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Sorondo D, Delpierre C, Côté P, Salmi LR, Cedraschi C, Taylor-Vaisey A, Lemeunier N. Determinants of clinical practice guidelines' utilization for the management of musculoskeletal disorders: a scoping review. BMC Musculoskelet Disord 2021; 22:507. [PMID: 34074285 PMCID: PMC8170973 DOI: 10.1186/s12891-021-04204-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Abstract
Context Many clinical practice guidelines have been developed for the management of musculoskeletal disorders (MSDs). However, there is a gap between evidence-based knowledge and clinical practice, and reasons are poorly understood. Understanding why healthcare providers use clinical practice guidelines is essential to improve their implementation, dissemination, and adherence. Aim To identify determinants of clinical practice guidelines’ utilization by health care providers involved in the assessment and management of MSDs. Method A scoping review of the literature was conducted. Three databases were searched from inception to March 2021. Article identification, study design, methodological quality, type of healthcare providers, MSDs, barriers and facilitators associated with guidelines’ utilization were extracted from selected articles. RESULTS: 8671 citations were retrieved, and 43 articles were selected. 51% of studies were from Europe, and most were quantitative studies (64%) following a cross-sectional design (88%). Almost 80% of articles dealt with low back pain guidelines, and the most studied healthcare providers were general practitioners or physiotherapists. Five main barriers to guideline utilization were expressed by providers: 1) disagreement between recommendations and patient expectations; 2) guidelines not specific to individual patients; 3) unfamiliarity with “non-specific” term, or with the bio psychosocial model of MSDs; 4) time consuming; and 5) heterogeneity in guideline methods. Four main facilitators to guideline utilization were cited: 1) clinician’s interest in evidence-based practice; 2) perception from clinicians that the guideline will improve triage, diagnosis and management; 3) time efficiency; and 4) standardized language. Conclusion Identifying modifiable determinants is the first step in developing implementation strategies to improve guideline utilization in clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04204-w.
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Affiliation(s)
- Delphine Sorondo
- UMR1295, Toulouse III University, Inserm, Equipe EQUITY, Equipe constitutive du CERPOP, Toulouse, France. .,Institut Franco-Européen de Chiropraxie, 72 chemin de la Flambère-31,300, Toulouse, France.
| | - Cyrille Delpierre
- UMR1295, Toulouse III University, Inserm, Equipe EQUITY, Equipe constitutive du CERPOP, Toulouse, France
| | - Pierre Côté
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.,Centre for Disability Prevention and Rehabilitation at Ontario Tech University and the Canadian Memorial Chiropractic College, Oshawa and Toronto, Ontario, Canada
| | - Louis-Rachid Salmi
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000, Bordeaux, France
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, University of Geneva, Geneva, Switzerland.,Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Anne Taylor-Vaisey
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.,Centre for Disability Prevention and Rehabilitation at Ontario Tech University and the Canadian Memorial Chiropractic College, Oshawa and Toronto, Ontario, Canada
| | - Nadège Lemeunier
- UMR1295, Toulouse III University, Inserm, Equipe EQUITY, Equipe constitutive du CERPOP, Toulouse, France.,Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
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Effects of Multimodal Intervention Program Among Elite Weightlifters with Knee Pain. Asian J Sports Med 2020. [DOI: 10.5812/asjsm.95220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Grace S, Stockhausen L, Patton N, Innes E. Experiential learning in nursing and allied health education: Do we need a national framework to guide ethical practice? Nurse Educ Pract 2018; 34:56-62. [PMID: 30458411 DOI: 10.1016/j.nepr.2018.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/19/2018] [Accepted: 11/03/2018] [Indexed: 10/27/2022]
Abstract
Experiential learning is widely used in health courses to develop students' clinical skills. Students act as models for demonstrations of practical techniques and work in small groups to practise clinical skills. These classes present a number of ethical challenges including removing clothing, physical touch and disclosing personal information. The aim of this study was to ascertain the views of nursing and allied health regulators and professional associations regarding the need for a national framework to facilitate ethical experiential learning in health courses. Ten semi-structured interviews were conducted either face-to-face or by phone and their audio-recordings transcribed verbatim for thematic analysis. Students' willingness to participate as models was taken-for-granted by educators. Risks to students' wellbeing were considered minor and outweighed by the benefits of experiential learning. The increasing diversity of students enrolled in health courses has increased awareness of students' rights, including choosing not to participate in some learning activities. Ongoing cycles of curriculum review provided an opportunity to respond to changing social values, including increased collective awareness and respect for, students' rights, cultural diversity, professional standards, and risk/benefit analysis of all student activities. There is a need for a national framework to guide ethical experiential learning in practical classes.
