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Leung B, Treleaven J, Dinsdale A, Marsh L, Thomas L. Serious adverse events associated with conservative physical procedures directed towards the cervical spine: A systematic review. J Bodyw Mov Ther 2025; 41:56-77. [PMID: 39663097 DOI: 10.1016/j.jbmt.2024.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 07/16/2024] [Accepted: 10/13/2024] [Indexed: 12/13/2024]
Abstract
BACKGROUND Previous reviews on serious adverse events (SAEs) following physical interventions involving the neck have focused on vascular SAEs or those related to cervical manipulation. OBJECTIVE To review the evidence for all serious adverse events associated with any physical cervical procedures and describe SAE characteristics. METHODS Searches were conducted in PubMed, EMBASE, CINAHL, Scopus, Cochrane, Web of Science and Index to Chiropractic Literature from inception to May 2023 for studies reporting characteristics of SAE following any neck intervention and patient demographics. RESULTS Two hundred and thirty-three studies describing 334 SAE cases were identified. Forty-one were reported in the last 5 years. The results confirmed findings of past reviews with most events being vascular (58%) and mainly arterial dissection or vertebral artery related and the majority involving manipulation (75%). However lesser-known SAES ie neurological (25%), combined vascular/neurological (12%) and others (5%) which included cases such as cerebrospinal fluid leaks, phrenic nerve palsies and retinal detachments were identified. Further, some followed procedures such as vestibular testing, gentle mobilization, exercises, acupuncture or even massage. Initial symptoms included sharp increases in headache/neck pain, nausea, vomiting, dizziness and altered sensation, during treatment or within 48 h, often preceding neurological signs. Most recovered favourably (62%), 16% with disability, 6% died, the rest were unspecified. CONCLUSION Most SAEs were vascular and associated with manipulation but awareness of potential neurological and orthopaedic injuries and other procedures should be raised. Monitoring for early signs of SAEs for up to 48 h post-intervention is advisable if a SAE is suspected.
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Affiliation(s)
- Bryden Leung
- School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - Julia Treleaven
- School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - Alana Dinsdale
- School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - Linda Marsh
- School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - Lucy Thomas
- School of Health and Rehabilitation Sciences, University of Queensland, Australia.
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Meyer KW, Trager RJ, Daniels CJ, Cupler ZA. Letter to the Editor: Self-Manipulation Inaccurately Associated With the Chiropractic Profession. Am J Forensic Med Pathol 2024; 45:366-367. [PMID: 38833369 DOI: 10.1097/paf.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
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Wölfle-Roos J. [Atlas block and alar ligament lesion-Underestimated or overrated?]. Schmerz 2024; 38:352-358. [PMID: 37468617 PMCID: PMC11420371 DOI: 10.1007/s00482-023-00731-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Disorders of the upper cervical spine, most notably lesions of the alar ligament and atlas block, are associated with numerous symptoms, especially as reported in the lay press. Thus, physicians are often confronted with patients who see in them a monocausal origin of complex complaints and hope for a quick remedy. OBJECTIVE This review article presents the currently available evidence-based literature on atlas block and alar ligament lesions in order to adequately appreciate their significance. MATERIAL AND METHODS Summary and critical evaluation of an extensive review of the literature on the diagnostics, clinical presentation, and treatment of disorders of the upper cervical spine. RESULTS The current literature shows that alar ligament lesions are caused only by extremely high-speed trauma and that the reliability of their detection on magnetic resonance imaging (MRI) is moderate at best. As several studies have failed to demonstrate a correlation between symptoms and abnormalities of the alar ligaments on MRI, surgical stabilization of the upper cervical joints is not indicated. The diversity of symptoms associated with atlas block may be explained by the convergence of afferent neurons originating in C1-C3 on several cranial nerve nuclei found in neuroanatomical studies, but this association has yet to be proven. First studies show that highly significant improvements in cervical pain and range of motion can be achieved by means of manual therapy of the upper cervical spine with lasting effects even after 6 months. CONCLUSION The importance of alar ligament lesions has often been overrated in the past; however, a more nuanced multifactorial understanding of the disorder should be conveyed to the patient. An atlas block should be considered mainly as a possible cause of pain and restricted range of motion of the cervical spine and in this context manual therapy can be an effective treatment option.
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Affiliation(s)
- J Wölfle-Roos
- Abteilung Orthopädie/Schmerztherapie, m&i Fachklinik Ichenhausen, Krumbacher Str. 45, 89335, Ichenhausen, Deutschland.
- Universität Ulm, Ulm, Deutschland.
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de Best RF, Coppieters MW, van Trijffel E, Compter A, Uyttenboogaart M, Bot JC, Castien R, Pool JJ, Cagnie B, Scholten-Peeters GG. Risk assessment of vascular complications following manual therapy and exercise for the cervical region: diagnostic accuracy of the International Federation of Orthopaedic Manipulative Physical Therapists framework (The Go4Safe project). J Physiother 2023; 69:260-266. [PMID: 37690959 DOI: 10.1016/j.jphys.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/29/2023] [Accepted: 08/11/2023] [Indexed: 09/12/2023] Open
Abstract
QUESTION What is the diagnostic accuracy of the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) framework to assess the risk of vascular complications in patients seeking physiotherapy care for neck pain and/or headache? DESIGN Cross-sectional diagnostic accuracy study. PARTICIPANTS One hundred and fifty patients seeking physiotherapy for neck pain and/or headache in primary care. METHODS Nineteen physiotherapists performed the index test according to the IFOMPT framework. Patients were classified as having a high, intermediate or low risk of vascular complications, following manual therapy and/or exercise, derived from the estimated risk of the presence of vascular pathology. The reference test was a consensus medical decision reached by a vascular neurologist and an interventional neurologist, with input from a neuroradiologist. The neurologists had access to clinical data and magnetic resonance imaging of the cervical spine, including an angiogram of the cervical arteries. OUTCOME MEASURES Diagnostic accuracy measures were calculated for 'no contraindication' (ie, the low-risk category) and 'contraindication' (ie, the high-risk and intermediate-risk categories) for manual therapy and/or exercise. Sensitivity, specificity, predictive values, likelihood ratios and the area under the curve were calculated. RESULTS Manual therapy and/or exercise were contraindicated in 54.7% of the patients. The sensitivity of the IFOMPT framework was low (0.50, 95% CI 0.39 to 0.61) and its specificity was moderate (0.63, 95% CI 0.51 to 0.75). The positive and negative likelihood ratios were weak at 1.36 (95% CI 0.93 to 1.99) and 0.79 (95% CI 0.60 to 1.05), respectively. The area under the curve was poor (0.57, 95% CI 0.49 to 0.65). CONCLUSION The IFOMPT framework has poor diagnostic accuracy when compared with a reference standard consisting of a consensus medical decision.
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Affiliation(s)
- Rogier F de Best
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Michel W Coppieters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Menzies Health Institute Queensland, School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, Australia
| | | | - Annette Compter
- Department of Neuro-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maarten Uyttenboogaart
- Department of Neurology and Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joost C Bot
- Department of Radiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Rene Castien
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Jan Jm Pool
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Gwendolyne Gm Scholten-Peeters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
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Garrett B, Caulfield T, Musoke R, Murdoch B, Tang X, Lam JST. Demographic and psychometric predictors associated with engagement in risk-associated alternative healthcare behaviours. PLoS One 2023; 18:e0291016. [PMID: 37733748 PMCID: PMC10513319 DOI: 10.1371/journal.pone.0291016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/20/2023] [Indexed: 09/23/2023] Open
Abstract
This paper builds on prior work exploring the use of risk-associated alternative healthcare (RAAH) in Canada. RAAH uptake was surveyed to explore the characteristics of adult RAAH users and the value of established psychometric instruments previously used in alternative healthcare studies in predicting RAAH behaviours: the Control Beliefs Inventory (CBI), the Reward Responsiveness Behavioural Activation System (RBAS) scale, the Positive Attitudes to Science (PAS) scale, the Satisfaction with Orthodox Medicine (SOM) scale, and the brief version of the Susceptibility to Persuasion-II (StP-II-B) scale. Findings suggest RAAH is influenced by gender, age, income, education, employment, chronic illness status, and ethnicity. Engagement in some form of RAAH was common (around 40%) and the most common types of RAAH use reported were physical manipulation and herbal/nutritional supplement use. Other higher-risk AH activities (such as use of toxins and physically invasive procedures) were also reported by about 5% of respondents. The StP-II-B and PAS instruments were predictive of the likelihood of engagement in RAAH behaviours, as illustrated by higher risk tolerance, desire for novelty, positive attitude to advertising and social influence, and positive beliefs about science. The CBI, RBAS, and SOM instruments were not predictive overall. However, the CBI and SOM instruments were predictive of engagement with physical manipulative RAAH activities, while the RBAS was predictive of herbal/nutritional RAAH engagement. These findings can help inform health professionals' understanding of public health-seeking behaviours with respect to risk.
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Affiliation(s)
- Bernie Garrett
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Timothy Caulfield
- Health Law Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Richard Musoke
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Blake Murdoch
- Health Law Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Xuyan Tang
- Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joyce S. T. Lam
- Pacific Parkinson’s Research Centre, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
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Minnucci S, Innocenti T, Salvioli S, Giagio S, Yousif MS, Riganelli F, Carletti C, Feller D, Brindisino F, Faletra A, Chiarotto A, Mourad F. Benefits and Harms of Spinal Manipulative Therapy for Treating Recent and Persistent Nonspecific Neck Pain: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2023; 53:510-528. [PMID: 37561605 DOI: 10.2519/jospt.2023.11708] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
OBJECTIVE: We aimed to estimate the benefits and harms of cervical spinal manipulative therapy (SMT) for treating neck pain. DESIGN: Intervention systematic review with meta-analysis of randomized controlled trials (RCTs). LITERATURE SEARCH: We searched the MEDLINE, Cochrane CENTRAL, Embase, CINAHL, PEDro, Chiropractic Literature Index bibliographic databases, and grey literature sources, up to June 6, 2022. STUDY SELECTION CRITERIA: RCTs evaluating SMT compared to guideline-recommended and nonrecommended interventions, sham SMT, and no intervention for adults with neck pain were eligible for our systematic review. Prespecified outcomes included pain, range of motion, disability, health-related quality of life. DATA SYNTHESIS: Random-effects meta-analysis for clinically homogenous RCTs at short-term and long-term outcomes. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 Tool. We used the Grading of Recommendations, Assessment, Development, and Evaluations approach to judge the certainty of evidence. RESULTS: We included 28 RCTs. There was very low to low certainty evidence that SMT was more effective than recommended interventions for improving pain at short term (standardized mean difference [SMD], 0.66; 95% confidence interval [CI]: 0.35, 0.97) and long term (SMD, 0.73; 95% CI: 0.31, 1.16), and for reducing disability at short-term (SMD, 0.95; 95% CI: 0.48, 1.42) and long term (SMD, 0.65; 95% CI: 0.23, 1.06). Transient side effects only were found (eg, muscle soreness). CONCLUSION: There was very low certainty evidence supporting cervical SMT as an intervention to reduce pain and improve disability in people with neck pain. J Orthop Sports Phys Ther 2023;53(9):510-528. Epub: 10 August 2023. doi:10.2519/jospt.2023.11708.
