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Integration of Pressure Sensors in Lumbar Palpation Education
Panchmatia, J. H. [1]
Docherty, J. [10]
Kooyman, P. [5]
Abu-Sbaih, R. [16]
Yao, S. C. [54]

Journal: Journal of Osteopathic Medicine Date: 2018/11, 118(11):Pages: e175-e177. doi: Subito , type of study: randomized controlled trial

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2018.163/html)

Keywords:

diagnosis [263]
lumbar spine [43]
osteopathic medicine [1540]
palpation [170]
pressure sensors [1]
randomized controlled trial [710]
USA [1086]

Abstract:

Introduction: Palpatory skills are necessary in the field of osteopathic medicine and are important for diagnosing and examining somatic dysfunctions. Osteopathic students practice and refine their palpatory skills throughout the 4 years of medical school, starting in a laboratory setting and then continuing to improve with real patients in clinical rotations. As a result, research related to palpation and pressure is useful in the field of osteopathic medicine. To determine how to avoid inflicting pain, previous research in related fields of study have evaluated how much pressure can induce pain in muscles. A recent study found that subjects who use equal force in both contact points (left and right hands) tend to have higher diagnostic accuracy than those who have unequal force. The study used the TekScan pressure sensor to measure force applied while diagnosing a lumbar segment. The TekScan system has been used to gauge pressure in various areas of medical research and to assess palpation forces when diagnosing somatic dysfunction. This study examines the effects of integrating the TekScan in lumbar palpation education. Hypothesis: Students who use the pressure sensors during a lumbar diagnosis workshop will use more bilaterally equal and less force overall when diagnosing the lumbar segment and thus will be more accurate than students who do not have pressure sensor exposure. Methods: This study was NYIT institutional review board approved. Matriculated first- (OMS I) and second-year (OMS II) osteopathic medical students were recruited for the study. Thirty-two students participated in this study. Students were randomly assigned to 2 groups. Both groups received a 10-minute didactic on the lumbar spine, including lumbar diagnosis. Afterward, both groups had 15 minutes to practice lumbar diagnosis with an attending helping to guide their practice time. The students in the experimental group had a TekScan sensor available for practice to ensure that they were using equal pressure in both palpating thumbs. The students in the control group were instructed to attempt to use equal pressure during palpation; however they did not have access to a TekScan sensor. Participants were asked to diagnose an L5 lumbar segment on a model patient after their workshop. The model patient had his/her L5 lumbar diagnosis confirmed by 2 NMM/OMM board-certified attending physicians before diagnosis by the participants. A TekScan sensor was placed over the model patient's L5 region to capture the pressure and time to diagnosis. Subjects were instructed to record an L5 diagnosis using proper osteopathic terminology. The magnitude of force exerted on the TekScan sensor upon palpation, as well as the amount of time elapsed during the course of palpation, were measured by the sensor. Palpation by the subject was recorded in real time using the TekScan Pressure sensor. An attending physician checked the L5 diagnosis after the students completed their diagnoses to make sure it had not changed. Data Analysis: Independent samples t test was performed to analyze differences in average force between left and right hand based between the 2 groups. Independent samples t test was also used to measure magnitude of force used by the control and experimental group and well as time to diagnosis. χ2 analysis was used to determine if there was a relationship between the groups and correct diagnosis. Results: Thirty-two subjects were included in our analysis (25 OMS I and 7 OMS II). The difference in average force applied by the left and right hand by the subjects was an average of 285.7 g in the control group and 128.8 g in the experimental group. This demonstrates that the students exposed to the TekScan as an educational tool applied a lower average force compared with the control group. However, the difference in groups was not statistically significant (P=.059). The control group had an average of 36.15 seconds for diagnosis, while the experimental group had an average of 28.196 seconds for diagnosis, which was also not statistically significant (P=.116). There was no statistical significance between either group getting a correct diagnosis. Additionally, there was no statistical significance between either group in relation to the magnitude of pressure applied.Conclusion: Our findings demonstrated that the TekScan-exposed students used a more equal force between left and right hands. While this was not statistically significant, the TekScan may increase diagnostic capabilities of osteopathic medical students. These results suggest that students who received table training with the TekScan learn to better apply equal pressure when diagnosing a lumbar somatic dysfunction. Since these results are trending toward statistical significance as subject numbers increase, further studies are needed to increase the sample size. There was no statistically significant difference between either group with regard to assessing for a correct diagnosis. This could be due to some confounding variables such as prior student diagnostic exposures, comfort of palpating through the plastic sensors, and proper contact with the correct level. Additional research needs to be conducted to further determine the potential benefits of using pressure sensors in osteopathic diagnosis education.

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