The effect of real-time feedback on learning lumbar spine joint mobilization by entry-level doctor of physical therapy students: a randomized, controlled, crossover trial

ABSTRACT

Objective

To examine the effects of real-time, objective feedback on learning lumbar spine joint mobilization techniques by entry-level Doctor of Physical Therapy (DPT) students.

Methods

A randomized, controlled, crossover design was used. Twenty-four 1st Year DPT students were randomized into two groups. Group 1 (n = 12) practiced with the real-time feedback device first and then without it, while Group 2 (n = 12) practiced without the device first and then with it. Both practice periods with and without the device were 4 weeks long. Data were collected at Baseline, 5 weeks, 11 weeks, and 16 weeks. The crossover period was 5 weeks long, during which neither group practiced with or without the device. Eight force parameters were measured: R1 force; R2 force; Grade III and Grade IV mean peak force, frequency, and amplitude.

Results

When students practiced with the real-time feedback device, they more closely matched the reference standard for two outcomes: 1) the mean difference in R2 force between student and reference standard was better with device (38.0 ± 26.7 N) than without it (51.0 ± 38.5 N); P = .013; and 2) the mean difference in Grade III peak to peak amplitude force was also better with device (8.9 ± 9.3 N) than without it (11.8 ± 11.0); P = .026. All other force parameters improved when students practiced with the real-time feedback device, however, the differences between when they practiced without the device were not statistically significant.

Discussion

Real-time, objective feedback using a direct force measurement device improved learning for some aspects of lumbar spine joint mobilization by entry-level physical therapy students.

Level of Evidence

2b

KEYWORDS:

• Manual therapy
• motor skills
• force

Acknowledgments

The authors wish to thank Steve Allison and David Fike for their contributions in the statistical analysis of the manuscript. We also wish to thank Jonathan Koborsi, Tommy Lee, Kelly Miller, and Catherine Shaw for their contributions with data collection.

Disclosure statement

No potential conflict of interest was reported by the authors.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This study was funded in part by the University of the Incarnate Word (UIW), Office of Research and Graduate Studies. Additional donations in kind were provided by the UIW School of Physical Therapy to complete the study.This study was reviewed and accepted by the Institutional Review Board at the University of the Incarnate Word, San Antonio, TX. The IRB deemed this study as non-clinical as the purpose was to examine the effect only on the providers (for example, provider knowledge or attitudes). In this study the effect of real-time feedback on the learning of a manual therapy technique was studied. Therefore, it was not included in a public trials registry.

Notes on contributors

Evan J. Petersen

Evan J. Petersen, PT, DSc, OCS, FAAOMPT is an Associate Professor at the University of the Incarnate Word, School of Physical Therapy where he teaches Patient/Client Management and Clinical Reasoning. Prior to his appointment at UIW, he was the Graduate Program Director of the Army-Baylor University Doctoral Fellowship in Orthopaedic Manual Physical Therapy. He has been a licensed physical therapist since 1999 and has practiced in outpatient orthopaedic clinics in the United States, Germany, and Afghanistan. He is a board certified clinical specialist in Orthopaedics and a fellow in the American Academy of Orthopaedic Manual Physical Therapists.

Stephanie M. Thurmond

Stephanie M. Thurmond, PT, DPT, ScD, COMT, CFMT is an Associate Professor at the University of the Incarnate Word, School of Physical Therapy. She serves as the Year 1 curriculum coordinator and teaches primarily orthopaedic content to first-year physical therapy students. Additionally, she is the Director of the Post-Professional DPT Program at UIW. She received her Doctorate of Physical Therapy from Hardin-Simmons University in 2002 and her Doctorate of Science from Texas Tech Health Sciences Center in 2011. She has primarily worked as a clinician in outpatient orthopaedics and entered academia in 2013.

Sydney I. Buchanan

Sydney I. Buchanan, PT, DPT, is a physical therapist at Baptist Medical Center, San Antonio, TX. She graduated from the University of the Incarnate Word, School of Physical Therapy in 2019.

Diana H. Chun

Diana H. Chun, PT, DPT, is a physical therapist at Baylor Scott & White, Dallas, TX. She graduated from the University of the Incarnate Word, School of Physical Therapy in 2019.

Ashley M. Richey

Ashley M. Richey, PT, DPT, is a physical therapist at Inspire Physical Therapy, College Station, TX. She graduated from the University of the Incarnate Word, School of Physical Therapy in 2019.

Lauren P. Nealon

Lauren P. Nealon, PT, DPT, is a physical therapist at Medical City Arlington in Arlington, TX. She graduated from the University of the Incarnate Word, School of Physical Therapy in 2019.