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Stickler K, Kearns G. Spinal manipulation and adverse event reporting in the pregnant patient limits estimation of relative risk: a narrative review. J Man Manip Ther 2023; 31:162-173. [PMID: 36047253 PMCID: PMC10288923 DOI: 10.1080/10669817.2022.2118653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVE To describe variability in spinal manipulation technique details and adverse event (AE) documentation of spinal manipulation during pregnancy. METHODS Five databases were searched for peer-reviewed investigations of spinal manipulation during pregnancy. Criteria for inclusion was as follows: high velocity, low amplitude thrust manipulation performed, subjects pregnant during manipulation, and English language. Studies were excluded when participants were not currently pregnant, and when the manipulation performed was not high-velocity, low-amplitude thrust. Data extraction included study design, number of participants, gestational age, spinal region, number of manipulations, manipulation technique details, profession of manipulator, AE reporting (Yes vs. No), type, and number of AE. RESULTS Out of 18 studies included in the review, only three provide details of the spinal manipulation technique. The reported variables include patient position, practitioner position, and direction of thrust. Fourteen studies documented AE; however, only seven provide AE details. DISCUSSION Reporting of spinal manipulation techniques and AE during pregnancy were inconsistent. Replication of methods in future investigations is limited without more detailed documentation of manipulation techniques performed. Furthermore, determining the relative risk and safety of spinal manipulation during pregnancy is not possible without more detailed reporting of AE. Due to these inconsistencies, a checklist is proposed for standardized reporting of spinal manipulation techniques and AE. With more consistent reporting of these parameters, results of future investigations may allow for more definitive and generalizable safety recommendations on spinal manipulation during pregnancy.
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Affiliation(s)
- Kellie Stickler
- Cerner Corporation, Workforce Health Services, Overland Park, Kansas, USA
| | - Gary Kearns
- Texas Tech University Health Sciences Center, DPT Program, Lubbock, Texas, USA
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Thomas M, Swait G, Finch R. Ten years of online incident reporting and learning using CPiRLS: implications for improved patient safety. Chiropr Man Therap 2023; 31:9. [PMID: 36793096 PMCID: PMC9933370 DOI: 10.1186/s12998-023-00477-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/19/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Safety incident (SI) reporting and learning via incident reporting systems (IRSs) is used to identify areas for patient safety improvement. The chiropractic patient incident reporting and learning system (CPiRLS) is an online IRS that was launched in the UK in 2009 and, from time to time, has been licensed for use by the national members of the European Chiropractors' Union (ECU), members of Chiropractic Australia and a Canada-based research group. The primary aim of this project was to analyse the SIs submitted to CPiRLS over a 10-year period to identify key areas for patient safety improvement. METHOD All SIs reported to CPiRLS between April 2009 and March 2019 were extracted and analysed. Descriptive statistics were used to describe: (1) the frequency of SI reporting and learning by the chiropractic profession, and (2) the character of reported SIs. Key areas for patient safety improvement were developed following a mixed methods approach. RESULTS A total of 268 SIs were recorded on the database over the 10-year period, 85% of which originated from the UK. Evidence of learning was documented in 143 (53.4%) SIs. The largest subcategory of SIs related to post-treatment distress or pain (n = 71, 26.5%). Seven key areas for patient improvement were developed including: (1) patient trip/fall, (2) post treatment distress/pain, (3) negative effects during treatment, (4) significant post-treatment effects, (5) syncope, (6) failure to recognize serious pathology, and (7) continuity of care. CONCLUSION The low number of SIs reported over a 10-year period suggests significant under-reporting, however, an upward trend was identified over the 10-year period. Several key areas for patient safety improvement have been identified for dissemination to the chiropractic profession. Improved reporting practice needs to be facilitated to improve the value and validity of reporting data. CPiRLS is important in identifying key areas for patient safety improvement.
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Affiliation(s)
- Mark Thomas
- Institute of Health and Social Care, London South Bank University, London, UK.
| | - Gabrielle Swait
- Royal College of Chiropractors, Chiltern House, 45 Station Road, Henley on Thames, Oxfordshire, RG9 1AT, UK
| | - Rob Finch
- Royal College of Chiropractors, Chiltern House, 45 Station Road, Henley on Thames, Oxfordshire, RG9 1AT, UK
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Rushton A, Carlesso LC, Flynn T, Hing WA, Rubinstein SM, Vogel S, Kerry R. International Framework for Examination of the Cervical Region for Potential of Vascular Pathologies of the Neck Prior to Musculoskeletal Intervention: International IFOMPT Cervical Framework. J Orthop Sports Phys Ther 2023; 53:7-22. [PMID: 36099171 DOI: 10.2519/jospt.2022.11147] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
SYNOPSIS: This position statement, stemming from the International IFOMPT (International Federation of Orthopaedic Manipulative Physical Therapists) Cervical Framework, was developed based upon the best contemporary evidence and expert opinion to assist clinicians during their clinical reasoning process when considering presentations involving the head and neck. Developed through rigorous consensus methods, the International IFOMPT Cervical Framework guides assessment of the cervical spine region for potential vascular pathologies of the neck in advance of planned interventions. Within the cervical spine, events and presentations of vascular pathologies of the neck are rare but are an important consideration as part of patient examination. Vascular pathologies may be recognizable if the appropriate questions are asked during the patient history-taking process, if interpretation of elicited data enables recognition of this potential, and if the physical examination can be adapted to explore any potential vasculogenic hypothesis. J Orthop Sports Phys Ther 2023;53(1):7-22. Epub: 14 September 2022. doi:10.2519/jospt.2022.11147.
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Mourad F, Yousif MS, Maselli F, Pellicciari L, Meroni R, Dunning J, Puentedura E, Taylor A, Kerry R, Hutting N, Kranenburg HA. Knowledge, beliefs, and attitudes of spinal manipulation: a cross-sectional survey of Italian physiotherapists. Chiropr Man Therap 2022; 30:38. [PMID: 36096835 PMCID: PMC9465888 DOI: 10.1186/s12998-022-00449-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVE High-velocity low-amplitude thrust spinal manipulation (SM) is a recommended and commonly used manual therapy intervention in physiotherapy. Beliefs surrounding the safety and effectiveness of SM have challenged its use, and even advocated for its abandonment. Our study aimed to investigate the knowledge and beliefs surrounding SM by Italian physiotherapists compared with similar practitioners in other countries. METHODS An online survey with 41 questions was adapted from previous surveys and was distributed via a mailing list of the Italian Physiotherapists Association (March 22-26, 2020). The questionnaire was divided into 4 sections to capture information on participant demographics, utilization, potential barriers, and knowledge about SM. Questions were differentiated between spinal regions. Attitudes towards different spinal regions, attributes associated with beliefs, and the influence of previous educational background were each evaluated. RESULTS Of the 7398 registered physiotherapists, 575 (7.8%) completed the survey and were included for analysis. The majority of respondents perceived SM as safe and effective when applied to the thoracic (74.1%) and lumbar (72.2%) spines; whereas, a smaller proportion viewed SM to the upper cervical spine (56.8%) as safe and effective. Respondents reported they were less likely to provide and feel comfortable with upper cervical SM (respectively, 27.5% and 48.5%) compared to the thoracic (respectively, 52.2% and 74.8%) and lumbar spines (respectively, 46.3% and 74.3%). Most physiotherapists (70.4%) agreed they would perform additional screening prior to upper cervical SM compared to other spinal regions. Respondents who were aware of clinical prediction rules were more likely to report being comfortable with SM (OR 2.38-3.69) and to perceive it as safe (OR 1.75-3.12). Finally, physiotherapists without musculoskeletal specialization, especially those with a traditional manual therapy background, were more likely to perform additional screening prior to SM, use SM less frequently, report being less comfortable performing SM, and report upper cervical SM as less safe (p < 0.001). DISCUSSION The beliefs and attitudes of physiotherapists surrounding the use of SM are significantly different when comparing the upper cervical spine to other spinal regions. An educational background in traditional manual therapy significantly influences beliefs and attitudes. We propose an updated framework on evidence-based SM.
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Affiliation(s)
- Firas Mourad
- Department of Physiotherapy, Exercise and Sports, LUNEX International University of Health, 4671, Differdange, Luxembourg.
