Research says experience improves instrument-assisted adjustments

Over the duration of a long career in chiropractic, your clinical know-how will continually build on your previous experience as you gain new insights.

At the same time, you’ll keep your skills fresh to reflect emerging research and technologies.

In cases of professional development, repeated practice naturally leads to improvements in technique, and this practice must be maintained to avoid losing hard-earned ground. But does the idea of “practice makes perfect” apply even when a mechanical device enters the chiropractic picture?

A study recently published in the Journal of Spine set to find out. The research examined how individual DCs improve over time with repeated practice of instrument-assisted adjustment (intra-examiner reliability), as well as how more experienced DCs perform better than less experienced ones (inter-examiner reliability).

Study design

In this study, two groups of DCs (three experienced doctors compared to three novice doctors) performed two rounds instrument-assisted adjustments. One round was conducted with human subjects as patients, and the other analyzed the DCs performance on a non-human scientific measurement tool (called a durometer) to detect the amount of pressure being applied by the instrument.

This design allowed the researchers to not only see if each DC’s ability to perform an adjustment improved over time but also how novice users compared to more experienced ones. The novice users were given a four-hour training session prior to start of the experiment, which followed the manufacturer’s suggested guidelines.

Thirty sites on the spine were evaluated, from C1 to S5, as suggested by the manufacturer. Six pounds of pressure was considered optimal. Each site was adjusted twice for both the durometer and patients to determine the difference between the first and second adjustment.

Durometer results

The researchers noted an increase in intra-examiner reliability, or the ability of an individual DC to improve over time when performing instrument-assisted adjustments on the durometer. However, inter-examiner reliability, or the comparison of more experienced DCs to those with less experience, varied more.

Interestingly, one experienced DC was an outlier, as they did not use the analysis function on the adjusting devices, despite being certified in the technique. Nevertheless, all the adjustments fell within manufacturer’s recommended guidelines.

Patient participants results

There was greater variance in intra-examiner reliability in adjustments performed on patient participants. The opposite was true of the durometer results. However, inter-examiner reliability also had greater variance, similar to results from the durometer.

The researchers suggested that novice users should be expected to have a certain level of expertise with using an adjusting instrument, which is will improve over time.

What this research means

The human factor makes a significant difference in the results. While novice users did very well performing adjustments on the durometer, their reliability to be within the therapeutic range was less certain when adjusting human subjects.

Overall the research indicates that the number of years you have under your belt as a chiropractor does make a difference in your abilities, even when it comes to the use of a mechanically assisted technique.

References

¹ Auger F, Comtois AS, Roy R. Intra- and inter-examiner reliability study for the characteristics of evaluation of the SA201. Journal of Spine. 2015;4:245.