Original Article
Effects of Visual Feedback on Manipulation Performance and Patient Ratings

https://doi.org/10.1016/j.jmpt.2006.04.014Get rights and content

Abstract

Objective

This study examined the explicit targeted outcome (a criterion standard) and visual feedback on the immediate change in and the short-term retention of performance by novice operators for a high-velocity, low-amplitude procedure under realistic conditions.

Methods

This study used a single-blind randomized experimental design. Forty healthy male (n = 26) and female (n = 14) chiropractic student volunteers with no formal training in spinal manipulative therapy participated. Biomechanical parameters of an L4 mammillary push spinal manipulation procedure performed by novice operators were quantified. Participants were randomly assigned to 2 groups and paired. One group received visual feedback from load-time histories of their performance compared with a criterion standard before a repeat performance. Participants then performed a 10-minute distractive exercise consisting of National Board of Chiropractic Examiners review questions. The second group received no feedback. An independent rating of performance was conducted for each participant by his/her partner. Results were analyzed separately for biomechanical parameters for partner ratings using the Student t test with levels of significance (P < .01) adjusted for repeated testing.

Results

Expressed in percent change for each individual, visual feedback was associated with change in the biomechanical performance of group 2, a minimum of 14% and a maximum of 32%. Statistical analysis rating of the performance favored the feedback group on 4 of the parameters (fast, P < .0008; force, P < .0056; precision, P < .0034; and composite, P < .0016).

Conclusion

Quantitative feedback, based on a tangible conceptualization of the target performance, resulted in immediate and significant improvement in all measured parameters. Newly developed skills were retained at least over short intervals even after distractive tasks. Learning what to do with feedback on one's own performance may be more important than the classic teaching of how to do it.

Section snippets

Subjects

Forty healthy male (n = 26) and female (n = 14) chiropractic student volunteers from the second year, in their first term with no formal training in spinal manipulative therapy, participated in the study. Subjects were naive about the hypotheses of the experiment. Informed consent statements were signed, and all procedures in the study were conducted with the approval of the institutional review board.

Task and Apparatus

The HVLA task was the application of an L4 mammillary push (L4MP) procedure commonly taught at

Results

No reports of injury or discomfort by any of the participants during or after the acquisition and retention trials were observed.

Discussion

Manual skill training relies heavily on the combination of feedback and repetition. Earlier work in our laboratory4 showed that preparation for learning these procedures and its format and context is an important consideration with respect to improving performance. The training of spinal manipulative therapy has historically provided subjective instructor feedback and tactile cueing without objective measurement of performance or a tangible conceptualization of the target objective. Triano et al

Conclusion

Quantitative visual feedback based on a tangible conceptualization of the target performance resulted in immediate and significant improvement in all measured parameters. The magnitude of improvement is significantly larger for complex tasks under realistic circumstances than has been reported before. Differences in skill are demonstrable both by changes in biomechanical parameters of HVLA procedures as well as by ranking of perceived performance by simulated patients. Newly developed skills

Acknowledgment

This research was supported, in part, by a grant from the National Chiropractic Mutual Insurance Company, Clive, Iowa, and administered by the Foundation for Chiropractic Education and Research, Norwalk, Iowa.

References (24)

  • DJ Rose
  • A Abbott
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      The HAM also permitted standardized sensory feedback as simulation for the participants as they applied treatment procedures. The mannequin was part of a high-fidelity28,29 force-sensing treatment table system (FSTT; CMCC, Toronto, Ontario, Canada) instrumented with an AMTI (Advanced Mechanical Technology Inc, Watertown, MA) force plate providing quantification of force-time profiles transmitted through the torso support section. The location of the T9 vertebral analog was marked on the posterior surface and served as the target site for application of the HVLA maneuver.

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