Manipulative practice in the cervical spine: a survey of IFOMPT member countries

Abstract

The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) aims to achieve worldwide promotion of excellence and unity in clinical and academic standards for manual and musculoskeletal physical therapists. To this end, IFOMPT has sponsored several conference panel sessions and a survey of Member Organizations (MOs) and Registered Interest Groups (RIGs) regarding current cervical spine manipulation and pre-manipulative screening practice in each country. The purpose of this study was to determine common elements of cervical spine manipulative practice and premanipulative screening between countries. In late 2007, a questionnaire investigating recommended premanipulative screening protocol/guideline use, informed consent regarding risks, screening procedures, and treatment/manipulation technique was sent to all twenty MOs and five RIGs. The response rate was 88%. The main findings of the survey included: 77% of respondent organizations use pre-manipulative guidelines, with Australian guidelines the most frequently adopted internationally (36%); recommendations concerning the provision of information about the possibility of serious adverse events is not standard practice in all countries (50%); positional tests for vertebrobasilar insufficiency are used by all respondent organizations; craniovertebral ligament testing is sometimes taught as a pre-manipulative screening tool (36%); the use of upper cervical spine manipulation has declined in some countries (41%); and of the respondent organizations that continue to teach upper cervical manipulation, most (70%) minimize the rotation component. The findings of this research will inform an IFOMPT international standard for screening the cervical region prior to orthopaedic manual therapy intervention. The development of an IFOMPT endorsed document will be of assistance to manual therapy clinicians worldwide in safely managing disorders of the cervical spine.

A cross-sectional postal survey of musculoskeletal physiotherapists’ current practice of cervical pain assessment in relation to vertebrobasilar artery insufficiency, attitudes toward guidelines, and manual therapy practice

“…Manipulation techniques to the thoracic spine were not commonly practised (32%): unlike in this sample (83.6%), many fewer osteopaths applied these treatments to the cervical spine (13%). This confirms a declining trend in the use of manipulation in the upper cervical spine seen in previous studies 26,28,37 and again seen in this study (4.5%). The research provided evidence of patients reporting being asked for their consent for these treatments less often than osteopaths reported receiving consent, implying the osteopaths were making socially desirable responses to the legally obliging questions, suggesting standards of practice were not met.…”

“…25 This study notes a further decline in manipulative techniques of the upper cervical spine (4.5%), which confirms a trend seen in previous studies. 26,28,36,37 The results imply that cervical spine assessment by a physiotherapist may be reliant on detailed subjective assessment that lacks objective testing, which could limit the scope of clinical reasoning between diagnoses of vascular (VBI, arterial dissection) and vestibular (BPPV) sources of symptoms. 27 BPPV has a significantly greater lifetime prevalence of 2.4-9% 20,21 versus that of CAD (2.6 per 100 000) and VAD (1 per 100 000 annually [7][8][9] ), so the patient may have prior knowledge or experience of their BPPV.…”

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

“…Separate questionnaires were developed for the current students and graduates. The questionnaires were developed through questions retrieved from previous surveys investigating manipulative therapy practice in the cervical spine in IFOMPT member countries (Carlesso and Rivett, 2011), and the incidence and prevalence of side effects of spinal manipulation (Cagnie et al, 2004); and extended beyond manipulative techniques. Question selection was informed by an understanding of potential recollection bias, where patients show greatest accuracy for questions focused to location and frequency of pain and activities affecting pain, in contrast to discrepancies for questions on severity of pain (Dawson et al, 2002).…”

“…Spinal manipulation, particularly when performed on the upper cervical spine, is associated with minor to moderate adverse effects in clinical populations (Carlesso et al, 2010b;Carnes et al, 2010a;Ernst, 2007;Rubinstein, 2008;Senstad et al, 1996). This has been has been a professional concern for some decades (Carlesso and Rivett, 2011;Carlesso, Gross, 2010b;Carlesso et al, 2013;Kerry et al, 2008;Taylor and Kerry, 2005). While the risk of major adverse effects with manipulation is low, 50e60% of manual therapy patients may experience minor to moderate adverse effects after treatment (Cagnie et al, 2004;Carlesso et al, 2010b;Carnes, Mars, 2010a;Ernst, 2007;Hurwitz et al, 2005;Paanalahti et al, 2014).…”

Impulstechniken an der HWS

“…In einer Befragung von 22 manualtherapeutischen Organisationen [17] weltweit wurde ermittelt, dass die meisten von ihnen vor Ausführen einer Impulstechnik Tests für die Suffizienz der Aa. vertebrales vorschlagen.…”