- Luxembourg Health & Sport Sciences Research Institute A.S.B.L., 50, Avenue du Parc des Sports, 4671, Differdange, Luxembourg.
| | - Marzia Stella Yousif
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Filippo Maselli
- Department of Human Neurosciences, Sapienza" University of Rome, Rome, Italy
- Sovrintendenza Sanitaria Regionale Puglia INAIL, Bari, Italy
| | | | - Roberto Meroni
- Department of Physiotherapy, Exercise and Sports, LUNEX International University of Health, 4671, Differdange, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute A.S.B.L., 50, Avenue du Parc des Sports, 4671, Differdange, Luxembourg
| | - James Dunning
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA
- Montgomery Osteopractic Physiotherapy & Acupuncture Clinic, Montgomery, AL, USA
| | - Emilio Puentedura
- Doctor of Physical Therapy Program, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
| | - Alan Taylor
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Roger Kerry
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Nathan Hutting
- Department of Occupation and Health, School of Organisation and Development, HAN University of Applied Sciences, Nijmegen, The Netherlands
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11
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Funabashi M, Gorrell LM, Pohlman KA, Bergna A, Heneghan NR. Definition and classification for adverse events following spinal and peripheral joint manipulation and mobilization: A scoping review. PLoS One 2022; 17:e0270671. [PMID: 35839253 PMCID: PMC9286262 DOI: 10.1371/journal.pone.0270671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 06/14/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Spinal and peripheral joint manipulation and mobilization are interventions used by many healthcare providers to manage musculoskeletal conditions. Although there are many reports of adverse events (or undesirable outcomes) following such interventions, there is no common definition for an adverse event or clarity on any severity classification. This impedes advances of patient safety initiatives and practice. This scoping review mapped the evidence of adverse event definitions and classification systems following spinal and peripheral joint manipulation and mobilization for musculoskeletal conditions in adults. METHODS An electronic search of the following databases was performed from inception to February 2021: MEDLINE, EMBASE, CINAHL, Scopus, AMED, ICL, PEDro, Cochrane Library, Open Grey and Open Theses and Dissertations. Studies including adults (18 to 65 years old) with a musculoskeletal condition receiving spinal or peripheral joint manipulation or mobilization and providing an adverse event definition and/or classification were included. All study designs of peer-reviewed publications were considered. Data from included studies were charted using a standardized data extraction form and synthesised using narrative analysis. RESULTS From 8248 identified studies, 98 were included in the final synthesis. A direct definition for an adverse event and/or classification system was provided in 69 studies, while 29 provided an indirect definition and/or classification system. The most common descriptors to define an adverse event were causality, symptom severity, onset and duration. Twenty-three studies that provided a classification system described only the end anchors (e.g., mild/minor and/or serious) of the classification while 26 described multiple categories (e.g., moderate, severe). CONCLUSION A vast array of terms, definition and classification systems were identified. There is no one common definition or classification for adverse events following spinal and peripheral joint manipulation and mobilization. Findings support the urgent need for consensus on the terms, definition and classification system for adverse events related to these interventions.
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Affiliation(s)
- Martha Funabashi
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON, Canada
- Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Lindsay M. Gorrell
- Department of Chiropractic Medicine, Integrative Spinal Research Group, University of Zürich and University Hospital Balgrist, Zürich, Switzerland
| | | | - Andrea Bergna
- Research Department, SOMA Istituto Osteopatia Milano, Milan, Italy
- AISO-Associazione Italiana Scuole di Osteopatia, Pescara, Italy
| | - Nicola R. Heneghan
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
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12
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Garrett B, Caulfield T, Murdoch B, Brignall M, Kapur AK, Murphy S, Nelson E, Reardon J, Harrison M, Hislop J, Wilson‐Keates BJ, Anthony J, Loewen PS, Musoke RM, Braun J. A taxonomy of risk-associated alternative health practices: A Delphi study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1163-1181. [PMID: 34041822 PMCID: PMC9291966 DOI: 10.1111/hsc.13386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/23/2021] [Accepted: 03/08/2021] [Indexed: 06/12/2023]
Abstract
Defining alternative health care and the recording of associated adverse events and harm remains problematic. This Canadian study aimed to establish and classify risk-associated alternative health practices in a Delphi study undertaken with an interdisciplinary panel of 17 health experts in 2020. It provides a new functional definition of alternative health care and an initial taxonomy of risk-associated alternative health care practices. A number of risk-associated practices were identified and categorized into general practices that conflict with biomedical care or largely untested therapies, alternative beliefs systems, physical manipulative alternative therapies, and herbal and nutritional supplements. Some risk significant harms including major physical injuries or even death. The lack of systematic methods for recording adverse events in alternative health care makes establishing the frequency of such events challenging. However, it is important that people engaging with alternative health care understand they are not necessarily risk-free endeavours, and what those risks are.
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Affiliation(s)
- Bernie Garrett
- School of NursingUniversity of British ColumbiaVancouverBCCanada
| | - Timothy Caulfield
- Faculty of LawHealth Law InstituteUniversity of AlbertaEdmontonABCanada
| | - Blake Murdoch
- Faculty of LawHealth Law InstituteUniversity of AlbertaEdmontonABCanada
| | | | | | - Susan Murphy
- Department of Physical TherapyFaculty of MedicineUniversity of British ColumbiaVancouverBCCanada
| | - Erin Nelson
- Faculty of LawHealth Law InstituteUniversity of AlbertaEdmontonABCanada
| | - Jillian Reardon
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBCCanada
| | - Mark Harrison
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBCCanada
- Centre for Health Evaluation and Outcome Sciences (CHEOS)St. Paul’s HospitalVancouverBCCanada
| | - Jonathan Hislop
- Family MedicineUniversity of British ColumbiaVancouverBCCanada
| | | | - Joseph Anthony
- Department of Physical TherapyFaculty of MedicineUniversity of British ColumbiaVancouverBCCanada
| | - Peter S. Loewen
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBCCanada
| | - Richard M. Musoke
- School of Population and Public HealthUniversity of British ColumbiaVancouverBCCanada
| | - Joan Braun
- Bora Laskin Faculty of LawLakehead UniversityThunder BayONCanada
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13
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Kim S, Kim GB, Kim HJ, Park J, Lee JW, Jeong WJ, Kim HG, Kim MY, Park KS, Lee J, Lee JH, Shin JS, Shin BC, Ha IH. Safety of Chuna Manipulation Therapy in 289,953 Patients with Musculoskeletal Disorders: A Retrospective Study. Healthcare (Basel) 2022; 10:healthcare10020294. [PMID: 35206908 PMCID: PMC8871927 DOI: 10.3390/healthcare10020294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 11/24/2022] Open
Abstract
Studies have reported that mild adverse events (AEs) are common after manual therapy and that there is a risk of serious injury. We aimed to assess the safety of Chuna manipulation therapy (CMT), a traditional manual Korean therapy, by analysing AEs in patients who underwent this treatment. Patients who received at least one session of CMT between December 2009 and March 2019 at 14 Korean medicine hospitals were included. Electronic patient charts and internal audit data obtained from situation report logs were retrospectively analysed. All data were reviewed by two researchers. The inter-rater agreement was assessed using the Cohen’s kappa coefficient, and reliability analysis among hospitals was assessed using Cronbach’s Alpha coefficient. In total, 2,682,258 CMT procedures were performed in 289,953 patients during the study period. There were 50 AEs, including worsened pain (n = 29), rib fracture (n = 11), falls during treatment (n = 6), chest pain (n = 2), dizziness (n = 1), and unpleasant feeling (n = 1). The incidence of mild to moderate AEs was 1.83 (95% confidence interval [CI] 1.36–2.39) per 100,000 treatment sessions, and that of severe AEs was 0.04 (95% CI 0.00–0.16) per 100,000 treatment sessions. Thus, AEs of any level of severity were very rare after CMT. Moreover, there were no instances of carotid artery dissection or spinal cord injury, which are the most severe AEs associated with manual therapy in other countries.
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Affiliation(s)
- Suna Kim
- Daejeon Jaseng Hospital of Korean Medicine, Daejeon 35263, Korea; (S.K.); (G.-B.K.); (H.-j.K.); (J.P.); (J.-W.L.); (W.-j.J.); (H.-G.K.)
| | - Gook-Beom Kim
- Daejeon Jaseng Hospital of Korean Medicine, Daejeon 35263, Korea; (S.K.); (G.-B.K.); (H.-j.K.); (J.P.); (J.-W.L.); (W.-j.J.); (H.-G.K.)
| | - Hyo-jun Kim
- Daejeon Jaseng Hospital of Korean Medicine, Daejeon 35263, Korea; (S.K.); (G.-B.K.); (H.-j.K.); (J.P.); (J.-W.L.); (W.-j.J.); (H.-G.K.)
| | - Joon Park
- Daejeon Jaseng Hospital of Korean Medicine, Daejeon 35263, Korea; (S.K.); (G.-B.K.); (H.-j.K.); (J.P.); (J.-W.L.); (W.-j.J.); (H.-G.K.)
| | - Ji-Won Lee
- Daejeon Jaseng Hospital of Korean Medicine, Daejeon 35263, Korea; (S.K.); (G.-B.K.); (H.-j.K.); (J.P.); (J.-W.L.); (W.-j.J.); (H.-G.K.)
| | - Wu-jin Jeong
- Daejeon Jaseng Hospital of Korean Medicine, Daejeon 35263, Korea; (S.K.); (G.-B.K.); (H.-j.K.); (J.P.); (J.-W.L.); (W.-j.J.); (H.-G.K.)
| | - Hye-Gyeong Kim
- Daejeon Jaseng Hospital of Korean Medicine, Daejeon 35263, Korea; (S.K.); (G.-B.K.); (H.-j.K.); (J.P.); (J.-W.L.); (W.-j.J.); (H.-G.K.)
| | - Min-Young Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundations, Seoul 06110, Korea;
| | - Kyoung-Sun Park
- Jaseng Hospital of Korean Medicine, Seoul 06110, Korea; (K.-S.P.); (J.L.); (J.-S.S.)
| | - Jinho Lee
- Jaseng Hospital of Korean Medicine, Seoul 06110, Korea; (K.-S.P.); (J.L.); (J.-S.S.)
| | - Jun-Hwan Lee
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Korea;
- Korean Medicine Life Science, Campus of Korea Institute of Oriental Medicine, University of Science & Technology (UST), Daejeon 34113, Korea
| | - Joon-Shik Shin
- Jaseng Hospital of Korean Medicine, Seoul 06110, Korea; (K.-S.P.); (J.L.); (J.-S.S.)
| | - Byung-Cheul Shin
- School of Korean Medicine, Pusan National University, Yangsan 50612, Korea
- Spine & Joint Center, Pusan National University Korean Medicine Hospital, Yangsan 50612, Korea
- Correspondence: (B.-C.S.); (I.-H.H.)
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundations, Seoul 06110, Korea;
- Correspondence: (B.-C.S.); (I.-H.H.)