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Affiliation(s)
- Sandra Grace
- School of Health and Human Sciences, PO Box 157, Lismore, NSW, 2480, Australia.
| | - Lynette Stockhausen
- School of Health and Human Sciences, Southern Cross University, Locked Mail Bag 4, Coolangatta, Qld, 4225, Australia.
| | - Narelle Patton
- The Education for Practice Institute, Charles Sturt University, Locked Bag 450, Silverwater, NSW, 2128, Australia.
| | - Ev Innes
- School of Health and Human Sciences, Southern Cross University, Locked Mail Bag 4, Coolangatta, Qld, 4225, Australia.
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McRae M, Hancock MJ. Adults attending private physiotherapy practices seek diagnosis, pain relief, improved function, education and prevention: a survey. J Physiother 2017; 63:250-256. [PMID: 28967562 DOI: 10.1016/j.jphys.2017.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/04/2017] [Accepted: 08/07/2017] [Indexed: 11/29/2022] Open
Abstract
QUESTIONS How important are different aspects of physiotherapy care to patients presenting to a primary care physiotherapist? Are patient factors (eg, age and gender) associated with how important different aspects of physiotherapy care are to individual patients? DESIGN A cross-sectional survey with consecutive recruitment. PARTICIPANTS A total of 500 adults aged≥18years who presented to a primary care physiotherapist. METHODS Participants were recruited from 10 private practices within the Sydney metropolitan area. Participants completed a survey assessing how important five aspects of physiotherapy care were in their initial decision to present to a primary care physiotherapist. These aspects were: diagnosis; information and education; treatment for pain relief; treatment to improve function; and prevention. The survey also collected characteristics of the patients and information about their presentation to the physiotherapist, to assess whether these factors were associated with the aspects of physiotherapy care that they considered most important. RESULTS A total of 500 surveys were completed, with a response rate of 94%. All five aspects of physiotherapy care were considered either 'quite important' or 'extremely important' by most participants (diagnosis 65%; information and education 68%; pain relief 89%; improved function 93%; prevention 90%). Patient factors were associated with the participants' ratings of importance. Female participants and those with spinal pain more commonly rated pain relief as highly important. Participants with lower educational levels were more likely to rate diagnosis and information and education as important. CONCLUSION This study demonstrated that most patients presenting to primary care physiotherapists value all aspects of physiotherapy care and do not simply want treatment for pain. Patient characteristics were associated with what individual patients considered the most important reason for presenting to a private primary care physiotherapist. [McRae M, Hancock MJ (2017) Adults attending private physiotherapy practices seek diagnosis, pain relief, improved function, education and prevention: a survey. Journal of Physiotherapy 63: 250-256].
