A Model for Standardizing Manipulation Terminology in Physical Therapy Practice

Objective: The purpose of this study was to investigate the immediate and long-term effects of a 1-year multimodal program with the addition of 2 different traction approaches on the pain, function, disability, and nerve root function in patients with discogenic cervical radiculopathy (CR). This study also attempted to identify the optimal traction angle based on the maximum recovery of the peak-to-peak amplitude of the flexor carpi radialis (FCR) H-reflex. Methods: This randomized clinical trial with one-year follow-up included a total of 216 (101 female) patients with unilateral lower discogenic CR were randomly assigned to 1 of 3 groups. The standard care group (C) received the multimodal program (pain relief methods, muscle strengthening, and thoracic spine manipulation). The ventroflexion traction group (A) received the same multimodal program as group C, with added traditional ventroflexion traction. The novel traction group (B) received the same multimodal program as group C in addition to a flexor carpi radialis (FCR) H-reflex-based traction method. Primary outcomes were the Neck Disability Index (NDI) and secondary outcomes included neck pain, arm pain, and the amplitude and latency of the H-reflex. Patients were assessed at 3 intervals (pre-treatment, 4 weeks post-treatment, and the 1-year follow-up). Results: The mixed linear model with repeated measures indicated a significant group × time effect in favor of the novel cervical traction group (B) for measures of NDI (F = 412.6, P b .0005), neck pain (F = 108.9, P b .0005), arm pain (F = 91.3, P b .0005), H-reflex amplitude (F = 207.7, P b .0005), and H-reflex latency (F = 58.9 P b .0005). We found that the extension position of cervical spine (5°extension) was the position that achieved the maximum improvement in the novel cervical traction method. Conclusions: This preliminary study showed that a multimodal program with a novel cervical traction method added improved NDI, neck pain, arm pain, and the amplitude and latency of FCR H-reflex for a group of patients with chronic discogenic CR.

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“…According to the model for describing thrust manipulations recently proposed by Mintken et al, 35,36 the following techniques were used:…”

Section: Thoracic Spine Manipulationmentioning

confidence: 99%

Multimodal Treatment Program Comparing 2 Different Traction Approaches for Patients With Discogenic Cervical Radiculopathy: A Randomized Controlled Trial

Moustafa

Diab

2014

Journal of Chiropractic Medicine

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“…Based on the results of this review, we propose that cases regarding AE to CSM should provide more standardized information. This should include detailed information regarding the manipulation technique, as proposed by Mintken et al 121 The six categories suggested include: (1) rate of force application; (2) location in range of available movement; (3) direction of force; (4) target of force; (5) relative structural movement; and (6) patient position. 121 Additionally, cases should include: total number of CSMs performed for the present condition; for what condition the CSM was performed; which clinician performed the CSM; and a description of examination procedures to rule out contraindications and red flags.…”

Section: 112mentioning

confidence: 99%

Safety of cervical spine manipulation: are adverse events preventable and are manipulations being performed appropriately? A review of 134 case reports

Puentedura

March

Anders

et al. 2012

Journal of Manual & Manipulative Therapy

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Background: Cervical spine manipulation (CSM) is a commonly utilized intervention, but its use remains controversial.Purpose: To retrospectively analyze all available documented case reports in the literature describing patients who had experienced severe adverse events (AEs) after receiving CSM to determine if the CSM was used appropriately, and if these types of AEs could have been prevented using sound clinical reasoning on the part of the clinician. Data sources: PubMed and the Cumulative Index to Nursing and Allied Health were systematically searched for case reports between 1950 and 2010 of AEs following CSM. Study selection: Case reports were included if they were peer-reviewed; published between 1950 and 2010; case reports or case series; and had CSM as an intervention. Articles were excluded if the AE occurred without CSM (e.g. spontaneous); they were systematic or literature reviews. Data extracted from each case report included: gender; age; who performed the CSM and why; presence of contraindications; the number of manipulation interventions performed; initial symptoms experienced after the CSM; and type of resultant AE. Data synthesis: Based on the information gathered, CSMs were categorized as appropriate or inappropriate, and AEs were categorized as preventable, unpreventable, or unknown. Chi-square analysis with an alpha level of 0.05 was used to determine if there was a difference in proportion between six categories: appropriate/preventable, appropriate/unpreventable, appropriate/unknown, inappropriate/ preventable, inappropriate/unpreventable, and inappropriate/unknown. Results: One hundred thirty four cases, reported in 93 case reports, were reviewed. There was no significant difference in proportions between appropriateness and preventability, P5.46. Of the 134 cases, 60 (44.8%) were categorized as preventable, 14 (10.4%) were unpreventable and 60 (44.8%) were categorized as 'unknown'. CSM was performed appropriately in 80.6% of cases. Death resulted in 5.2% (n57) of the cases, mostly caused by arterial dissection. Limitations: There may have been discrepancies between what was reported in the cases and what actually occurred, since physicians dealing with the effects of the AE, rather than the clinician performing the CSM, published many of the cases. Conclusions: This review showed that, if all contraindications and red flags were ruled out, there was potential for a clinician to prevent 44.8% of AEs associated with CSM. Additionally, 10.4% of the events were unpreventable, suggesting some inherent risk associated with CSM even after a thorough exam and proper clinical reasoning.

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“…[26][27][28][29][30][31][32] However, research that supports the use of regional techniques also often encourages the use of segmental motion palpation as part of the clinical decision-making process. 27,29,[33][34][35] Although there is no consensus regarding the overall validity and reliability of static and dynamic spinal assessment, it is widely used clinically and often included in entry level and postgraduate physical therapy education. 36,37 It has been reported that 98% of MTs use motion assessment as part of their evaluation of spinal pain and a majority believe PPIVM and PAIVM assessments are accurate in assessing spinal segment motion.…”

Section: -11mentioning

confidence: 99%

Factors affecting confidence and knowledge in spinal palpation among International Manual Physical Therapists

Karas

Schneiders

Reid

et al. 2016

Journal of Manual & Manipulative Therapy

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Objectives: We sought to find if there was a relationship between the confidence in use of static palpation, passive physiological intervertebral motion (PPIVM) and passive accessory intervertebral motion (PAIVM) and the manual therapist's (MTs) knowledge of the literature on these topics. Methods: We designed an international survey to achieve our objectives. Each skill was surveyed for the cervical, thoracic and lumbar spines. We also included several other factors that we believed might influence the use of these skills. Results: We concluded that familiarity of the literature was significantly associated with a MTs' confidence in the use of static palpation, PPIVM and PAIVM techniques. We also found a relationship with the country of practice of the MT and their confidence using these techniques. Discussion: Spinal palpation is an integral part of the MT's evaluation and treatment abilities. The vast majority of MTs use spinal palpation and nearly all entry-level education programmes include it in their training. Knowing what factors influence MTs' confidence assessing and treating the spine may allow for more effective teaching and training, as well as improved patient outcomes.

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A Model for Standardizing Manipulation Terminology in Physical Therapy Practice

Cited by 44 publications

References 54 publications

Multimodal Treatment Program Comparing 2 Different Traction Approaches for Patients With Discogenic Cervical Radiculopathy: A Randomized Controlled Trial

Multimodal Treatment Program Comparing 2 Different Traction Approaches for Patients With Discogenic Cervical Radiculopathy: A Randomized Controlled Trial

Safety of cervical spine manipulation: are adverse events preventable and are manipulations being performed appropriately? A review of 134 case reports

Factors affecting confidence and knowledge in spinal palpation among International Manual Physical Therapists

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