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14
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Hay W, Steinke L, Foster L. Complementary and Alternative Medicine. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Jenkins HJ, Kongsted A, French SD, Jensen TS, Doktor K, Hartvigsen J, Hancock M. What are the effects of diagnostic imaging on clinical outcomes in patients with low back pain presenting for chiropractic care: a matched observational study. Chiropr Man Therap 2021; 29:46. [PMID: 34814923 PMCID: PMC8611826 DOI: 10.1186/s12998-021-00403-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/11/2021] [Indexed: 12/29/2022] Open
Abstract
Background Evidence suggests that diagnostic imaging for low back pain does not improve care in the absence of suspicion of serious pathology. However, the effect of imaging use on clinical outcomes has not been investigated in patients presenting to chiropractors. The aim of this study was to determine if diagnostic imaging affects clinical outcomes in patients with low back pain presenting for chiropractic care. Methods A matched observational study using prospective longitudinal observational data with one year follow up was performed in primary care chiropractic clinics in Denmark. Data was collected from November 2016 to December 2019. Participants included low back pain patients presenting for chiropractic care, who were either referred or not referred for diagnostic imaging during their initial visit. Patients were excluded if they were less than 18 years old, had a diagnosis of underlying pathology, or had previous imaging relevant to their current clinical presentation. Coarsened exact matching was used to match participants referred for diagnostic imaging with participants not referred for diagnostic imaging on baseline variables including participant demographics, pain characteristics, and clinical history. Mixed linear and logistic regression models were used to assess the effect of imaging on back pain intensity and disability at two-weeks, three-months, and one-year, and on global perceived effect and satisfaction with care at two-weeks. Results 2162 patients were included, with 24.1% referred for imaging. Near perfect balance between matched groups was achieved for baseline variables except age and leg pain. Participants referred for imaging had slightly higher back pain intensity at two-weeks (0.4, 95%CI: 0.1, 0.8) and one-year (0.4, 95%CI: 0.0, 0.7), and disability at two-weeks (5.7, 95%CI: 1.4, 10.0), but the changes are unlikely to be clinically meaningful. No difference between groups was found for the other outcome measures. Similar results were found when sensitivity analysis, adjusted for age and leg pain intensity, was performed. Conclusions Diagnostic imaging did not result in better clinical outcomes in patients with low back pain presenting for chiropractic care. These results support that current guideline recommendations against routine imaging apply equally to chiropractic practice.
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Affiliation(s)
- Hazel J Jenkins
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Rm 347, 17 Wally's Walk, Sydney, 2109, Australia.
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark
| | - Simon D French
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Rm 347, 17 Wally's Walk, Sydney, 2109, Australia
| | - Tue Secher Jensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark.,Diagnostic Centre - Imaging Section, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Klaus Doktor
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark
| | - Mark Hancock
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Rm 347, 17 Wally's Walk, Sydney, 2109, Australia
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16
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Brück K, Jacobi K, Schmidt T. Fascial treatment versus manual therapy (HVLA) in patients with chronic neck pain: A randomized controlled trial. J Back Musculoskelet Rehabil 2021; 34:997-1006. [PMID: 34092587 DOI: 10.3233/bmr-191731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chronic neck pain (CNP) is a common health problem in western industrialized nations. In recent years, the fascial tissue has attracted the attention of therapists, and a treatment of the fasciae promises to be a meaningful approach in the therapy of patients with CNP. OBJECTIVE The aim of this study was to investigate the effectiveness of a fascial treatment (FT) compared to manual therapy (MT) and to no intervention (control group, CG) in patients with CNP. METHODS Sixty participants with CNP were randomized into three groups. Primary outcome parameters were pain intensity as measured by the visual analogue scale (VAS), and severity of illness as measured by the Neck Pain and Disability Scale (NPAD). Secondary outcome parameter was the range of motion (ROM) of the cervical spine. RESULTS Repeated measures t-tests demonstrated significant decreases with medium to large effect sizes for the FT (VAS: dRM= 1.14; NPAD: dRM= 0.51) and for the MT (VAS: dRM= 1.15; NPAD: dRM= 0.72). CONCLUSION Our results confirmed the effectiveness of MT on pain and severity of illness in the treatment of patients suffering from CNP. Furthermore, the results demonstrated the effectiveness and clinical relevance of FT for this population.
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Affiliation(s)
- Katrin Brück
- Praxis für Osteopathie und Naturheilkunde, Geestland, Germany.,Praxis für Osteopathie und Naturheilkunde, Geestland, Germany
| | - Kirsten Jacobi
- Faszium GbR, Altenholz, Germany.,Praxis für Osteopathie und Naturheilkunde, Geestland, Germany
| | - Tobias Schmidt
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany.,Osteopathie-Schule Deutschland (OSD), Hamburg, Germany
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17
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The methodological quality was low and conclusions discordant for meta-analyses comparing proximal humerus fracture treatments: a meta-epidemiological study. J Clin Epidemiol 2021; 142:100-109. [PMID: 34718123 DOI: 10.1016/j.jclinepi.2021.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/08/2021] [Accepted: 10/19/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate the association between methodological quality and reported conclusions of meta-analyses comparing operative with non-operative treatments for proximal humerus fractures. STUDY DESIGN AND SETTING Cross-sectional meta-epidemiological study. We searched EMBASE, PubMed, The Cochrane Library, and Web of Science for systematic reviews with meta-analyses comparing non-operative with operative treatments for proximal humerus fractures. Methodological quality was assessed using AMSTAR2 and the reported conclusions were scored for three outcome domains (functional outcome, quality of life, and harm) on a scale from 1 to 6. The Mann-Whitney and Kruskal-Wallis tests were used to investigate the association between methodological quality and reported conclusions. RESULTS We included 21 systematic reviews: 19 pairwise meta-analyses and 2 network meta-analyses, although there are only 8 published randomized controlled trials. Most (n = 18) of the meta-analyses were rated as critically low quality, while the remaining 1 was rated as high quality. The conclusions were discordant for all three outcome domains, even for meta-analyses reporting similar inclusion criteria. We could not perform most of the statistical tests due to the predominantly critically low quality. CONCLUSION The methodological quality was so predominantly critically low that it was not possible to evaluate the association between methodological quality and reported conclusions.
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18
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Reid DA, Monaghan M, Puentedura EJ, Sizer PS, Brismée JM. Thrust joint manipulation: just do it! J Man Manip Ther 2021; 29:265-266. [PMID: 34591743 DOI: 10.1080/10669817.2021.1973634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Duncan A Reid
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Michael Monaghan
- New Zealand Musculoskeletal Physiotherapy Association, Auckland, New Zealand
| | - Emilio J Puentedura
- Doctor of Physical Therapy Program, Robbins College of Health and Human Services, Baylor University, Waco, Texas, USA
| | - Phillip S Sizer
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Jean-Michel Brismée
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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19
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Measuring the Appropriateness of Spinal Manipulation for Chronic Low Back and Chronic Neck Pain in Chiropractic Patients. Spine (Phila Pa 1976) 2021; 46:1344-1353. [PMID: 34517404 PMCID: PMC8438222 DOI: 10.1097/brs.0000000000004009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN RAND/UCLA Appropriateness Method (RUAM) applied to chiropractic manipulation for patients with chronic low-back pain (CLBP) and chronic neck pain (CNP). OBJECTIVE Determine the rate of appropriate care provided by US chiropractors. SUMMARY OF BACKGROUND DATA Spinal manipulation has been shown effective for CLBP and CNP but may not be appropriate for all patients with these conditions. METHODS Ratings of the appropriateness of spinal and cervical manipulation previously developed by two RUAM expert panels were applied to data abstracted from random samples of patient charts from chiropractors in six US regions to determine the appropriateness of manipulation for each patient. RESULTS Of 125 chiropractors sampled, 89 provided charts that could be abstracted. Of the 2128 charts received, 1054 were abstracted. Charts received but not abstracted included 460 that were unusable (e.g., illegible), and 555 did not have CLBP or CNP. Across the abstracted charts 72% had CLBP, 57% had CNP, and 29% had both; 84% of patients with CLBP and 86% with CNP received manipulation. Patients with CLBP who had minor neurologic findings, sciatic nerve irritation, or no joint dysfunction were significantly less likely to receive manipulation. Patients with CNP who had substantial trauma etiology, no joint dysfunction, or no radiographs were significantly less likely to receive manipulation. Most manipulation for CLBP (64%) was appropriate and most manipulation for CNP (93%) was for patients where appropriateness was uncertain or equivocal. The proportions of patients receiving inappropriate manipulation for either condition were low (1%-3%) as were the numbers of patients presenting to these chiropractors for which manipulation was inappropriate. CONCLUSION Chiropractors in this US sample tend to provide manipulation to very few patients with CLBP or CNP for which it is inappropriate. However, more research is needed to determine which patients with CNP benefit from manipulation.Level of Evidence: 4.
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20
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Liu H, Zhang T, Qu T, Yang CW, Li SK. Spinal epidural hematoma after spinal manipulation therapy: Report of three cases and a literature review. World J Clin Cases 2021; 9:6501-6509. [PMID: 34435018 PMCID: PMC8362556 DOI: 10.12998/wjcc.v9.i22.6501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/04/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Spinal manipulation therapy (SMT) has been widely used worldwide to treat musculoskeletal diseases, but it can cause serious adverse events. Spinal epidural hematoma (SEH) caused by SMT is a rare emergency that can cause neurological dysfunction. We herein report three cases of SEH after SMT.
CASE SUMMARY The first case was a 30-year-old woman who experienced neck pain and numbness in both upper limbs immediately after SMT. Her symptoms persisted after 3 d of conservative treatment, and she was admitted to our hospital. Magnetic resonance imaging (MRI) demonstrated an SEH, extending from C6 to C7. The second case was a 55-year-old man with sudden back pain 1 d after SMT, numbness in both lower limbs, an inability to stand or walk, and difficulty urinating. MRI revealed an SEH, extending from T1 to T3. The third case was a 28-year-old man who suddenly developed symptoms of numbness in both lower limbs 4 h after SMT. He was unable to stand or walk and experienced mild back pain. MRI revealed an SEH, extending from T1 to T2. All three patients underwent surgery after failed conservative treatment. The three cases recovered to ASIA grade E on day 5, 1 wk, and day 10 after surgery, respectively. All patients returned to normal after 3 mo of follow-up.
CONCLUSION SEH caused by SMT is very rare, and the condition of each patient should be evaluated in full detail before operation. SEH should be diagnosed immediately and actively treated by surgery.
