Real-time feedback improves accuracy of manually applied forces during cervical spine mobilisation

Purpose: to determine if real-time feedback enables students to apply mobilisation forces to the cervical spine that are similar to an expert physiotherapist. Methods: an instrumented treatment table collected mobilisation force data with feedback about forces displayed on a computer screen. An expert physiotherapist performed posteroanterior mobilisation of C7 on 21 asymptomatic subjects while forces were recorded. These data were used as force targets for 51 students who mobilised one of the asymptomatic subjects on two occasions. Students' forces were recorded before and after practice either with (experimental group) or without real-time feedback (control group). Improved performance was defined as a smaller difference between expert and student forces, comparing groups with non-parametric statistics. Results: students receiving feedback applied more accurate forces than controls (median difference between student and expert forces in the experimental group, 4.0 N, inter-quartile range (IQR) 1.9–7.7; in controls, 14.3 N, IQR 6.2–26.2, difference between groups p < 0.001). One week later, these students still applied forces that more closely matched the expert's compared to controls (p < 0.01), but the differences between the students' and expert's forces were greater (6.4 N, IQR 3.1–14.7). Conclusion: practice with real-time objective feedback enables students to apply forces similar to an expert, supporting its use in manual therapy training