Chiropractic students' perception of remote learning during the COVID-19 pandemic.

OBJECTIVE: To investigate chiropractic students' preferences and perceptions of remote learning with a secondary aim of comparing individuals with and without learning challenges. METHODS: Following the mandatory period of remote education, a 33-question, mixed-methods, anonymous online survey was distributed from March to September 2021 to a single-campus chiropractic student body with an estimated sample study population of N = 1375. Demographic variables, self-reported learning challenges, technology skills, and perceptions of remote and on-ground learning delivery modalities were gathered. Percentages, measures of central tendency, and chi-square tests were performed on the data. RESULTS: There were 117 participants (8.5%), of whom 63.2% were female (n = 74) and 87.2% (n = 102) were aged 18-34 years. Self-identified learning challenges were present in 33.3% (n = 39) of participants, of whom 28 stated they had attention-deficit/hyperactivity disorder or attention-deficit disorder. More than 85.5% (n = 100) of participants agreed they were proficient with the necessary technology. For basic science classes with a lecture and lab component, 61.5% (n = 72) preferred on-ground labs and remote lectures. Participants agreed that remote lectures and on-ground labs were a good use of time (75.2% [n = 88] and 79.5% [n = 93], respectively). There was a significant χ2 between individuals with and without learning challenges for the perception of "stimulating and interesting" (p = .044) and "attention" (p = .001) for on-ground lectures. CONCLUSION: Chiropractic students preferred remote and on-ground education differentially for labs and lectures. On-ground labs provided greater perceived educational benefits; perceived benefits of remote lecture courses were only modestly supported. Students with self-identified learning challenges presented with some differences related to perception of on-ground lectures.

Assessing the feasibility of using an electronic records database system in use in a group of private chiropractic clinics for practice-based research.

OBJECTIVE: To explore the feasibility of collecting aggregated patient data from the electronic records of a group of private practices and to determine the suitability of the data for comparative effectiveness or other practice-based research (PBR). METHODS: Assess the type and quality of healthrelated variables contained in a commercially available electronic records system (Vitalogics) in use in consenting chiropractor's offices. Descriptively analyze baseline patient records to identify demographic variables, vital signs, case types and diagnoses. RESULTS: Of the 46,000 individual patient records that were analyzed, only a fraction had usable demographic data while more than half contained ICD-9 codes, including records for non-insurance case-types. None contained outcome variables. CONCLUSION: We did not find that the electronic record system we examined had the types of demographic and outcomes variables that would be useful for comparative effectiveness research. The addition of special fields to code chief complaint and health status indicators not typically included in an electronic records system would be most useful.

OBJECTIF: Examiner la possibilité de recueillir des macrodonnées de patients dans les dossiers électroniques d'un groupe de cliniques privées et déterminer leur utilité pour mener une recherche comparative d'efficacité ou mener d'autres recherches fondées sur la pratique. MÉTHODOLOGIE: Évaluer le type et la qualité des variables de santé contenus dans le logiciel de gestion de dossiers médicaux informatisés de Vitalogics en usage dans les cabinets des chiropraticiens consentants. Effectuer une analyse descriptive de dossiers de patients de référence pour trouver des variables démographiques, des signes vitaux, des cas types et des diagnostics. RÉSULTATS: Des 46 000 dossiers de patients examinés, seule une partie contenaient des données démographiques utiles alors que moins de la moitié contenaient les codes de la classification ICD-9, et des données sur des cas types non assurés. Aucun ne contenait de variables de résultats. CONCLUSION: À notre avis, le système de gestion de dossiers électroniques examinés ne fournit pas des types de variables démographiques et de variables de résultats qui seraient utiles pour mener une recherche comparative d'efficacité. L'ajout de champs spéciaux permettant de saisir le code du symptôme principal et des indicateurs de l'état de santé, ce qui d'habitude ne se trouve pas dans un logiciel de gestion de dossiers électroniques, s'avérerait très utile.

Changes in adjustment force, speed, and direction factors in chiropractic students after 10 weeks undergoing standard technique training.