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Affiliation(s)
- Hua Liu
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Tao Zhang
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Tao Qu
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Cheng-Wei Yang
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Song-Kai Li
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
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21
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Huang X, Lin D, Liang Z, Deng Y, He Z, Wang M, Tan J, Li Y, Yang Y, Huang W. Mechanical Parameters and Trajectory of Two Chinese Cervical Manipulations Compared by a Motion Capture System. Front Bioeng Biotechnol 2021; 9:714292. [PMID: 34381767 PMCID: PMC8351596 DOI: 10.3389/fbioe.2021.714292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/29/2021] [Indexed: 12/29/2022] Open
Abstract
Objective: To compare the mechanical parameters and trajectory while operating the oblique pulling manipulation and the cervical rotation–traction manipulation. Methods: An experimental research measuring kinematics parameter and recording motion trajectories of two cervical manipulations were carried out. A total of 48 healthy volunteers participated in this study, who were randomly divided into two groups of 24 representing each of the two manipulations. A clinician performed two manipulations in two groups separately. A motion capture system was used to monitor and analyze kinematics parameters during the operation. Results: The two cervical manipulations have similar thrust time, displacement, mean velocity, max velocity, and max acceleration. There were no significant differences in active and passive amplitudes between the two cervical rotation manipulations. The thrust amplitudes of the oblique pulling manipulation and the cervical rotation–traction manipulation were 5.735 ± 3.041° and 2.142 ± 1.742°, respectively. The thrust amplitudes of the oblique pulling manipulation was significantly greater than that of the cervical rotation–traction manipulation (P < 0.001). Conclusion: Compared with the oblique pulling manipulation, the cervical rotation–traction manipulation has a less thrust amplitudes.
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Affiliation(s)
- Xuecheng Huang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.,Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Biomechanics, Southern Medical University, Guangzhou, China.,Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Dongxin Lin
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.,Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Biomechanics, Southern Medical University, Guangzhou, China
| | - Zeyu Liang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.,Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Biomechanics, Southern Medical University, Guangzhou, China
| | - Yuping Deng
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.,Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Biomechanics, Southern Medical University, Guangzhou, China
| | - Zaopeng He
- Hand and Foot Surgery and Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, Foshan, China
| | - Mian Wang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.,Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Biomechanics, Southern Medical University, Guangzhou, China
| | - Jinchuan Tan
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.,Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Biomechanics, Southern Medical University, Guangzhou, China
| | - Yikai Li
- School of Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Yang Yang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.,Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Biomechanics, Southern Medical University, Guangzhou, China
| | - Wenhua Huang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.,Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Biomechanics, Southern Medical University, Guangzhou, China
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22
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Clinical Scenarios for Which Cervical Mobilization and Manipulation Are Considered by an Expert Panel to Be Appropriate (and Inappropriate) for Patients With Chronic Neck Pain. Clin J Pain 2021; 36:273-280. [PMID: 31985500 DOI: 10.1097/ajp.0000000000000800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Cervical mobilization and manipulation are 2 therapies commonly used for chronic neck pain (CNP). However, safety, especially of cervical manipulation, is controversial. This study identifies the clinical scenarios for which an expert panel rated cervical mobilization and manipulation as appropriate and inappropriate. METHODS An expert panel, following a well-validated modified-Delphi approach, used an evidence synthesis and clinical acumen to develop and then rate the appropriateness of cervical mobilization and manipulation for each of an exhaustive list of clinical scenarios for CNP. Key patient characteristics were identified using decision tree analysis (DTA). RESULTS Three hundred seventy-two clinical scenarios were defined and rated by an 11-member expert panel as to the appropriateness of cervical mobilization and manipulation. Across clinical scenarios more were rated inappropriate than appropriate for both therapies, and more scenarios were rated inappropriate for manipulation than mobilization. However, the number of patients presenting with each scenario is not yet known. Nevertheless, DTA indicates that all clinical scenarios that included red flags (eg, fever, cancer, inflammatory arthritides, or vasculitides), and some others involving major neurological findings, especially if previous manual therapy was unfavorable, were rated as inappropriate for both cervical mobilization and manipulation. DTA also identified the absence of cervical disk herniation, stenosis, or foraminal osteophytosis on additional testing as the most important patient characteristic in predicting ratings of appropriate. CONCLUSIONS Clinical guidelines for CNP should include information on the clinical scenarios for which cervical mobilization and manipulation were found inappropriate, including those with red flags, and others involving major neurological findings if previous manual therapy was unfavorable.
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23
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de Best RF, Coppieters MW, van Trijffel E, Compter A, Uyttenboogaart M, Bot JC, Castien R, Pool JJM, Cagnie B, Scholten-Peeters GGM. Interexaminer Agreement and Reliability of an Internationally Endorsed Screening Framework for Cervical Vascular Risks Following Manual Therapy and Exercise: The Go4Safe Project. Phys Ther 2021; 101:6309589. [PMID: 34174073 PMCID: PMC8494014 DOI: 10.1093/ptj/pzab166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 03/25/2021] [Accepted: 05/27/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Clinicians are recommended to use the clinical reasoning framework developed by the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) to provide guidance regarding assessment of the cervical spine and potential for cervical artery dysfunction prior to manual therapy and exercise. However, the interexaminer agreement and reliability of this framework is unknown. This study aimed to estimate the interexaminer agreement and reliability of the IFOMPT framework among physical therapists in primary care. METHODS Ninety-six patients who consulted a physical therapist for neck pain or headache were included in the study. Each patient was tested independently by 2 physical therapists, from a group of 17 physical therapists (10 pairs) across The Netherlands. Patients and examiners were blinded to the test results. The overall interexaminer agreement, specific agreement per risk category (high-, intermediate-, and low-risk), and interexaminer reliability (weighted κ) were calculated. RESULTS Overall agreement was 71% (specific agreement in high-risk category = 63%; specific agreement in intermediate-risk category = 38%; specific agreement in low-risk category = 84%). Overall reliability was moderate (weighted κ = 0.39; 95% CI = 0.21-0.57) and varied considerably between pairs of physical therapists (κ = 0.14-1.00). CONCLUSION The IFOMPT framework showed an insufficient interexaminer agreement and fair interexaminer reliability among physical therapists when screening the increased risks for vascular complications following manual therapy and exercise prior to treatment. IMPACT The IFOMPT framework contributes to the safety of manual therapy and exercise. It is widely adopted in clinical practice and educational programs, but the measurement properties are unknown. This project describes the agreement and reliability of the IFOMPT framework.
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Affiliation(s)
- Rogier F de Best
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - Michel W Coppieters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands,Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
| | - Emie van Trijffel
- SOMT University of Physiotherapy, Amersfoort, The Netherlands,Department of Experimental Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Annette Compter
- Department of Neuro-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maarten Uyttenboogaart
- Department of Neurology and Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joost C Bot
- Department of Radiology, Amsterdam University Medical Center, The Netherlands
| | - Rene Castien
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - Jan J M Pool
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Gwendolyne G M Scholten-Peeters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands,Address all correspondence to Dr Scholten-Peeters at:
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“Who am I to disagree?” A qualitative study of how patients interpret the consent process prior to manual therapy of the cervical spine. INT J OSTEOPATH MED 2021. [DOI: 10.1016/j.ijosm.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Filippo M, Mourad F. The Flat Earth Theory: is Evidence-Based Physiotherapy a Sphere? J Man Manip Ther 2021; 29:67-70. [PMID: 33797340 DOI: 10.1080/10669817.2021.1890902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Maselli Filippo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genoa - Campus of Savona, Savona, Italy
| | - Firas Mourad
- Department of Musculoskeletal Physical Therapy and Rehabilitation Science, Poliambulatorio Physio Power, Brescia, Italy
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Luceño-Mardones A, Luceño-Rodríguez I, Rodríguez-López ES, Oliva-Pascual-Vaca J, Rosety I, Oliva-Pascual-Vaca Á. Effects of Osteopathic T9-T10 Vertebral Manipulation in Tonsillitis: A Randomized Clinical Trial. Healthcare (Basel) 2021; 9:394. [PMID: 33916061 PMCID: PMC8065872 DOI: 10.3390/healthcare9040394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/03/2021] [Accepted: 03/25/2021] [Indexed: 11/16/2022] Open
Abstract
This study aimed to determine whether osteopathic manipulation of the T9-T10 vertebrae improves the evolution of tonsillitis. A randomized, stratified, controlled clinical trial with blinded patients, evaluator and data analyst was performed. The patients in the control group (CG) underwent a "sham" manipulation. A high-speed, low-amplitude technique was applied to the T9-T10 vertebrae in the osteopathic manipulative group (OMG) patients. The number of days needed to resolve the tonsillitis was significantly lower (p = 0.025) in the OMG (2.03 ± 0.95 days) than the CG (2.39 ± 0.82 days). Additionally, the number of episodes of tonsillitis after the treatment decreased significantly more in the OMG (0.8 ± 1.88 episodes/year in total) than the CG (2 ± 2.12) (p = 0.005). In the OMG, 60.8% had no recurrences of tonsillitis, compared to 22.5% of the CG, in the following year (χ2 (1) = 15.57, p < 0.001). No patients reported adverse effects. It has been concluded that during an episode of tonsillitis, the number of days to resolution was significantly lower after the application of an osteopathic manipulation of the T9-T10 vertebrae, compared to a sham manipulation. The number of subsequent year tonsillitis episodes was greatly reduced in both groups, significantly more in the OMG than in the CG patients.
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Affiliation(s)
- Agustín Luceño-Mardones
- Escuela de Osteopatía de Madrid, 28002 Madrid, Spain; (A.L.-M.); (J.O.-P.-V.); (Á.O.-P.-V.)
- Centro Sanitario de Fisioterapia y Osteopatía Agustín Luceño, 10005 Cáceres, Spain
| | | | - Elena Sonsoles Rodríguez-López
- Escuela de Osteopatía de Madrid, 28002 Madrid, Spain; (A.L.-M.); (J.O.-P.-V.); (Á.O.-P.-V.)
- Department of Physiotherapy, Universidad Camilo José Cela, 28692 Madrid, Spain
| | - Jesús Oliva-Pascual-Vaca
- Escuela de Osteopatía de Madrid, 28002 Madrid, Spain; (A.L.-M.); (J.O.-P.-V.); (Á.O.-P.-V.)
