Comparison of Student Manipulation Performance Following Simulation and Standard Training

Background:
High velocity low amplitude (HVLA) thrust joint manipulation, is the application of
physical force, or impulse enacted over a short period of time.1 Studies demonstrate that HVLA
thrust manipulations to the atlanto-occipital (AO), talocrural (TC), and coxofemoral (CF) joints
improve clinical outcomes and range of motion.2-5 Doctorate of Physical therapy (DPT) programs
incorporate teaching of this skill in their curricula, however, students are unable to judge their
own performance and develop self-efficacy given the lack of uniformity in the instructor’s ability
to provide direct and objective feedback. 1,6 Currently, there is a decrease in the use of
manipulations in physical therapy practice despite research supporting their benefits.1,7

This study aimed to compare TC, CF, and AO joint manipulation performance in
physical therapy students who receive simulation training with biofeedback and motor learning
principles to students who receive standard lab training.

Methods:

Twenty-eight 2nd year DPT students received a 2-hour lecture including background and
demonstration on AO, TC, and CF manipulations. Subjects were randomly assigned to either the
standard or simulation group. The standard group received verbal feedback by a FAAOMPT
(Fellows of the American Academy of Orthopedic Manual Therapists) member and DPT
professor. The simulation group performed manipulations on a mannequin designed to provide
random and faded feedback. All of the students returned within 2-14 days for post-testing.
Preload, rate, and peak forces were calculated from the average of the 5 trials for each
manipulation.
Results:

The simulation group demonstrated significantly more AO pre-load (p=.005), CF pre-load

(p=.04 ), TC pre-load (p=.001 ), AO peak (p=.02 ), and TC peak forces (p=.002 ). No significant
(p>.05) differences between groups for CF peak force and AO, CF and TC rate of force. Males
demonstrated significant greater AO peak (p=.02), CF peak (p=.003), CF pre-load (p=.03), AO
rate (p=.01), hip rate (p=.04) and TC rate (p=.02) of forces.

Discussion:
The results of this study demonstrate the value of simulation learning with objective feedback to
improve early spinal manipulation force parameters compared to standard learning. Use of
simulation learning should be utilized to improve manipulation performance of novice physical
therapy students.
Comparison of Student Manipulation Performance Following Simulation and Standard Training

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