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Clinician proficiency in delivering manual treatment for neck pain within specified force ranges
Maruti Ram Gudavalli1, Robert D Vining1, Stacie A Salsbury1
1Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, Davenport, IA 52803, USA.
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.
