The Effect of Feedback on Manual Therapy Skill Acquisition: A Systematic Review

Objective To investigate the influences of feedback on manual therapy skill acquisition as presented in the literature. Data Source(s) An electronic search was conducted across 4 databases: PubMed, EBSCOhost, SPORTDiscus, and CINAHL. The key words that were used in the search included manual therapy, physiotherapy, mobilizations, manipulation, education, instruction, feedback, intrinsic feedback, and extrinsic feedback. The Boolean phrases AND and OR were used to combine the search terms. Study Selections Studies that collected outcomes related to manual therapy skill acquisition from inception of the databases to September 2019 were included. Studies were excluded if they examined solely patient-rated or clinical outcomes of manual therapy or did not use feedback as the primary instructional intervention. Data Synthesis After quality appraisal with the Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies, the articles included in the review were categorized according to generalized manual therapy skills. Joint distraction/traction was the skill examined in 2 studies. The effect of feedback on joint mobilizations was investigated in 5 studies. Studies examining joint manipulations represented the largest portion of the articles in this review, with 11 total studies being included. The primary forms of feedback that were examined in the literature included visual, verbal, and combined forms of auditory and visual feedback. Conclusion(s) Visual feedback that provides learners with graphical representations of their performance, such as force-time relationships, appear to have the greatest effects in improving force-related parameters. Visual feedback can be useful during the initial acquisition phases of manual therapy skills, as indicated by the concentration of significant findings immediately after use in training sessions. A limited number of studies examining outcomes at long-term follow-up reported that training effects decrease rapidly over time. Thus, future studies should investigate if optimal dosages or scheduling strategies exist to increase the retention of effects.