- Departamento de Fisioterapia, Universidad de Sevilla, 41004 Sevilla, Spain
- Escuela Universitaria Fco. Maldonado, Osuna, 41640 Sevilla, Spain
| | - Ignacio Rosety
- School of Medicine, University of Cadiz, 11003 Cádiz, Spain;
| | - Ángel Oliva-Pascual-Vaca
- Escuela de Osteopatía de Madrid, 28002 Madrid, Spain; (A.L.-M.); (J.O.-P.-V.); (Á.O.-P.-V.)
- Departamento de Fisioterapia, Universidad de Sevilla, 41004 Sevilla, Spain
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Kirkwood J, Allan GM, Korownyk CS, McCormack J, Garrison S, Thomas B, Ton J, Perry D, Kolber MR, Dugré N, Moe S, Lindblad AJ. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:e15-e19. [PMID: 33483409 PMCID: PMC7822616 DOI: 10.46747/cfp.6701e15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Jessica Kirkwood
- Médecin de famille et professeure adjointe à l'Université de l'Alberta (UA) à Edmonton
| | - G Michael Allan
- Médecin de famille, directeur des programmes et du soutien à la pratique au Collège des médecins de famille du Canada (CMFC) et professeur au Département de médecine familiale de l'UA
| | - Christina S Korownyk
- Médecin de famille et professeur agrégé au Département de médecine familiale de l'UA
| | - James McCormack
- Professeur à la Faculté des sciences pharmaceutiques de l'Université de la Colombie-Britannique à Vancouver
| | - Scott Garrison
- Médecin de famille et professeur agrégé au Département de médecine familiale de l'UA
| | - Betsy Thomas
- Pharmacienne et experte en données probantes cliniques pour le CMFC à Edmonton
| | - Joey Ton
- Pharmacien et expert en données probantes cliniques pour le CMFC à Edmonton
| | - Danielle Perry
- Infirmière et experte en données probantes cliniques pour le CMFC à Edmonton
| | - Michael R Kolber
- Médecin de famille et professeur au Département de médecine familiale de l'UA
| | - Nicolas Dugré
- Pharmacien au CIUSSS du Nord-de-l'Île-de-Montréal et professeur agrégé de clinique à la Faculté de pharmacie de l'Université de Montréal (Québec)
| | - Samantha Moe
- Pharmacienne et experte en données probantes cliniques au CMFC
| | - Adrienne J Lindblad
- Pharmacienne, experte en données probantes cliniques pour le CMFC et professeure agrégée de clinique au Département de médecine familiale de l'UA
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Complementary and Alternative Medicine. Fam Med 2021. [DOI: 10.1007/978-1-4939-0779-3_143-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kirkwood J, Allan GM, Korownyk CS, McCormack J, Garrison S, Thomas B, Ton J, Perry D, Kolber MR, Dugré N, Moe S, Lindblad AJ. PEER simplified decision aid: chronic back pain treatment options in primary care. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:31-34. [PMID: 33483394 PMCID: PMC7822602 DOI: 10.46747/cfp.670131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Jessica Kirkwood
- Family physician and Assistant Professor at the University of Alberta (UA) in Edmonton
| | - G Michael Allan
- Family physician, Director of Programs and Practice Support at the College of Family Physicians of Canada (CFPC), and Professor in the Department of Family Medicine at UA
| | - Christina S Korownyk
- Family physician and Associate Professor in the Department of Family Medicine at UA
| | - James McCormack
- Professor in the Faculty of Pharmaceutical Sciences at the University of British Columbia in Vancouver
| | - Scott Garrison
- Family physician and Associate Professor in the Department of Family Medicine at UA
| | - Betsy Thomas
- Pharmacist and Clinical Evidence Expert for the CFPC in Edmonton
| | - Joey Ton
- pharmacist and Clinical Evidence Expert for the CFPC in Edmonton
| | - Danielle Perry
- Nurse and Clinical Evidence Expert for the CFPC in Edmonton
| | - Michael R Kolber
- Family physician and Professor in the Department of Family Medicine at UA
| | - Nicolas Dugré
- Pharmacist at the CIUSSS du Nord-de-l'Ile-de-Montréal and Clinical Associate Professor in the Faculty of Pharmacy at the University of Montreal in Quebec
| | - Samantha Moe
- Pharmacist and Clinical Evidence Expert at the CFPC
| | - Adrienne J Lindblad
- Pharmacist, Clinical Evidence Expert Lead for the CFPC, and Associate Clinical Professor in the Department of Family Medicine at UA
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Kranenburg HA(R, Schmitt MA, Puentedura EJ, van der Schans CP, Heneghan NR, Hutting N. Manual therapists’ beliefs and use of spinal thrust joint manipulation. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1857831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Hendrikus Antonius (Rik) Kranenburg
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- Department of Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maarten A. Schmitt
- Research Center Innovations in Care, Rotterdam University of Applied Science, Rotterdam, The Netherlands
| | | | - Cees P. van der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- Department of Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nicola R. Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | - Nathan Hutting
- Department of Occupation & Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
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ADEMOĞLU E, İSLAM MM, AKSEL G, EROĞLU SE. An unusual occurrence of acute cerebellar infarct after self-cervical manipulation: a case report. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2020. [DOI: 10.33706/jemcr.789735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Evaluation of the effect of chiropractic manipulative treatment on oxidative stress in sacroiliac joint dysfunction. Turk J Phys Med Rehabil 2020; 66:176-183. [PMID: 32760895 DOI: 10.5606/tftrd.2020.3301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 12/13/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to investigate the effect of chiropractic manipulative treatment on sacroiliac joint dysfunction (SIJD) and its relationship to oxidative stress (OXS) parameters. Patients and methods Thirty-three patients diagnosed with SIJD (20 males, 13 females; mean age 36.3±9.7 years; range, 18 to 60 years) and 30 healthy volunteers (20 males, 10 females; mean age 36.4±12.2 years; range, 20 to 57 years) were included in this cross-sectional, case-control study conducted between February 2017 and September 2017. Manipulation was applied to the patients once a week for a duration of four weeks. The patients were evaluated at pre-treatment and one month after treatment with visual analog scale, SIJD test, and total thiol, native thiol, disulphide, and ischemia-modified albumin (IMA) as OXS indicators. Results Prior to treatment, we demonstrated that serum native thiol (μmol/L) and total thiol (μmol/L) levels in the patient group were lower compared to control subjects (p=0.03 and p=0.02, respectively). Serum IMA levels were higher in the patient group (p=0.01). There was no change in OXS parameters after manipulative treatment in the patient group. Conclusion Manipulation is useful in SIJD. Thiol/disulphide homeostasis and serum IMA levels may be used to measure the OXS in patients with SIJD.
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Joo S, Kim J, Lee Y, Song C. The Biomechanical Analysis of Magnitude and Direction of Force by Different Techniques of Thoracic Spinal Manipulation. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8928071. [PMID: 32775447 PMCID: PMC7399734 DOI: 10.1155/2020/8928071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/10/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Spinal manipulation (SM) has been widely recognized and used with success in health care fields for spinal joint dysfunction and pain. SM is a procedure that involves small amplitude manipulative thrusts performed with speed. These forces are complex three-dimensional (3-D) forces delivered to create forces and moments at the joint of interest to cause joint movements. The aim of this study was to conduct a 3-dimensional analysis of the magnitude and direction of the forces transmitted in 2 techniques of thoracic spinal manipulation (TSM). Materials/Methods. Thirty-two healthy participants were recruited from the university community. The physical therapist performed TSM using anterior (A) to posterior (P) and P to A techniques once at each of T3, T7, and T12 spinal levels. The magnitude and direction of the forces transmitted during TSM were sensed by the force plates, and the camera system monitored vertebral motion by tracking motion markers. RESULTS There were no significant differences on the x-axis while there were significant differences on the y-axis between the measured spinal levels in the P to A technique. There were significant differences found at preload force maximum, preload force minimum, and peak force between T3 and T12 and between T7 and T12 and at peak base force between T7 and T12 on the z-axis. In the A to P technique, there were significant differences in the change of force in measured spinal levels at different axes. CONCLUSION These study findings can help therapists better understand the mechanism of TSM and enhance the clinical usefulness of TSM.
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Affiliation(s)
- Sunghee Joo
- Department of Physical Therapy, College of Health Science, Sahmyook University, Republic of Korea
| | - Junghyun Kim
- Department of Physical Therapy, College of Health Science, Sahmyook University, Republic of Korea
| | - Yongwoo Lee
- Department of Physical Therapy, College of Health Science, Sahmyook University, Republic of Korea
| | - Changho Song
- Department of Physical Therapy, College of Health Science, Sahmyook University, Republic of Korea
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Fernández-de-las-Peñas C, Florencio LL, Plaza-Manzano G, Arias-Buría JL. Clinical Reasoning Behind Non-Pharmacological Interventions for the Management of Headaches: A Narrative Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114126. [PMID: 32527071 PMCID: PMC7312657 DOI: 10.3390/ijerph17114126] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 12/13/2022]
Abstract
Headache is the clinical syndrome most commonly observed by neurologists in daily practice. Pharmacological and non-pharmacological treatments are commonly used for the management of headaches; however, the clinical reasoning behind these interventions is not properly applied. We conducted a narrative literature review using as data sources for academic PubMed, MEDLINE, EMBASE, AMED, CINAHL, EBSCO, PEDro, Cochrane Database of Systematic Reviews, Cochrane Collaboration Trials Register, and SCOPUS. This narrative literature review mainly considered systematic reviews, meta-analyses, randomised clinical trials, and expert opinions published after the year 2000 discussing clinical reasoning for application of non-pharmacological interventions in individuals with tension-type, migraine, and cervicogenic headaches. After the data extraction, we organized the literature thematically as follows: (1) mapping of theoretical aspects of non-pharmacological interventions; (2) summarizing most updated literature about effectiveness of non-pharmacological interventions grouped by targeted tissue and headache; (3) identifying research gaps in the existing literature and proposing hypotheses for better understanding of current clinical reasoning. We found that there are many non-pharmacological treatment strategies used for headaches, including beyond the tissue-based impairment treatments (bottom-up) and strategies targeting the central nervous system (top down). Bottom-up strategies include joint-biased, soft-tissue biased, or needling interventions, whereas top-down strategies include exercise and cognitive interventions. Evidence shows that the effectiveness of these interventions depends on the application of proper clinical reasoning, since not all strategies are effective for all headaches. For instance, evidence of non-pharmacological interventions is more controversial for migraines than for tension-type or cervicogenic headaches, since migraine pathogenesis involves activation of sub-cortical structures and the trigemino- vascular system, whereas pathogenesis of tension-type or cervicogenic headaches is most associated to musculoskeletal impairments of the cervical spine. We conclude that current literature suggests that not all non-pharmacological interventions are effective for all headaches, and that multimodal, not isolated, approaches seem to be more effective for patients with headaches. Most published studies have reported small clinical effects in the short term. This narrative literature review provides some hypotheses for discrepancies in the available literature and future research. Clinical reasoning should be applied to better understand the effects of non-pharmacological interventions.
