PhD Project - Instrumented Feedback in the Acquisition of Manipulative Skills: implications for learner confidence, clinical performance, and patient experience

Overview

High-velocity, low-amplitude (HVLA) manipulation, remains central to the education and professional identity of manual therapy professions – chiropractic, osteopathy and physiotherapists.

Despite their prominence, the empirical literature does not demonstrate a clear relationship between specific biomechanical parameters of HVLA (e.g. thrust speed or peak force) and patient outcomes, with comparable effectiveness reported between manipulation and mobilisation (1).

This raises important educational and theoretical questions: why is biomechanical precision emphasised in training, and what mechanisms might justify continued pedagogical focus on these parameters?

One potential explanation lies not in direct biomechanical effects, but in processes of skill acquisition, practitioner confidence, and the therapeutic encounter. Theories of motor learning and deliberate practice suggest that augmented feedback can accelerate skill acquisition, enhance consistency, and reduce cognitive load during performance (2). In clinical education, increased technical confidence may influence clinical decision-making, communication, and the quality of the therapeutic interaction, all of which are recognised contributors to patient experience and outcomes. However, these mechanisms remain underexplored in the context of manipulative therapy education.

AECC School of Chiropractic has invested in Force Sensing Tables (FST), which integrate force plates into treatment plinths to provide objective feedback on parameters such as preload, thrust speed, depth, and back-off during manipulative and combined techniques.

Preliminary work with undergraduate students indicates perceived educational benefit, including improved understanding of technique and enhanced tutor insight into performance errors that are difficult to detect through observation alone. Yet existing research has focused largely on describing or benchmarking force parameters (3,4), rather than explaining how such feedback influences learning, confidence, or downstream clinical care.