Implementation of the International IFOMPT Cervical Framework: A survey among educational programmes

Implementation of the International IFOMPT Cervical Framework: A survey among IFOMPT organisations

BACKGROUND

The IFOMPT (International Federation of Orthopaedic Manual and Musculoskeletal Physical Therapists) Cervical Framework was first published in 2012 and reviewed in 2020. The document was a result of the IFOMPT Member Organisations' (MO) request for consistency and guidance regarding teaching and practice of safe assessment and management of individuals with neck and head pain and dysfunction.

OBJECTIVE

To evaluate the knowledge, dissemination, and implementation of the 2020 IFOMPT Cervical Framework by MOs.

METHODS

An international survey with closed- and open-ended questions was conducted among all IFOMPT MOs. Formal informed consent was requested, and data were collected anonymously.

RESULTS

Twenty-five of 42 invited organisations completed the survey. Respondents reported that the Framework was extensively disseminated to both members (100%) and educational programs (92%). 52% provided recommendations regarding implementation in the own country while only 12.5% towards educational programs. Five representatives (20%) reported having designed an information sheet for patients about cervical musculoskeletal interventions safety, mainly for thrust manipulation (84.3%) but none for exercise (0%). End-range thrust manipulation remains rarely recommended, especially for the upper cervical spine (8.7%).

CONCLUSIONS

The dissemination of the new IFOMPT Cervical Framework among members and educational programs was successful. However, only marginal recommendations were provided by the MOs/AMOs/RIGs regarding implementation of the Framework. Moreover, improvement is possible regarding providing information to patients and the Frameworks' recommendation to avoid end range treatment techniques.

Optimizing safety in conservative physical management of the cervical spine: A modified Delphi study

BACKGROUND

Conservative cervical spine treatment is generally safe, but serious adverse events (SAEs) still occur despite various available clinical guidelines. There have been several challenges in understanding the specific circumstances of these events to direct prevention such as inconsistent reporting, misuse of professional titles, and incomplete data. There are also differences in opinions between professions. It is now important to understand expert views and consensus across professions regarding prevention strategies and minimum requirements for reporting standards for future SAEs.

METHODS

A modified Delphi method was used, involving 28 international experts from various allied health professions, including chiropractic, physiotherapy, osteopathy, and medicolegal fields. The experts took part in three rounds of online surveys to reach a consensus on reporting, characteristics, risk factors, and prevention of SAEs associated with neck treatments. An agreement of >74 % was required before consensus was reached.

RESULTS

Consensus was reached for more standardised reporting of SAEs across different types of treatments and professions. Addressing underlying health conditions and improving the recognition of potential risks, precautions, and contraindications during treatment were highlighted. Recommendations for strategies to improve safety, including early identification of risk factors and careful application of techniques, especially in vulnerable populations were also provided.

CONCLUSION

Experts called for the development of universally accepted clinician friendly clinical guidelines that focus on improving SAE reporting, early identification of SAEs, and safer technique application, particularly in special populations. Implementing these recommendations will help reduce the occurrence of SAEs and improve the safety of conservative cervical spine management across professions.

Use of the International IFOMPT Cervical Framework to inform clinical reasoning in postgraduate level physiotherapy students: a qualitative study using think aloud methodology

BACKGROUND

Vascular pathologies of the head and neck are rare but can present as musculoskeletal problems. The International Federation of Orthopedic Manipulative Physical Therapists (IFOMPT) Cervical Framework (Framework) aims to assist evidence-based clinical reasoning for safe assessment and management of the cervical spine considering potential for vascular pathology. Clinical reasoning is critical to physiotherapy, and developing high-level clinical reasoning is a priority for postgraduate (post-licensure) educational programs.

OBJECTIVE

To explore the influence of the Framework on clinical reasoning processes in postgraduate physiotherapy students.

METHODS

Qualitative case study design using think aloud methodology and interpretive description, informed by COnsolidated criteria for REporting Qualitative research. Participants were postgraduate musculoskeletal physiotherapy students who learned about the Framework through standardized delivery. Two cervical spine cases explored clinical reasoning processes. Coding and analysis of transcripts were guided by Elstein's diagnostic reasoning components and the Postgraduate Musculoskeletal Physiotherapy Practice model. Data were analyzed using thematic analysis (inductive and deductive) for individuals and then across participants, enabling analysis of key steps in clinical reasoning processes and use of the Framework. Trustworthiness was enhanced with multiple strategies (e.g., second researcher challenged codes).

RESULTS

For all participants (n = 8), the Framework supported clinical reasoning using primarily hypothetico-deductive processes. It informed vascular hypothesis generation in the patient history and testing the vascular hypothesis through patient history questions and selection of physical examination tests, to inform clarity and support for diagnosis and management. Most participant's clinical reasoning processes were characterized by high-level features (e.g., prioritization), however there was a continuum of proficiency. Clinical reasoning processes were informed by deep knowledge of the Framework integrated with a breadth of wider knowledge and supported by a range of personal characteristics (e.g., reflection).

CONCLUSIONS

Findings support use of the Framework as an educational resource in postgraduate physiotherapy programs to inform clinical reasoning processes for safe and effective assessment and management of cervical spine presentations considering potential for vascular pathology. Individualized approaches may be required to support students, owing to a continuum of clinical reasoning proficiency. Future research is required to explore use of the Framework to inform clinical reasoning processes in learners at different levels.