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Affiliation(s)
- Martin McRae
- Department of Health Professions, Macquarie University, Sydney, Australia
| | - Mark J Hancock
- Department of Health Professions, Macquarie University, Sydney, Australia
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Chipchase L, Cavaleri R, Jull G. Can a professional development workshop with follow-up alter practitioner behaviour and outcomes for neck pain patients? A randomised controlled trial. ACTA ACUST UNITED AC 2016; 25:87-93. [DOI: 10.1016/j.math.2016.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 06/01/2016] [Accepted: 06/17/2016] [Indexed: 10/21/2022]
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Karas S, Schneiders A, Reid D, Talisa V. Factors affecting confidence and knowledge in spinal palpation among International Manual Physical Therapists. J Man Manip Ther 2016; 24:166-73. [PMID: 27559287 DOI: 10.1080/10669817.2015.1125082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
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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Affiliation(s)
- Steve Karas
- Department of Physical Therapy, Chatham University, Pittsburgh, PA, USA
| | - Anthony Schneiders
- Department of Physiotherapy, Central Queensland University, Bundaberg, Australia
| | - Duncan Reid
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Victor Talisa
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Puentedura EJ, Slaughter R, Reilly S, Ventura E, Young D. Thrust joint manipulation utilization by U.S. physical therapists. J Man Manip Ther 2016; 25:74-82. [PMID: 28559666 DOI: 10.1080/10669817.2016.1187902] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
STUDY DESIGN Online survey study. OBJECTIVE To determine physical therapists' utilization of thrust joint manipulation (TJM) and their comfort level in using TJM between the cervical, thoracic, and lumbar regions of the spine. We hypothesized that physical therapists who use TJM would report regular use and comfort providing it to the thoracic and lumbar spines, but not so much for the cervical spine. BACKGROUND Recent surveys of first professional physical therapy degree programs have found that TJM to the cervical spine is not taught to the same degree as to the thoracic and lumbar spines. METHODS We developed a survey to capture the required information and had a Delphi panel of 15 expert orthopedic physical therapists review it and provide constructive feedback. A revised version of the survey was sent to the same Delphi panel and consensus was obtained on the final survey instrument. The revised survey was made available to any licensed physical therapists in the U.S.A. using an online survey system, from October 2014 through June 2015. RESULTS Of 1014 responses collected, 1000 completed surveys were included for analysis. There were 478 (48%) males; the mean age of respondents was 39.7 ± 10.81 years (range 24-92); and mean years of clinical experience was 13.6 ± 10.62. A majority of respondents felt that TJM was safe and effective when applied to lumbar (90.5%) and thoracic (91.1%) spines; however, a smaller percentage (68.9%) felt that about the cervical spine. More therapists reported they would perform additional screening prior to providing TJM to the cervical spine than they would for the lumbar and thoracic spines. Therapists agreed they were less likely to provide and feel comfortable with TJM in the cervical spine compared to the thoracic and lumbar spines. Finally, therapists who are male; practice in orthopedic spine setting; are aware of manipulation clinical prediction rules; and have manual therapy certification, are more likely to use TJM and be comfortable with it in all three regions. CONCLUSION Results indicate that respondents do not believe TJM for the cervical spine to be as safe and efficacious as that for the lumbar and thoracic spines. Further, they are more likely to perform additional screening, abstain from and do not feel comfortable performing TJM for the cervical spine. CLINICAL RELEVANCE Our research reveals there is a discrepancy between utilization of TJM at different spinal levels. This research provides an opportunity to address variability in clinical practice among physical therapists utilizing TJM.