OBJECTIVE: To assess the force profiles of high-velocity low-amplitude thrusts delivered to a mannequin on a force platform by novice students given only verbal instructions. METHODS: Student volunteers untrained in adjusting delivered a series of adjustments to a mannequin on a force platform. Participants performed 3 light, 3 normal, and 3 heavy thrusts on 5 listings specifying contact point, hand, and direction. Force profiles were analyzed for speed and amplitude, consistency, and force discrimination. Two recording sessions occurred 10 weeks apart. RESULTS: Sixteen participants (11 females, 5 male) completed the study. Peak forces ranged from 880 to 202 N for heavy thrusts and 322- to 66 N for light thrusts. Thrust rate was from 8.1 to 1.8 Newtons per millisecond. Average coefficients of variability (CV = STD/mean) at each load level (initial/final) were heavy: 17%/15%; normal: 16%/15%; and light: 20%/20%, with 0 as ideal. A force ratio measured students' abilities to distinguish thrust magnitude. The heavy/normal ratio (initial/final) was 1.35/1.39, and the light/normal ratio was 0.70/0.67. CONCLUSIONS: At this point, without force feedback being used in the classroom, novice students can produce thrusts that look like those of their teachers and of experienced practitioners, but they may not produce similar speed and force values. They are consistent within and between sessions and can discriminate between light and heavy loads. A natural next step in our educational research will be to measure adjustment factors on more experienced cohorts of students with and without the presence of force-feedback training apparatus.

Thrust Magnitudes, Rates, and 3-Dimensional Directions Delivered in Simulated Lumbar Spine High-Velocity, Low-Amplitude Manipulation.

OBJECTIVES: The purpose of this study was to measure faculty performance of simulated spinal manipulation on a mannequin to help identify teaching standards. METHODS: We measured 3-dimensional transmitted loads using a force plate mounted in the table. Thrusts were delivered through a compliant, jointed mannequin by faculty members along predefined "listings" as taught in lumbopelvic technique courses. RESULTS: Eleven chiropractic faculty members participated, delivering 9 thrusts at 3 loads (light, moderate, and heavy) along 9 different prone and side-posture listings, totaling 81 thrusts per participant. Single-hand Gonstead-style thrusts had variability in magnitude across participants and loads: light thrusts averaged 365 N (95% confidence interval [CI] 327-402), moderate thrusts 454 N (421-487), and heavy thrusts 682 N (623-740). All faculty members could easily distinguish the loads within their performances, but there was some crossover of load levels between participants. Thrust rates averaged 3.55 N/ms (95% CI 3.29-3.82). The dominant vector of prone thrusts was in the z direction (vertically downward), but side-to-side and inferior-to-superior vector components occurred. CONCLUSION: Faculty member performance of simulated spinal manipulation indicated that they are able to control the thrust magnitude and rate as well as direction. In this sample, there was significant variability in peak loads between participants, which needs to be considered in student learning standards. These findings may be useful in translating the understanding of force characteristics to the technique teaching lab.

Establishing force and speed training targets for lumbar spine high-velocity, low-amplitude chiropractic adjustments.

OBJECTIVE: We developed an adjusting bench with a force plate supporting the lumbar portion to measure loads transmitted during lumbar manual adjustment. It will be used to provide force-feedback to enhance student learning in technique labs. The study goal is to define the learning target loads and speeds, with instructors as expert models. METHODS: A total of 11 faculty members experienced in teaching Gonstead technique methods performed 81 simulated adjustments on a mannequin on the force plate. Adjustments were along 9 lumbopelvic "listings" at 3 load levels: light, normal, and heavy. We analyzed the thrusts to find preload, peak load, duration, and thrust rate. RESULTS: Analysis of 891 thrusts showed wide variations between doctors. Peak loads ranged from 100 to 1400 N. All doctors showed clear distinctions between peak load levels, but there was overlap between high and low loads. Thrust rates were more uniform across doctors, averaging 3 N/ms. CONCLUSION: These faculty members delivered a range of thrusts, not unlike those seen in the literature for high velocity, low amplitude manipulation. We have established at least minimum force and speed targets for student performance, but more work must be done to create a normative adjustment to guide refinement of student learning.