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J Orthop Sports Phys Ther. 2012 Feb;42(2):114-24. doi: 10.2519/jospt.2012.3691. Epub 2011 Oct 25.

Learning lumbar spine mobilization: the effects of frequency and self-control of feedback.

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Physiotherapist, Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, Callaghan, NSW, Australia.



Controlled laboratory study, longitudinal.


To investigate the effects of frequency and self-control of feedback on physiotherapy students learning lumbar spinal mobilization.


Posterior-to-anterior mobilization is included in most physiotherapy curricula. However, force application varies between therapists and the optimal feedback for learning is unknown.


Sixty-two physiotherapy students were randomized to 3 feedback groups: constant (100% of practice trials), intermittent (33%), and self-controlled (varied according to student choice) feedback. Students performed 12 practice trials of grade II posterior-to-anterior mobilization to the third lumbar vertebra while receiving real-time feedback. The differences between students' force parameters (mean peak force [N], force amplitude [N], and oscillation frequency [Hz]) and those of a physiotherapist expert were compared between groups posttest and at a follow-up of 5 to 7 days using analysis of covariance. Students completed a survey regarding their perceptions of feedback.


Students in the self-controlled group applied mean peak force (mean difference between student and expert, 6.7 N; 95% confidence interval [CI]: 4.4, 9.0) and force amplitude (6.3 N; 95% CI: 4.2, 8.4) that more closely matched the expert's than those applied by the constant group (13.7 N; 95% CI: 8.7, 18.6; P = .021, and 13.1 N; 95% CI: 8.9, 17.4; P = .028) at posttest, with similar results at follow-up for force amplitude only (self-controlled, 9.5 N; 95% CI: 5.8, 18.1; constant, 21.0 N; 95% CI: 13.3, 28.7; P = .018). There were no other significant differences. All students reported a better understanding of manual force application, but feedback preferences varied.


Self-controlled feedback appears to be more beneficial than constant feedback for students learning to apply forces during lumbar mobilization.

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