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Affiliation(s)
- César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain; (L.L.F.); (J.L.A.-B.)
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia, Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain
- Correspondence:
| | - Lidiane L. Florencio
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain; (L.L.F.); (J.L.A.-B.)
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia, Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain
| | - Gustavo Plaza-Manzano
- Radiology, Rehabilitation and Physiotherapy Department, Universidad Complutense de Madrid, 28040 Madrid, Spain;
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - José L. Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain; (L.L.F.); (J.L.A.-B.)
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia, Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain
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Herman PM, Whitley MD, Ryan GW, Hurwitz EL, Coulter ID. The impact of patient preferences and costs on the appropriateness of spinal manipulation and mobilization for chronic low back pain and chronic neck pain. BMC Musculoskelet Disord 2019; 20:519. [PMID: 31699077 PMCID: PMC6839252 DOI: 10.1186/s12891-019-2904-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the delivery of appropriate healthcare is an important goal, the definition of what constitutes appropriate care is not always agreed upon. The RAND/UCLA Appropriateness Method is one of the most well-known and used approaches to define care appropriateness from the clinical perspective-i.e., that the expected effectiveness of a treatment exceeds its expected risks. However, patient preferences (the patient perspective) and costs (the healthcare system perspective) are also important determinants of appropriateness and should be considered. METHODS We examined the impact of including information on patient preferences and cost on expert panel ratings of clinical appropriateness for spinal mobilization and manipulation for chronic low back pain and chronic neck pain. RESULTS The majority of panelists thought patient preferences were important to consider in determining appropriateness and that their inclusion could change ratings, and half thought the same about cost. However, few actually changed their appropriateness ratings based on the information presented on patient preferences regarding the use of these therapies and their costs. This could be because the panel received information on average patient preferences for spinal mobilization and manipulation whereas some panelists commented that appropriateness should be determined based on the preferences of individual patients. Also, because these therapies are not expensive, their ratings may not be cost sensitive. The panelists also generally agreed that preferences and costs would only impact their ratings if the therapies were considered clinically appropriate. CONCLUSIONS This study found that the information presented on patient preferences and costs for spinal mobilization and manipulation had little impact on the rated appropriateness of these therapies for chronic low back pain and chronic neck pain. Although it was generally agreed that patient preferences and costs were important to the appropriateness of M/M for CLBP and CNP, it seems that what would be most important were the preferences of the individual patient, not patients in general, and large cost differentials.
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Affiliation(s)
| | | | - Gery W Ryan
- RAND Corporation, Santa Monica, CA, United States
| | - Eric L Hurwitz
- Office of Public Health Studies, University of Hawaii, Honolulu, HI, United States
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Effects of Head and Neck Positions on Blood Flow in the Vertebral, Internal Carotid, and Intracranial Arteries: A Systematic Review. J Orthop Sports Phys Ther 2019; 49:688-697. [PMID: 31276624 DOI: 10.2519/jospt.2019.8578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Manual therapy interventions targeting the neck include various positions and movements of the craniocervical region. The hemodynamic changes in various spinal positions potentially have clinical relevance. OBJECTIVES To investigate the effects of craniocervical positions and movements on hemodynamic parameters (blood flow velocity and/or volume) of cervical and craniocervical arteries. METHODS A search of 4 databases (PubMed, Embase, CINAHL, and Index to Chiropractic Literature) and, subsequently, a hand search of reference lists were conducted. Full-text experimental and quasi-experimental studies on the influence of cervical positions on blood flow of the vertebral, internal carotid, and basilar arteries were eligible for this review. Two independent reviewers selected and extracted the data using the double-screening method. RESULTS Of the 1453 identified studies, 31 were included and comprised 2254 participants. Most studies mentioned no significant hemodynamic changes during maximal rotation (n = 16). A significant decrease in hemodynamics was identified for the vertebral artery, with a hemodynamic decrease in the position of maximum rotation (n = 8) and combined movement of maximum extension and maximum rotation (n = 4). A similar pattern of decreased hemodynamics was also identified for the internal carotid and intracranial arteries. Three studies focused on high-velocity thrust positioning and movement. None of the studies reported hemodynamic changes. The synthesized data suggest that in the majority of people, most positions and movements of the craniocervical region do not affect blood flow. CONCLUSION The findings of this systematic review suggest that craniocervical positioning may not alter blood flow as much as previously expected. LEVEL OF EVIDENCE Therapy, level 2a. J Orthop Sports Phys Ther 2019;49(10):688-697. Epub 5 Jul 2019. doi:10.2519/jospt.2019.8578.
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Abdi M, Ghazavi Z, Abrishamkar S. The Effect of Electronical Film on the Anxiety of Patients Candidate for Lumbar Disc Surgery. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2019; 24:330-336. [PMID: 31516517 PMCID: PMC6714121 DOI: 10.4103/ijnmr.ijnmr_233_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: This study aimed at investigating the effect of showing surgery educational documentary film on the anxiety of patients candidate for lumbar disc surgery. Materials and Methods: This study, as a randomized clinical trial, was conducted in 2018 on 60 patients undergoing lumbar disc surgery, Iran. The patients were divided into two groups of intervention and control (N = 30). An educational film was shown to the patients of the intervention group for 20 min and the control group was provided with the ward's routine trainings. All patients completed demographic characteristics questionnaire and the Spielberger State-Trait Anxiety Inventory (SSTAI) on the admission day, 1 day before the surgery, and 2 h before the surgery. SSTAI was recompleted by the patients. Data analysis was performed using independent t-test, Chi-square, Mann–Whitney test, and paired t-test. Results: Before the intervention, the mean score of the state (obvious) and trait (hidden) anxieties was not significantly different between the two groups, but after the intervention, the mean [standard deviation (SD)] score of the state anxiety in the intervention group was significantly lower than that of the control group [mean (SD) = 40.78 (10.34) vs. 47.45 (10.33), F10,33 = 58, p = 0.01]. In addition, after the intervention, the mean (SD) anxiety score of the patients in the intervention group was significantly lower than that of the control group [mean (SD) = 38.65 (11.01) vs. 44.71 (10.34), F10,34 = 58, p = 0.03). Conclusions: The results showed that educational film reduces the patients' level of anxiety before the surgery. As such, it is recommended that these trainings be included in preoperative nursing practices.
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Affiliation(s)
- Mohamadreza Abdi
- Psychiatric Department, Nursing and Midwifery School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Ghazavi
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saied Abrishamkar
- Faculty Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Switters JM, Podar S, Perraton L, Machotka Z. Is visceral manipulation beneficial for patients with low back pain? A systematic review of the literature. INT J OSTEOPATH MED 2019. [DOI: 10.1016/j.ijosm.2019.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Mabry LM, Notestine JP, Moore JH, Bleakley CM, Taylor JB. Safety Events and Privilege Utilization Rates in Advanced Practice Physical Therapy Compared to Traditional Primary Care: An Observational Study. Mil Med 2019; 185:e290-e297. [DOI: 10.1093/milmed/usz176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/23/2019] [Indexed: 01/16/2023] Open
Abstract
Abstract
Introduction
The general practitioner shortage in the United States coupled with a growing number of Americans living with disability has fueled speculation of non-physician providers assuming a greater role in musculoskeletal healthcare. Previous physician shortages have been similarly addressed, and expanding physical therapy (PT) scope of practice may best serve to fill this need. Resistance to expanding PT practice focuses on patient safety as PTs assume the roles traditionally performed by primary care providers. While studies have shown advanced practice PT to be safe, none have compared safety events in advanced practice PT compared to primary care to determine if there are increased patient risks. Therefore, the purpose of our study is to examine the rate of safety events and utilization of services in an advanced practice PT clinic compared to a primary care clinic. A secondary aim of our study was to report safety events associated with spinal manipulation and dry needling procedures.
Materials and Methods
Productivity and safety data were retrospectively collected from Malcolm Grow Medical Center from 2015 to 2017 for the Family Health Clinic (FHC) and an advanced practice Physical Therapy Clinic (PTC). Chi-square tests for independence, risk ratios (RR) and 95% confidence intervals (95%) were used to compare the relationship between the frequency of (1) patient encounters and clinical procedures and (2) clinical procedures and safety events.
Results
Seventy-five percent (12/16) of safety events reported in the PTC were defined as near misses compared to 50% (28/56) within the FHC (RR 1.5; 95% CIs: 1.0 to 2.2). Safety events were more likely to reach patients in the FHC compared to the PTC (RR 1.9; 95% CIs: 0.8 to 4.7). Safety events associated with minor harm to patients was n = 4 and n = 3 in the FHC and PTC respectively. No sentinel events, intentional harm events, nor actual events with more than minor harm were reported in either clinic. Significant relationships indicated that prescriptions, laboratory studies, imaging studies and referrals, were all more likely to be ordered in the FHC than the PTC (p < 0.01). The PTC ordered one diagnostic imaging study for every 37 encounters compared to one in every 5 encounters in the FHC. The PTC similarly referred one patient to another healthcare provider for every 52 encounters, fewer than the one per every 3 encounters in the FHC. There was a significant relationship between encounters and diagnoses, indicating a higher number of diagnoses per encounter in the FHC, though the difference of 0.31 diagnoses per encounter may not be clinically meaningful (p < 0.01). A total of 1,818 thrust manipulations and 2,910 dry needling procedures were completed without any reported safety events.
Conclusion
These results suggest advanced practice PT has a similar safety profile to primary care. The authority to order musculoskeletal imaging and refer to other clinicians were among the most commonly utilized privileges and may be of primary importance when establishing an advanced practice PT clinic. These results support research showing advanced practice PT may lead to reductions in specialty referrals, diagnostic imaging, and pharmaceutical interventions.
