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Observational Study
. 2015 Apr 1;15(4):570-6.
doi: 10.1016/j.spinee.2014.10.016. Epub 2014 Oct 22.

Clinician proficiency in delivering manual treatment for neck pain within specified force ranges

Maruti Ram Gudavalli  1 , Robert D Vining  2 , Stacie A Salsbury  2 , Lance G Corber  2 , Cynthia R Long  2 , Avinash G Patwardhan  3 , Christine M Goertz  2
Affiliations
Observational Study

Clinician proficiency in delivering manual treatment for neck pain within specified force ranges

Maruti Ram Gudavalli et al. Spine J. .

Abstract

Background context: Neck pain is a common musculoskeletal complaint responsive to manual therapies. Doctors of chiropractic commonly use manual cervical distraction, a mobilization procedure, to treat neck pain patients. However, it is unknown if clinicians can consistently apply standardized cervical traction forces, a critical step toward identifying an optimal therapeutic dose.

Purpose: To assess clinicians' proficiency in delivering manually applied traction forces within specified ranges to neck pain patients.

Study design: An observational study nested within a randomized clinical trial.

Sample: Two research clinicians provided study interventions to 48 participants with neck pain.

Outcome measures: Clinician proficiency in delivering cervical traction forces within three specified ranges (low force, less than 20 N; medium force, 21-50 N; and high force 51-100 N).

Methods: Participants were randomly allocated to three force-based treatment groups. Participants received five manual cervical distraction treatments over 2 weeks while lying prone on a treatment table instrumented with force sensors. Two clinicians delivered manual traction forces according to treatment groups. Clinicians treated participants first without real-time visual feedback displaying traction force and then with visual feedback. Peak traction force data were extracted and descriptively analyzed.

Results: Clinicians delivered manual cervical distraction treatments within the prescribed traction force ranges 75% of the time without visual feedback and 97% of the time with visual feedback.

Conclusions: This study demonstrates that doctors of chiropractic can successfully deliver prescribed traction forces while treating neck pain patients, enabling the capability to conduct force-based dose response clinical studies.

Trial registration: ClinicalTrials.gov NCT01765751.

Keywords: Biomechanics; Chiropractic; Clinician training; Dose; Manual therapy; Mobilization; Neck pain; Traction forces.

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Figures

Figure 1
Figure 1
Manual cervical distraction table with force plates and force sensor
Figure 2
Figure 2
Doctor delivering manual cervical distraction in prone position showing clinician hand contacts
Figure 3
Figure 3
A typical cyclical traction force application during manual cervical distraction
See this image and copyright information in PMC

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