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

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Authors: Gudavalli, M. R.; Vining, R. D.; Salsbury, S. A.; Corber, L. G.; Long, C. R.; Patwardhan, A. G.; Goertz, C. M.
Article Title: Clinician proficiency in delivering manual treatment for neck pain within specified force ranges
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.
Journal Title: The spine journal : official journal of the North American Spine Society
Volume: 15
Issue: 4
ISSN: 1878-1632; 1529-9430
Publisher: Unknown  
Journal Place: United States
Date Published: 2015
Start Page: 570
End Page: 576
Language: eng
DOI/URL:

10.1016/j.spinee.2014.10.016
Notes: LR: 20150615; CI: Copyright (c) 2015; ClinicalTrials.gov/NCT01765751; GR: 1 U19AT004663-01/AT/NCCIH NIH HHS/United States; GR: C06 RR015433/RR/NCRR NIH HHS/United States; GR: C06RR15433-01/RR/NCRR NIH HHS/United States; GR: U19 AT004663/AT/NCCIH NIH HHS/United States; JID: 101130732; NIHMS650293; OID: NLM: NIHMS650293 [Available on 04/01/16]; OID: NLM: PMC4375060 [Available on 04/01/16]; OTO: NOTNLM; PMCR: 2016/04/01 00:00; 2014/02/06 [received]; 2014/07/23 [revised]; 2014/10/16 [accepted]; 2014/10/22 [aheadofprint]; ppublish