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Affiliation(s)
- Emilio J Puentedura
- Department of Physical Therapy, School of Allied Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Rebecca Slaughter
- Department of Physical Therapy, School of Allied Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Sean Reilly
- Department of Physical Therapy, School of Allied Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Erwin Ventura
- Department of Physical Therapy, School of Allied Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Daniel Young
- Department of Physical Therapy, School of Allied Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
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van Trijffel E, Lindeboom R, Bossuyt PMM, Schmitt MA, Lucas C, Koes BW, Oostendorp RAB. Indicating spinal joint mobilisations or manipulations in patients with neck or low-back pain: protocol of an inter-examiner reliability study among manual therapists. Chiropr Man Therap 2014; 22:22. [PMID: 24982754 PMCID: PMC4074830 DOI: 10.1186/2045-709x-22-22] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 05/14/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Manual spinal joint mobilisations and manipulations are widely used treatments in patients with neck and low-back pain. Inter-examiner reliability of passive intervertebral motion assessment of the cervical and lumbar spine, perceived as important for indicating these interventions, is poor within a univariable approach. The diagnostic process as a whole in daily practice in manual therapy has a multivariable character, however, in which the use and interpretation of passive intervertebral motion assessment depend on earlier results from the diagnostic process. To date, the inter-examiner reliability among manual therapists of a multivariable diagnostic decision-making process in patients with neck or low-back pain is unknown. METHODS This study will be conducted as a repeated-measures design in which 14 pairs of manual therapists independently examine a consecutive series of a planned total of 165 patients with neck or low-back pain presenting in primary care physiotherapy. Primary outcome measure is therapists' decision about whether or not manual spinal joint mobilisations or manipulations, or both, are indicated in each patient, alone or as part of a multimodal treatment. Therapists will largely be free to conduct the full diagnostic process based on their formulated examination objectives. For each pair of therapists, 2×2 tables will be constructed and reliability for the dichotomous decision will be expressed using Cohen's kappa. In addition, observed agreement, prevalence of positive decisions, prevalence index, bias index, and specific agreement in positive and negative decisions will be calculated. Univariable logistic regression analysis of concordant decisions will be performed to explore which demographic, professional, or clinical factors contributed to reliability. DISCUSSION This study will provide an estimate of the inter-examiner reliability among manual therapists of indicating spinal joint mobilisations or manipulations in patients with neck or low-back pain based on a multivariable diagnostic reasoning and decision-making process, as opposed to reliability of individual tests. As such, it is proposed as an initial step toward the development of an alternative approach to current classification systems and prediction rules for identifying those patients with spinal disorders that may show a better response to manual therapy which can be incorporated in randomised clinical trials. Potential methodological limitations of this study are discussed.
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Affiliation(s)
- Emiel van Trijffel
- Department of Clinical Epidemiology, Biostatistics & Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
- Institute for Master Education in Musculoskeletal Therapy, Amersfoort, the Netherlands
| | - Robert Lindeboom
- Department of Clinical Epidemiology, Biostatistics & Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Patrick MM Bossuyt
- Department of Clinical Epidemiology, Biostatistics & Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Maarten A Schmitt
- Institute for Master Education in Musculoskeletal Therapy, Amersfoort, the Netherlands
| | - Cees Lucas
- Department of Clinical Epidemiology, Biostatistics & Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Bart W Koes
- Department of General Practice, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Rob AB Oostendorp
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Department of Rehabilitation, Physiotherapy and Manual Therapy, Faculty of Medicine and Pharmacology, Free University of Brussels, Brussels, Belgium
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Carlesso LC, Macdermid JC, Santaguida PL, Thabane L, Giulekas K, Larocque L, Millard J, Williams C, Miller J, Chesworth BM. Beliefs and practice patterns in spinal manipulation and spinal motion palpation reported by canadian manipulative physiotherapists. Physiother Can 2014; 65:167-75. [PMID: 24403681 DOI: 10.3138/ptc.2012-11] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE This practice survey describes how Fellows of the Canadian Academy of Manipulative Physiotherapy (FCAMPT) use spinal manipulation and mobilization and how they perceive their competence in performing spinal assessment; it also quantifies relationships between clinical experience and use of spinal manipulation. METHODS A cross-sectional survey was designed based on input from experts and the literature was administered to a random sample of the FCAMPT mailing list. Descriptive (including frequencies) and inferential statistical analyses (including linear regression) were performed. RESULTS The response rate was 82% (278/338 eligible FCAMPTs). Most (99%) used spinal manipulation. Two-thirds (62%) used clinical presentation as a factor when deciding to mobilize or manipulate. The least frequently manipulated spinal region was the cervical spine (2% of patients); 60% felt that cervical manipulation generated more adverse events. Increased experience was associated with increased use of upper cervical manipulation among male respondents (14% more often for every 10 years after certification; β, 95% CI=1.37, 0.89-1.85, p<0.001) but not among female respondents. Confidence in palpation accuracy decreased in lower regions of the spine. CONCLUSION The use of spinal manipulation/mobilization is prevalent among FCAMPTs, but is less commonly used in the neck because of a perceived association with adverse events.
