Beliefs, perceptions and practices of chiropractors and patients about mitigation strategies for benign adverse events after spinal manipulation therapy

Abstract

Background Approximately 50% of patients who receive spinal manipulative therapy (SMT) experience some kind of adverse event (AE), typically benign and transient in nature. Regardless of their severity, mitigating benign AEs is important to improve patient experience and quality of care. The aim of this study was to identify beliefs, perceptions and practices of chiropractors and patients regarding benign AEs post-SMT and potential strategies to mitigate them. Methods Clinicians and patients from two chiropractic teaching clinics were invited to respond to an 11-question survey exploring their beliefs, perceptions and practices regarding benign AEs post-SMT and strategies to mitigate them. Responses were analyzed using descriptive statistics. Results A total of 39 clinicians (67% response rate) and 203 patients (82.9% response rate) completed the survey. Most clinicians (97%) believed benign AEs occur, and 82% reported their own patients have experienced one. For patients, 55% reported experiencing benign AEs post-SMT, with the most common symptoms being pain/soreness, headache and stiffness. While most clinicians (61.5%) reported trying a mitigation strategy with their patients, only 21.2% of patients perceived their clinicians had tried any mitigation strategy. Clinicians perceived that patient education is most likely to mitigate benign AEs, followed by soft tissue therapy and/or icing after SMT. Patients perceived stretching was most likely to mitigate benign AEs, followed by education and/or massage. Conclusions This is the first study comparing beliefs, perceptions and practices from clinicians and patients regarding benign AEs post-SMT and strategies to mitigate them. This study provides an important step towards identifying the best strategies to improve patient safety and improve quality of care.

Reporting of adverse events associated with spinal manipulation in randomised clinical trials: an updated systematic review

“… 8 9 Adverse events associated with spinal manipulation are typically benign, transient and do not require further treatment. 10 Indeed, some authors classify increased muscle soreness or stiffness in the treatment area as an ‘expected outcome of treatment’ rather than an adverse event. 11 At the other end of the spectrum, catastrophic events, such as vertebral artery dissection, have been temporally associated with spinal manipulation.…”

“…Despite this, concerns remain surrounding adverse events following the intervention 8 9. Adverse events associated with spinal manipulation are typically benign, transient and do not require further treatment 10. Indeed, some authors classify increased muscle soreness or stiffness in the treatment area as an ‘expected outcome of treatment’ rather than an adverse event 11.…”

The World Federation of Chiropractic Global Patient Safety Task Force: a call to action

“…WHO advocates for an engagement paradigm in which patients, families, and caregivers are respected as equal partners in patient safety. Problematically, few studies have incorporated the critical insights and perspectives of patients and families regarding patient safety [14][15][16][17][18][19]. Learning from patients' experiences of healthcare will require healthcare leaders to engage in systematic activity to welcome patients and families with diverse backgrounds onto safety committees [20].…”

A modern way to teach and practice manual therapy

“…Mild to moderate adverse events from MT (e.g. mild muscle soreness) are common and generally considered acceptable [ 12 ], whilst serious adverse events are very rare and their risk may be mitigated by good practice [ 13 ]. MT has been reported by people with MSK disorders as a preferential and effective treatment with accepted levels of post-treatment soreness [ 14 ].…”