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Affiliation(s)
- Lance M Mabry
- High Point University, Department of Physical Therapy, One University Parkway, High Point, NC
| | - Jeffrey P Notestine
- 11th Medical Group, Physical Therapy Department, 1060 W Perimeter Rd, Joint Base Andrews, MD
| | - Josef H Moore
- Army-Baylor University Doctoral Program in Physical Therapy, ATTN: MCCS-WBB-GT, 3630 Stanley Road, Bldg 2841, Suite 1301, Joint Base San Antonio – Fort Sam Houston, TX
| | - Chris M Bleakley
- High Point University, Department of Physical Therapy, One University Parkway, High Point, NC
| | - Jeffrey B Taylor
- High Point University, Department of Physical Therapy, One University Parkway, High Point, NC
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Tick H, Nielsen A, Pelletier KR, Bonakdar R, Simmons S, Glick R, Ratner E, Lemmon RL, Wayne P, Zador V. Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care: The Consortium Pain Task Force White Paper. Explore (NY) 2018; 14:177-211. [PMID: 29735382 DOI: 10.1016/j.explore.2018.02.001] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/08/2018] [Indexed: 02/06/2023]
Abstract
Medical pain management is in crisis; from the pervasiveness of pain to inadequate pain treatment, from the escalation of prescription opioids to an epidemic in addiction, diversion and overdose deaths. The rising costs of pain care and managing adverse effects of that care have prompted action from state and federal agencies including the DOD, VHA, NIH, FDA and CDC. There is pressure for pain medicine to shift away from reliance on opioids, ineffective procedures and surgeries toward comprehensive pain management that includes evidence-based nonpharmacologic options. This White Paper details the historical context and magnitude of the current pain problem including individual, social and economic impacts as well as the challenges of pain management for patients and a healthcare workforce engaging prevalent strategies not entirely based in current evidence. Detailed here is the evidence-base for nonpharmacologic therapies effective in postsurgical pain with opioid sparing, acute non-surgical pain, cancer pain and chronic pain. Therapies reviewed include acupuncture therapy, massage therapy, osteopathic and chiropractic manipulation, meditative movement therapies Tai chi and yoga, mind body behavioral interventions, dietary components and self-care/self-efficacy strategies. Transforming the system of pain care to a responsive comprehensive model necessitates that options for treatment and collaborative care must be evidence-based and include effective nonpharmacologic strategies that have the advantage of reduced risks of adverse events and addiction liability. The evidence demands a call to action to increase awareness of effective nonpharmacologic treatments for pain, to train healthcare practitioners and administrators in the evidence base of effective nonpharmacologic practice, to advocate for policy initiatives that remedy system and reimbursement barriers to evidence-informed comprehensive pain care, and to promote ongoing research and dissemination of the role of effective nonpharmacologic treatments in pain, focused on the short- and long-term therapeutic and economic impact of comprehensive care practices.
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Affiliation(s)
- Heather Tick
- Departments of Family Medicine, Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA.
| | - Arya Nielsen
- Department of Family Medicine & Community Health, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Kenneth R Pelletier
- Department of Medicine, University of California School of Medicine, San Francisco, CA
| | - Robert Bonakdar
- Department of Pain Management, Scripps Center for Integrative Medicine, La Jolla, CA
| | | | - Ronald Glick
- Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Emily Ratner
- MedStar Health, Institute for Innovation, Integrative Medicine Initiatives, MedStar Montgomery Medical Center, Washington, DC
| | - Russell L Lemmon
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Peter Wayne
- Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Veronica Zador
- Beaumont Hospital Integrative Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI
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Degenhardt BF, Johnson JC, Brooks WJ, Norman L. Characterizing Adverse Events Reported Immediately After Osteopathic Manipulative Treatment. J Osteopath Med 2018; 118:141-149. [DOI: 10.7556/jaoa.2018.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Context
Although adverse events in various types of manual therapy have been previously investigated, little is known about the incidence and types of adverse events that occur after osteopathic manipulative treatment (OMT).
Objective
To estimate the incidence and characterize the types of adverse events that patients report after OMT and prior to leaving the office to increase the likelihood of identifying adverse events caused by OMT.
Methods
As part of a prospective study evaluating the use and effectiveness of OMT, patients assessed how they felt immediately after OMT compared with before OMT using a 5-point ordinal rating scale (much better, better, about the same, worse, much worse). For patients who indicated they felt their condition had changed, a follow-up, open-ended question asked them to describe how it had changed. Patients who felt worse or much worse were considered to have experienced an adverse event. Two reviewers independently coded the types of adverse events based on the descriptions provided by the patients. Generalized logistic regression models were used to calculate incidence rates and 95% CIs for the types of adverse events. These models were also used to calculate the ORs and 95% CIs for associations of adverse events with demographic characteristics and with individual OMT techniques after accounting for demographic characteristics.
Results
Immediately after OMT, 884 patients provided data at 1847 office visits (663 [76%] women; 794 [92%] identified as white; mean [SD] age, 51.8 [15.8] years). Patients reported they felt worse or much worse immediately after OMT at 45 office visits; the incidence rate for adverse events was 2.5% (95% CI, 1.3%-4.7%). Pain/discomfort was the most commonly identified type of adverse event (16 [0.9%]; 95% CI, 0.5%-1.6%). Insufficient information was provided to determine the type of adverse event at 20 office visits. Women reported adverse events more frequently than men (OR, 13.9; 95% CI, 1.7-115.6; P=.01).
Conclusion
The incidence of adverse events immediately after OMT, most commonly pain/discomfort, was lower than previous reports from other manual medicine disciplines. Larger studies are needed to determine the incidence of serious adverse events and to assess adverse events that occur in the days following OMT.
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Swait G, Finch R. What are the risks of manual treatment of the spine? A scoping review for clinicians. Chiropr Man Therap 2017; 25:37. [PMID: 29234493 PMCID: PMC5719861 DOI: 10.1186/s12998-017-0168-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 11/08/2017] [Indexed: 12/20/2022] Open
Abstract
Background Communicating to patients the risks of manual treatment to the spine is an important, but challenging element of informed consent. This scoping review aimed to characterise and summarise the available literature on risks and to describe implications for clinical practice and research. Method A methodological framework for scoping reviews was followed. Systematic searches were conducted during June 2017. The quantity, nature and sources of literature were described. Findings of included studies were narratively summarised, highlighting key clinical points. Results Two hundred and fifty articles were included. Cases of serious adverse events were reported. Observational studies, randomised studies and systematic reviews were also identified, reporting both benign and serious adverse events.Benign adverse events were reported to occur commonly in adults and children. Predictive factors for risk are unclear, but for neck pain patients might include higher levels of neck disability or cervical manipulation. In neck pain patients benign adverse events may result in poorer short term, but not long term outcomes.Serious adverse event incidence estimates ranged from 1 per 2 million manipulations to 13 per 10,000 patients. Cases are reported in adults and children, including spinal or neurological problems as well as cervical arterial strokes. Case-control studies indicate some association, in the under 45 years age group, between manual interventions and cervical arterial stroke, however it is unclear whether this is causal. Elderly patients have no greater risk of traumatic injury compared with visiting a medical practitioner for neuro-musculoskeletal problems, however some underlying conditions may increase risk. Conclusion Existing literature indicates that benign adverse events following manual treatments to the spine are common, while serious adverse events are rare. The incidence and causal relationships with serious adverse events are challenging to establish, with gaps in the literature and inherent methodological limitations of studies. Clinicians should ensure that patients are informed of risks during the consent process. Since serious adverse events could result from pre-existing pathologies, assessment for signs or symptoms of these is important. Clinicians may also contribute to furthering understanding by utilising patient safety incident reporting and learning systems where adverse events have occurred.
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Affiliation(s)
- Gabrielle Swait
- The Royal College of Chiropractors, Chiltern Chambers, St. Peters Avenue, Reading, RG4 7DH UK
| | - Rob Finch
- The Royal College of Chiropractors, Chiltern Chambers, St. Peters Avenue, Reading, RG4 7DH UK
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Cox JM. Response to "Best Practices for Chiropractic Care for Older Adults: A Systematic Review and Consensus Update". J Manipulative Physiol Ther 2017; 40:544-545. [PMID: 28739016 DOI: 10.1016/j.jmpt.2017.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 06/15/2017] [Indexed: 11/28/2022]
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Kranenburg HA, Lakke SE, Schmitt MA, Van der Schans CP. Adverse events following cervical manipulative therapy: consensus on classification among Dutch medical specialists, manual therapists, and patients. J Man Manip Ther 2017; 25:279-287. [PMID: 29449770 DOI: 10.1080/10669817.2017.1332556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Objectives To obtain consensus-based agreement on a classification system of adverse events (AE) following cervical spinal manipulation. The classification system should be comprised of clear definitions, include patients' and clinicians' perspectives, and have an acceptable number of categories. Methods Design: A three-round Delphi study. Participants: Thirty Dutch participants (medical specialists, manual therapists, and patients) participated in an online survey. Procedure: Participants inventoried AE and were asked about their preferences for either a three- or a four-category classification system. The identified AE were classified by two analysts following the International Classification of Functioning, Disability and Health (ICF), and the International Classification of Diseases and Related Health Problems (ICD-10). Participants were asked to classify the severity for all AE in relation to the time duration. Results Consensus occurred in a three-category classification system. There was strong consensus for 16 AE in all severities (no, minor, and major AE) and all three time durations [hours, days, weeks]. The 16 AE included anxiety, flushing, skin rash, fainting, dizziness, coma, altered sensation, muscle tenderness, pain, increased pain during movement, radiating pain, dislocation, fracture, transient ischemic attack, stroke, and death. Mild to strong consensus was reached for 13 AE. Discussion A consensus-based classification system of AE is established which includes patients' and clinicians' perspectives and has three categories. The classification comprises a precise description of potential AE in accordance with internationally accepted classifications. After international validation, clinicians and researchers may use this AE classification system to report AE in clinical practice and research.
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Affiliation(s)
- Hendrikus A Kranenburg
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Department of Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sandra E Lakke
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Maarten A Schmitt
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Cees P Van der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Department of Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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