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Affiliation(s)
| | - Joy C Macdermid
- School of Rehabilitation Sciences ; Clinical Research Lab, Hand and Upper Limb Centre, St. Joseph's Health Centre
| | | | | | | | | | | | | | | | - Bert M Chesworth
- School of Physical Therapy ; Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Ont
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Thoracic spine thrust manipulation improves pain, range of motion, and self-reported function in patients with mechanical neck pain: a systematic review. J Orthop Sports Phys Ther 2011; 41:633-42. [PMID: 21885904 DOI: 10.2519/jospt.2011.3670] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Systematic review. BACKGROUND Neck pain is a common diagnosis in the physical therapy setting, yet there is no gold standard for treatment. This study is part of a growing body of literature on the use of thoracic spine thrust manipulation for the treatment of individuals with mechanical neck pain. OBJECTIVE The purpose of this systematic review was to determine the effects of thoracic spine thrust manipulation on pain, range of motion, and self-reported function in patients with mechanical neck pain. METHODS Six online databases were comprehensively searched from their respective inception to October 2010. The primary search terms included "thoracic mobilization," "thoracic spine mobilization," "thoracic manipulation," and "thoracic spine manipulation." Of the 44 studies assessed for inclusion, 6 randomized controlled trials were retained. Between-group mean differences and effect sizes for pretreatment-to-posttreatment change scores, using Cohen's d formula, were calculated for pain, range of motion, and subjective function at all stated time intervals. RESULTS Effect size point estimates for the pain change scores were significant for global assessment across all studies (range, 0.38-4.03) but not conclusively significant at the end range of active rotation (range, 0.02-1.79). Effect size point estimates were large among all range-of-motion change measures (range, 1.40-3.52), and the effect size point estimates of the change scores among the functional questionnaires (range, 0.47-3.64) also indicated a significant treatment effect. CONCLUSIONS Thoracic spine thrust manipulation may provide short-term improvement in patients with acute or subacute mechanical neck pain. However, the body of literature is weak, and these results may not be generalizable. LEVEL OF EVIDENCE Therapy, level 1b-.
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Sweeney A, Doody C. Manual therapy for the cervical spine and reported adverse effects: a survey of Irish manipulative physiotherapists. ACTA ACUST UNITED AC 2009; 15:32-6. [PMID: 19632881 DOI: 10.1016/j.math.2009.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 04/22/2009] [Accepted: 05/18/2009] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to determine the use of manipulation and mobilisation by the Chartered Physiotherapists (CMPT) in Manipulative Therapy Ireland and to describe adverse effects associated with the use of these techniques. A 44 item postal survey was sent to all 259 members of the CPMT (response rate 49%, n=127). All 127 respondents used non-High Velocity Thrust Techniques (HVTT) and 27% (n=34) used HVTT. Nine percent (n=12) used HVTT on the upper cervical spine. Twenty six percent (n=33) reported an adverse effect in the previous 2 years. The adverse effects were associated with the use of HVTT (4%, n=5), non-HVTT (20%, n=26) and cervical traction (2%, n=2). The most serious adverse effects were associated with non-HVTT and included 1 drop attack, 1 fainting episode and 1 Transient Ischemic Attack (TIA) 4 days post treatment. Fifty three percent (n=18) of HVTT users and 40% (n=44) of non-HVTT users reported carrying out a vertebrobasilar insufficiency (VBI) assessment. The study shows that VBI assessment may not detect every patient at risk of adverse effects. Large scale studies to investigate the risk of serious adverse reactions are needed. A system of reporting adverse effects on a routine basis could be considered.
