novice clinician. The expert and a novice clinician performed central grade III mobilizations to T12 on a convenience sample of 15 asymptomatic subjects utilising a crossover design. Skin conductivity was utilised as a measure of peripheral sympathetic nervous system activity. A paired samples t-test was used to compare the mean change in skin conductivity between groups. Results demonstrated that the expert clinician elicited a statistically significant (P < 0.025) greater increase in skin conductivity when compared to the novice. Although it cannot be stated with absolute certainty that expert clinicians produce a greater sympathetic nervous system response when performing spinal manipulative therapy, we speculate that differences exist between therapists, which may have clinically significant implications.

Methodological Quality of Randomized Controlled Trials of Spinal Manipulation and Mobilization in Tension-Type Headache, Migraine, and Cervicogenic Headache

“…Although it is not clear to what extent the therapist's experience actually influences outcomes. 5,40 Another important shortcoming was that the nature of the control or reference groups varied considerably among trials. No study had a control group receiving a placebo intervention (sham-manipulation/mobilization) or a control group receiving no intervention.…”

Manipulation, Monkeys, and Bunches of Bananas

“…Gonella et al 11 reported on reliability of lumbar motion palpation tests by physical therapists and found higher interrater agreement for the two less experienced clinicians. Bybee and Dionne 12 showed significantly greater interrater reliability in PT students than in experienced PT clinicians for a McKenzie-based diagnosis for patients with neck pain, while Cleland et al 13 noted that a significantly greater sympatho-excitatory effect (increased skin conductivity) was elicited by an experienced (36.25%) versus a novice PT clinician (17.75%) when applying a grade III PA technique to T12. Finally, Cohen et al 14 found no differences in biomechani-cal parameters for a thoracic thrust technique performed by novice versus experienced chiropractic clinicians.…”