Training and certification of doctors of chiropractic in delivering manual cervical traction forces: Results of a longitudinal observational study

Abstract

Objective : Doctors of chiropractic (DCs) use manual cervical distraction to treat patients with neck pain. Previous research demonstrates variability in traction forces generated by different DCs. This article reports on a training protocol and monthly certification process using bioengineering technology to standardize cervical traction force delivery among clinicians. Methods : This longitudinal observational study evaluated a training and certification process for DCs who provided force-based manual cervical distraction during a randomized clinical trial. The DCs completed a 7-week initial training that included instructional lectures, observation, and guided practice by a clinical expert, followed by 3 hours of weekly practice sessions delivering the technique to asymptomatic volunteers who served as simulated patients. An instrument-modified table and computer software provided the DCs with real-time audible and visual feedback on the traction forces they generated and graphical displays of the magnitude of traction forces as a function of time immediately after the delivery of the treatment. The DCs completed monthly certifications on traction force delivery throughout the trial. Descriptive accounts of certification attempts are provided. Results : Two DCs achieved certification in traction force delivery over 10 consecutive months. No certification required more than 3 attempts at C5 and occiput contacts for 3 force ranges (0-20 N, 21-50 N, and 51-100 N). Conclusions : This study demonstrates the feasibility of a training protocol and certification process using bioengineering technology for training DCs to deliver manual cervical distraction within specified traction force ranges over a 10-month period.

Keywords: Chiropractic; Education; Manipulation, Cervical; Manipulations, Musculoskeletal; Traction.

Figures

Figure 1.

(a) Positioning of patient on the instrumented treatment table. (b) Chiropractor viewing graphical force feedback. (c) Hand contact positioning at C5. (d) Hand contact positioning at occiput.

Figure 2.

Cervical traction forces graphically displayed after manual cervical distraction procedure.

Figure 3.

Number of attempts for certification at occiput contact.

Figure 4.

Number of attempts for certification at C5 contact.