Adverse effects as a consequence of being the subject of orthopaedic manual therapy training, a worldwide retrospective survey

Graaf, Marloes Thoomes-de; Thoomes, Erik; Carlesso, Lisa C.; Kerry, Roger; Rushton, Alison

doi:10.1016/j.msksp.2017.02.009

Cited by 6 publications

(5 citation statements)

References 39 publications

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“…Only 40% of the sample utilized prethrust examination prior to TTJM, with considerable differences in practice from limited use of workplace standardized forms, to the majority utilizing either their own clinical reasoning or independently developed form for practice. This variability in practice and the documented under reporting of SE and AE [3,14,17] and potential for serious AE, highlights a need for further guidance to support clinical reasoning in practice. Our findings along with existing evidence offer a starting point from which this framework could be developed.…”

Section: Pre Thrust Examinationmentioning

confidence: 99%

“…The lack of consistency across the majority of AE and all SE highlights a need for more clinical knowledge and research in this relatively underresearched spine region [9]. With seven case studies (age 17-71 years) citing injury to the spinal cord following TTJM [3] a system by which instances of AE can be recorded in detail would usefully inform this relatively limited evidence base, a recommendation which has been made for both clinical practice and during training of TJM [14,17].…”

Section: Contraindications Precautions Red Flags and Risksmentioning

confidence: 99%

“…In the absence of data specific to the thoracic spine, a systematic review of AE and manual therapy reported that 41% of patients can expect SE after treatment (e.g. muscle tenderness, headache), especially after the first treatment, with the relative incidence of AE small [13,14]. Notwithstanding this AE such as stroke and in some cases death following manual therapy in the biomechanically linked cervical spine cannot be ignored [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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Knowledge and pre-thoracic spinal thrust manipulation examination: a survey of current practice in the UK

Heneghan

Davies

Puentedura

et al. 2018

Journal of Manual & Manipulative Therapy

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Objectives: The perceived relative safety of thoracic thrust joint manipulation (TTJM) has contributed to evidence supporting its use. Yet, TTJM is not without risk, where transient side effects (SE) and severe adverse events (AE) have been documented. With evidence supporting the importance of prethrust examination in reducing AE in other spinal regions this study investigated TTJM knowledge and pre-TTJM examination. Method: An e-survey, informed by existing evidence and expertise was designed and piloted. Eligibility criteria: UK-trained physiotherapists who use TTJM. Recruitment via professional networks and social media from December 2016 to February 2017. Data analysis included descriptive analyses (means, standard deviation and frequencies/central tendencies), and content analysis (themes and frequencies) for free text data. Results: From 306 responses, the sample comprised 146 (53%) males, mean (SD) age 36.37 (8.68) years, with 12.88(8.67) years in practice, 11.07(8.14) years specialization, working in National Health Service/private practice (81%) and performing 0-5 TTJM/week (86%). Examination: 40% (n = 83) utilized pre-TTJM examination with 45% (n = 139) adapting the examination for different regions. Technique selection and effect: preferred technique was prone rotational TTJM (67%). Perception of the primary underlying effect was neurophysiological (54%), biomechanical (45%) or placebo (1%). Knowledge: Levels of agreement were found for contraindications (85%), precautions (75%), and red flags (86%) with more variability for risks including AE and SE (61%). Discussion: UK physiotherapists demonstrated good knowledge and agreement of contraindications, precautions, and red flags to TTJM. With <50% respondents utilizing pre-TTJM examination, variable knowledge of TTJM risks, and therapeutic effects of TTJM further research is required.

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Section: Pre Thrust Examinationmentioning

confidence: 99%

Section: Contraindications Precautions Red Flags and Risksmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Knowledge and pre-thoracic spinal thrust manipulation examination: a survey of current practice in the UK

Heneghan

Davies

Puentedura

et al. 2018

Journal of Manual & Manipulative Therapy

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“…Numerous surveys in the United Kingdom (UK), Canada, the United States of America (USA), and the Netherlands have observed that most physiotherapists report high comfort levels when delivering SM to the thoracic and lumbar spines; however, for the cervical spine, increased anxiety on its safety is frequently reported [26][27][28]31]. Additionally, high levels of concern regarding the safety of SM have been promoted during musculoskeletal specialization programs (e.g., Orthopaedic Manipulative Physical Therapy [OMPT] and post-graduate programs belonging to the International Federation of Orthopaedic Manipulative Physical Therapists [IFOMPT]) [32].…”

Section: Introductionmentioning

confidence: 99%

Knowledge, beliefs, and attitudes of spinal manipulation: a cross-sectional survey of Italian physiotherapists

et al. 2022

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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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“…Although the framework is widely adopted in clinical practice and educational programs, 20 the reproducibility and accuracy of the IFOMPT framework have not yet been assessed. Agreement, specific agreement, and reliability provide an insight into reproducibility.…”

Section: Introductionmentioning

confidence: 99%

Interexaminer Agreement and Reliability of an Internationally Endorsed Screening Framework for Cervical Vascular Risks Following Manual Therapy and Exercise: The Go4Safe Project

et al. 2021

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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 of Cervical Artery Dysfunction (CAD) prior to manual therapy and exercise. However, the inter-examiner agreement and reliability of this framework is unknown. This study aimed to estimate the inter-examiner 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 inter-examiner agreement, specific agreement per risk category (high-, intermediate- and low-risk) and inter-examiner reliability (weighted kappa) 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 kappa 0.39; 95% CI = 0.21–0.57) and varied considerably between pairs of physical therapists (kappa: 0.14–1.00). Conclusion The IFOMPT- framework showed an insufficient inter-examiner agreement and fair inter-examiner 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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Adverse effects as a consequence of being the subject of orthopaedic manual therapy training, a worldwide retrospective survey

Abstract: Mild to moderate adverse effects after practising manual therapy techniques are commonly reported, but usually resolve within 24 h. However, this survey has identified the reported occurrence of major adverse effects that warrant further investigation.

Cited by 6 publications

References 39 publications

Knowledge and pre-thoracic spinal thrust manipulation examination: a survey of current practice in the UK

Knowledge and pre-thoracic spinal thrust manipulation examination: a survey of current practice in the UK

Knowledge, beliefs, and attitudes of spinal manipulation: a cross-sectional survey of Italian physiotherapists

Interexaminer Agreement and Reliability of an Internationally Endorsed Screening Framework for Cervical Vascular Risks Following Manual Therapy and Exercise: The Go4Safe Project

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