Improving Student Learning of Spinal Mobilization with Real-Time Objective Feedback
Purpose/Hypothesis:
Spinal mobilization is a manual therapy technique that is often used by physical therapists to decrease stiffness, improve range of motion, decrease pain, and improve function. The magnitude of spinal mobilization is categorized between grades I and V based on the applied force compared to the reaction of an individual patient. Traditionally, students learn spinal mobilization through classroom instructions with subjective feedback from the instructors and student peers. A force sensor that provides real-time objective feedback may improve student learning. The Activ5 device has a built-in force sensor that can provide such real-time objective feedback via a Bluetooth connected mobile device. The purpose of the study was to assess student learning of spinal mobilization with real-time objective feedback.
Number of Subjects: 28
Materials and Methods:
Materials/Methods: Twenty-eight subjects were recruited using convenience sampling in the second-year physical therapy class in a public university in Northeast Ohio. The research design was a randomized controlled trial. Subjects were randomly assigned to the experimental or control group. Both groups attended the 4-hour spinal manipulation class in the curriculum as usual. In the experimental group, subjects were able to practice spinal manipulation using the Activ5 device for real-time objective feedback during the in-class lecture and lab. In the control group, subjects were taught spinal mobilization using the traditional approach. At the end of the class, students completed an eight-question confidence questionnaire. Their skill of performing spinal mobilization was assessed by an instructor.
Results:
The experimental group (n=14) comprised of 7 females and 7 males with a mean age of 25.3 (SD 3.2 ) years old did not differ from the control group (n=14) comprised of 9 females and 5 males with a mean age 26.4 (SD 7.8) years old. There was no statistically significant difference for the confidence questionnaire scores between the experimental (5.12 (SD 1.03)) and control groups (5.44 (SD 0.84)), with p= 0.37 and an SMD of 0.34. The experimental group had a slightly higher average score (8.21(SD 1.20)) in the skill performance compared to the control group 7.96 (SD 1.47). However, there was no statistically significant difference between the experimental and control groups (p= 0.63 with an SMD of 0.19).
Conclusions:
The results did not demonstrate statistically significant benefits of using the Activ5 device in student learning compared to traditional approach. The sample size was small and there may have been some diffusion between groups in the lab during practice and training. Additionally, the time the class spent on learning mobilization with the device may not have been sufficient to produce increased confidence in spinal mobilization.
Clinical Relevance:
Physical therapy educators should continuously seek to improve their teaching methods for manual techniques. The use of real-time objective feedback provides a way to provide consistency in teaching methods. Although our study did not show a statistically significant difference in the results, future refinement of the pedagogical technique may prove that objective measurement can better assist students to transition into competent clinicians.