The effect of real-time feedback on learning lumbar spine joint mobilization by entry-level doctor of physical therapy students: a randomized, controlled, crossover trial

Abstract

Objective: To examine the effects of real-time, objective feedback on learning lumbar spine joint mobilization techniques by entry-level Doctor of Physical Therapy (DPT) students. Methods: A randomized, controlled, crossover design was used. Twenty-four 1st Year DPT students were randomized into two groups. Group 1 (n = 12) practiced with the real-time feedback device first and then without it, while Group 2 (n = 12) practiced without the device first and then with it. Both practice periods with and without the device were 4 weeks long. Data were collected at Baseline, 5 weeks, 11 weeks, and 16 weeks. The crossover period was 5 weeks long, during which neither group practiced with or without the device. Eight force parameters were measured: R1 force; R2 force; Grade III and Grade IV mean peak force, frequency, and amplitude. Results: When students practiced with the real-time feedback device, they more closely matched the reference standard for two outcomes: 1) the mean difference in R2 force between student and reference standard was better with device (38.0 ± 26.7 N) than without it (51.0 ± 38.5 N); P = .013; and 2) the mean difference in Grade III peak to peak amplitude force was also better with device (8.9 ± 9.3 N) than without it (11.8 ± 11.0); P = .026. All other force parameters improved when students practiced with the real-time feedback device, however, the differences between when they practiced without the device were not statistically significant. Discussion: Real-time, objective feedback using a direct force measurement device improved learning for some aspects of lumbar spine joint mobilization by entry-level physical therapy students.

Devices Used to Measure Force-Time Characteristics of Spinal Manipulations and Mobilizations: A Mixed-Methods Scoping Review on Metrologic Properties and Factors Influencing Use

“…The literature search was updated on June 30, 2021, and led to the identification of three additional articles fulfilling the inclusion criteria. Forty-six studies were deemed relevant and were included in this review ( 7 – 12 , 15 – 54 ). The literature search also revealed seven literature reviews from which no additional original studies were identified ( 2 , 6 , 55 – 59 ).…”

“…The characteristics of the included studies and both quantitative and qualitative data are reported in Supplementary Table 1 and visually presented in Figure 2 . From the 46 included studies, 20 (43.5%) used a device to measure SMT or MOB force-time characteristics at the clinician-patient interface ( 7 , 11 , 12 , 24 , 26 , 28 – 31 , 37 , 39 , 40 , 44 , 46 – 52 ), 23 (50%) at the patient-table interface ( 9 , 10 , 15 – 23 , 25 , 27 , 32 – 36 , 38 , 42 , 45 , 53 , 54 ), and 3 (6.5%) at both interfaces ( 8 , 41 , 43 ). A total of 10 different devices measured SMT/MOB force-time characteristics at clinician-patient interfaces and 6 at patient-table interfaces.…”

“…A total of 10 different devices measured SMT/MOB force-time characteristics at clinician-patient interfaces and 6 at patient-table interfaces. In light of the quantitative data, 37 (80.4%) studies reported at least one metrologic property ( 7 – 10 , 12 , 15 – 29 , 31 – 34 , 36 – 38 , 40 , 42 – 45 , 47 , 49 , 50 , 53 , 54 ), with 16 (34.8%) reporting previously published results or referring to other studies ( 8 , 12 , 15 , 22 , 23 , 27 , 33 , 34 , 36 , 38 , 42 , 43 , 45 , 50 , 53 , 54 ). On the other hand, facilitating and limiting factors were identified in 18 (39.1%) studies measuring forces at the clinician-patient interface ( 7 , 11 , 12 , 24 , 26 , 28 – 31 , 37 , 39 , 40 , 44 , 46 – 48 , 51 , 52 ), 13 (28.3%) studies measuring forces at the patient-table interface ( 10 , 17 , 19 , 20 , 22 , 23 , 25 , 32 – 36 , 38 ), and in 2 (4.3%) studies including measurement at both interfaces ( 8 , 41 ).…”

“…Devices utilized at the clinician-patient interface were commonly reported as small, thin, simple and easy to transport [devices ii ( 44 ), iv ( 40 ), vi ( 26 ), vii ( 12 ), and ix ( 30 )]. These characteristics allow clinicians to perform their regular movements without interference from the device.…”

“…On the other hand, load cells and force plates have also been mounted between the frame and the cushion of commercial standard treatment tables [e.g., Chiradejnant et al ( 9 ) and Snodgrass et al ( 10 )]. These devices have been used not only in research to investigate SMT and MOB's biomechanics and training, but also as a teaching tool in manual therapy professions curriculum [e.g., chiropractic ( 11 ) and physiotherapy ( 12 )].…”