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Contextual factors related to aging determine force-based manipulation dosage: a prospective cross-sectional study
Michele J Maiers1,2, Alexander R Sundin3, Ryan J Oster3
1Northwestern Health Sciences University, Bloomington, MN, USA. mmaiers@nwhealth.edu.
Chiropractic & Manual Therapies
|May 21, 2025
Summary
Experienced clinicians adjust force-based manipulation (FBM) dosage, like spinal manipulative therapy (SMT), based on patient age and health. This study shows age-related factors influence how SMT is delivered to older adults.
Area of Science:
- Geriatric medicine
- Biomechanical engineering
- Physical therapy
Background:
- Contextual factors significantly influence how clinicians apply force-based manipulation (FBM), such as spinal manipulative therapy (SMT).
- Understanding how these factors interact with therapeutic forces in older adults is crucial for minimizing risks and optimizing treatment dosage.
- This study investigated whether aging-related contextual factors alter the kinetic and kinematic parameters used by experienced clinicians during SMT delivery.
Purpose of the Study:
- To determine if aging-related contextual factors modulate the kinetic and kinematic parameters employed by experienced clinicians during spinal manipulative therapy (SMT).
- To explore how chronological, pathological, and perceived age influence the delivery of force-based manipulation (FBM).
Main Methods:
- AI-generated patient vignettes with visual and auditory content representing varying age-related factors (chronological, pathological, felt age) were presented to participants.
- Participants (licensed chiropractors) delivered SMT to a manikin based on these vignettes, with kinetic and kinematic parameters recorded.
- Data were analyzed using a 3-way repeated measures ANOVA to identify differences in force, acceleration, and velocity based on age-related factors.
Main Results:
- Peak force decreased significantly with increased chronological and pathological age, indicating a dose adjustment by clinicians.
- Peak acceleration and velocity were also affected by chronological age, but not by pathological or felt age.
- Time to peak velocity was shorter for perceived older age, suggesting a modulation in response to subjective age cues.
Conclusions:
- Contextual factors associated with aging demonstrably modulate specific kinetic and kinematic characteristics during SMT delivery.
- This provides evidence that practitioners adapt their force-based manipulation (FBM) dosage based on their perception of a patient's age and health status.
- Further research is necessary to establish ideal kinetic and kinematic parameters for SMT considering the complexities of aging.
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