Case study: ‘Real-time force feedback during flexion-distraction procedure for low back pain’

From simple spring-loaded, hand-held instruments to much more complex computer-assisted instruments, DCs are finding an increasing array of tools at their disposal.

The study “Real-time force feedback during flexion-distraction procedure for low back pain: A pilot study,” published in the June 2014 issue of The Journal of Canadian Chiropractic Association, takes a look at one new technology that shows promise.

The abstract reads:

“A form of chiropractic procedure known as Cox flexion-distraction is used by chiropractors to treat low back pain. Patient lies face down on a specially designed table having a stationery thoracic support and a moveable caudal support for the legs. The Doctor of Chiropractic (DC) holds a manual contact applying forces over the posterior lumbar spine and press down on the moving leg support to create traction effects in the lumbar spine. This paper reports on the development of real-time feedback on the applied forces during the application of the flexion-distraction procedure. In this pilot study we measured the forces applied by experienced DCs as well as novice DCs in using this procedure. After a brief training with real-time feedback novice DCs have improved on the magnitude of the applied forces. This real-time feedback technology is promising to do systematic studies in training DCs during the application of this procedure.” ¹

The study itself involved only four patients, but five experienced DCs and five novice DCs. The researchers measured the force applied during the treatments with “the help of a three-dimensional force transducer, amplifiers, analog-to-digital converters, laptop portable computer, and custom written Labview software. A custom written software provides the graphical visual feedback in real time as a function of time during the delivery of the treatment.”

Perhaps unsurprisingly, the visual, graphic feedback was most helpful for the novice DCs. The experienced DCs applied far greater force in their treatments, and the feedback helped the novice DCs increase the force they applied as well. The authors think this tool can be useful for training, and stated, “This method is based primarily on the subjective evaluation of distraction technique as a complex psychomotor skill rather than measuring the biomechanical event. The real-time visual graphical feedback of forces developed in this project extends this subjective evaluation process by providing real-time quantitative force data.”

Usually, the phrase “instrument-assisted adjusting” refers to tools that are used to make adjustments—to cause biomechanical events. In this case, the tools provide feedback that can improve the quality of a manual adjustment, particularly for a new DC.

The researchers concluded:

“Real-time visual graphical feedback was developed and used to train novice DCs to change the force magnitudes applied during flexion-distraction procedure. This technology has the potential to design and undertake well designed studies in training and assessing the delivery of forces during flexion-distraction procedure. The system developed in this study is portable with a laptop computer and can be easily implemented in any field clinician’s office.” ¹

This study will be of interest to DCs considering purchasing computer-assisted instruments that can provide similar feedback or those who are involved with training new doctors of chiropractic. It is also interesting to note that, as technology advances, the way instruments are used will likely continue to evolve and change, as well.

Reference

¹ Cox J, Gudavalli MR. Real-time force feedback during flexion-distraction procedure for low back pain: A pilot study. J Can Chiropr Assoc. 2014:58(2);193–200.