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Chiropractic treatment forces measured during clinician standardization sessions in a trial of patients with low back pain

Maruti Ram Gudavalli, PhD1, Robert M. Rowell, DC2, Cheryl Hawk, DC, PhD3, James Jedlicka, DC4, and Cynthia R. Long, PhD2. (1) Research, Palmer Center for Chiropractic Research, National University of Health Sciences, 741 Brady Street, Davenport, IA 52803, (563) 884-5260, Gudavalli_r@palmer.edu, (2) Palmer Center for Chiropractic Research, 741 Brady Street, Davenport, IA 52803, (3) Research, Parker Research Institute, 2500 Walnut Hill Lane, Dallas, TX 75229, (4) Research and Chiropractic Technique, National University of Health Sciences, 200 East Roosevelt Road, Lombard, IL 60148

Our objective was to measure the forces delivered by clinicians in treatment protocols during standardization sessions of a clinical trial. The placebo procedures were effleurage and a spring-loaded adjusting instrument set to zero; the active were flexion-distraction technique combined with trigger point therapy. Each of four chiropractors delivered the procedures to a single non-patient volunteer in 13-15 sessions over one year. For each session, the subject was positioned prone on a modified flexion-distraction table instrumented with two force plates, using Motion Monitor software to measure forces between the subject and the table. Clinicians were to deliver forces within a previously determined range for each procedure. Forces were descriptively analyzed for variation. Measured forces during flexion-distraction varied from 0 to 113 Newtons (N) in Fx (inferior to superior direction) and 0 to 164N in Fz (posterior to anterior direction). During trigger point therapy, Fz varied between 44N and 100N. For the placebo treatment, forces measured during effleurage were 0-16N in Fx and 0-42N in Fz, and during adjusting instrument procedure were 0-8N in Fx and 0-32N in Fz. For the active treatment, forces during flexion-distraction stayed within the preset limits, but were sometimes higher than that prescribed for trigger point therapy. For the placebo treatment, forces from the adjusting instrument and the effleurage did exceed the preset limits. During the standardization sessions, clinicians were given feedback and continued practicing until each protocol was within prescribed limits. This demonstrates the importance of force standardization sessions as part of placebo-controlled trials of manual therapies.

Learning Objectives: “At the conclusion of this presentation, the participant in this session will be able to

Keywords: Chiropractic, Computer-Assisted

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Chiropractic: Access, Outreach and Research

The 132nd Annual Meeting (November 6-10, 2004) of APHA