Clinician proficiency in delivering manual treatment for neck pain within specified force ranges

Background contextNeck pain is a common musculoskeletal complaint responsive to manual therapies. Doctors of chiropractic commonly use manual cervical distraction, a mobilization procedure, to treat neck pain patients. However, it is unknown if clinicians can consistently apply standardized cervical traction forces, a critical step toward identifying an optimal therapeutic dose.PurposeTo assess clinicians' proficiency in delivering manually applied traction forces within specified ranges to neck pain patients.Study designAn observational study nested within a randomized clinical trial.SampleTwo research clinicians provided study interventions to 48 participants with neck pain.Outcome measuresClinician proficiency in delivering cervical traction forces within three specified ranges (low force, less than 20 N; medium force, 21–50 N; and high force 51–100 N).MethodsParticipants were randomly allocated to three force-based treatment groups. Participants received five manual cervical distraction treatments over 2 weeks while lying prone on a treatment table instrumented with force sensors. Two clinicians delivered manual traction forces according to treatment groups. Clinicians treated participants first without real-time visual feedback displaying traction force and then with visual feedback. Peak traction force data were extracted and descriptively analyzed.ResultsClinicians delivered manual cervical distraction treatments within the prescribed traction force ranges 75% of the time without visual feedback and 97% of the time with visual feedback.ConclusionsThis study demonstrates that doctors of chiropractic can successfully deliver prescribed traction forces while treating neck pain patients, enabling the capability to conduct force-based dose response clinical studies.