Advanced search


Search results        Search results      Copy URL to E-Mail

Improving Upon Osteopathic Palpatory Skills using a 3D Printed Rotational Lumbar Spine Model
Rey, T. [2]
Thomas, A. [3]
Nolin, J. [2]
Sanders, J. G. [1]
Cedoz, K. [1]
Berwick, R. [1]

Journal: Journal of Osteopathic Medicine Date: 2021/12, 121(12):Pages: A70-A71. doi: Subito , type of study: cross sectional study

Full text    (https://www.degruyter.com/document/doi/10.1515/jom-2021-2000/html)

Keywords:

3D models [4]
clinical competence [216]
cross sectional study [783]
medical students [596]
osteopathic medicine [1955]
palpation [213]
USA [1531]

Abstract:

Context: Most osteopathic medical schools teach students intersegmental motion testing as a part of diagnosing somatic dysfunctions of the spine. Previous studies have investigated the palpatory skills of medical students in a transverse plane using a static lumbar spine model.1 One way in which students can learn and practice palpatory skills is through the use of 3D printed models.2 Many pathologies and examples can be printed, reducing cost and time needed to train students. Objective: To design and validate an improved instructional model to teach intersegmental diagnosing using a 3D printed rotational lumbar spine. Methods: Using a 3D printer, a lumber spine was constructed. A layer of dense foam and artificial silicone skin was placed overlying the 3D printed spine to simulate the texture of muscles and skin. These segments were fixated using a bronze stud that travelled through the body of each segment to allow for rotation in a transverse axis of each segment. For the purpose of the study, washers were used between the segments to mimic the joint space of each segment. Additionally, facet joints were cut to allow independent rotation of each segment rather than introducing group mechanics of the entire model. Springs and threaded rods were mounted onto the transverse processes of each segment. Nuts were placed on the front and back of the threads as they were mounted into the framework. Segments were placed at 0mm, 2mm, 4 mm, 6 mm, and 8mm of asymmetry based on the measured amount of thread behind the mounted structure, with 0 mm serving as a control. Segments and rotation (left or right) were assigned randomly for two different sessions. First, second-, and third-year medical students were invited to participate in the study with no exclusion criteria. Students were instructed to determine the orientation of the lumbar segments based on rotation and filled out a survey to calculate results. Two trials were completed with randomization of segment rotation for each trial. 82 students participated in the first trial, and 33 students participated in the second trial. An ANOVA was used to determine which segment was considered significant compared to the control. A two-way ANOVA was used to determine significance in relation to OMS status or gender. This study holds osteopathic significance as its goal is to validate a lumbar spine model for students to use in the future to practice palpatory skills. Results: A total of 115 trials (87 OMS I, 25 OMS II, 3 OMS III) were performed with no exclusions. GraphPad Prism version 9.1 was used for statistical analysis. The ratio of correct to incorrect identification of rotation at 0 mm, 2 mm, 4 mm, 6 mm, and 8 mm were 0.51 +/- 0.046, 0.27 +/- 0.042, 0.25 +/- 0.040, 0.34 +/- 0.045, and 0.46 +/- 0.047, respectively. A One-way AVOVA with a Dunnett post-hoc test was used to compare statistical difference from the 0 mm control revealing 2 mm (p=0.0008), 4 mm (p=0.0001), and 6 mm (p=0.0298) were statistically significant. The 8 mm segment was not statistically significant (p=0.82) compared to the control. A two-way ANOVA was not significant when comparing OMS I and II years (p=0.29). Conclusion: The goal of this study was to determine if a more accurate model could be developed to better teach students the principles of osteopathic manipulative medicine as related to intersegmental motion testing of the lumbar spine. When polling OMS I, II and III students with two different trials, a total of 115 students performed the experiment with no final exclusion criteria. When compared to the control, students were just as likely to determine rotation of a spinal segment at 8 mm of rotation. Students did not perform as well when segments were rotated at 2 mm, 4mm and 6 mm as determined by a one-way ANOVA. Many limitations were witnessed throughout the trials of this study. Correct location of landmarks was the largest challenge experienced by students as there was no guidance given for the location of the segments within the apparatus. Additionally, the level of interest was varied among different cohorts of students based on the time of the year that the study was conducted. Future research is expected to be performed to investigate some of these limitations to include; telling students where to palpate the transverse processes, removal of the muscle and skin layer to introduce more of a layered palpation approach to the model, and to be performed blindfolded. This study was used to determine the amount of rotation needed for future models to be calibrated and appropriately allow students to learn how to palpate. Additionally, a validated model could be explored in clinical encounters or simulation settings for students to use.

Search results      Copy URL to E-Mail

 
 
 






  • Impressum • Legal notice • Datenschutz •


ostlib.de/data_syjnwhakebgdzrtxcqmp



Supported by

OSTLIB recommends