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Affiliation(s)
- Aoife Sweeney
- School of Physiotherapy and Performance Science, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
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Rajendran D, Mullinger B, Fossum C, Collins P, Froud R. Monitoring self-reported adverse events: A prospective, pilot study in a UK osteopathic teaching clinic. INT J OSTEOPATH MED 2009. [DOI: 10.1016/j.ijosm.2008.08.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Donovan JS, Kerber CW, Donovan WH, Marshall LF. Development of spontaneous intracranial hypotension concurrent with grade IV mobilization of the cervical and thoracic spine: a case report. Arch Phys Med Rehabil 2007; 88:1472-3. [PMID: 17964890 DOI: 10.1016/j.apmr.2007.08.111] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Spontaneous intracranial hypotension (SIH) has been clinically defined as the development of severe orthostatic headaches caused by an acute cerebrospinal fluid (CSF) leak. Typically, intracranial hypotension occurs as a complication of lumbar puncture, but recent reports have identified cases caused by minor trauma. We report a case of SIH secondary to a dural tear caused by a cervical and thoracic spine mobilization. A 32-year-old woman with SIH presented with severe positional headaches with associated hearing loss and C6-8 nerve root distribution weakness. CSF opening pressure was less than 5cmH(2)O and showed no abnormalities in white blood cell count. Cranial, cervical, and thoracic magnetic resonance imaging revealed epidural and subdural collections of CSF with associated meningeal enhancement. Repeated computed tomography myelograms localized the leak to multiple levels of the lower cervical and upper thoracic spine. A conservative management approach of bedrest and increased caffeine intake had no effect on the dural tear. The headache, hearing loss, and arm symptoms resolved completely after 2 epidural blood patches were performed. Practitioners performing manual therapy should be aware of this rare, yet potential complication of spinal mobilizations and manipulations.
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Affiliation(s)
- J Skye Donovan
- Department of Physical Therapy, Chapman University, Orange, CA, USA
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Hoving JL, de Vet HCW, Koes BW, Mameren HV, Devillé WLJM, van der Windt DAWM, Assendelft WJJ, Pool JJM, Scholten RJPM, Korthals-de Bos IBC, Bouter LM. Manual Therapy, Physical Therapy, or Continued Care by the General Practitioner for Patients With Neck Pain. Clin J Pain 2006; 22:370-7. [PMID: 16691091 DOI: 10.1097/01.ajp.0000180185.79382.3f] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The authors' goals were to compare the effectiveness of manual therapy (MT; mainly spinal mobilization), physical therapy (PT; mainly exercise therapy), and continued care by the general practitioner (GP; analgesics, counseling and education) over a period of 1 year. METHODS One hundred eighty-three patients suffering for at least 2 weeks from nonspecific neck pain were randomized to receive a 6-week treatment strategy of MT once a week, PT twice a week, or GP care once every 2 weeks. The primary outcome measures were perceived recovery, severity of physical dysfunctioning, pain intensity, and functional disability. RESULTS The differences between groups considered over 1 year were statistically significant (repeated measurements analyses P<0.001 to P=0.02) for all outcomes but borderline for the Neck Disability Index (P=0.06). Higher improvement scores were observed for MT for all outcomes, followed by PT and GP care. The success rate, based on perceived recovery after 13 weeks, was 72% for MT, which was significantly higher than the success rate for continued GP care (42%, P=0.001) but not significantly higher compared with PT treatment (59%, P=0.16). The difference between PT and GP approached statistical significance (P=0.06). After 1 year the success rates were 75%, 63%, and 56%, respectively, and no longer significantly different. CONCLUSIONS Short-term results (at 7 weeks) have shown that MT speeded recovery compared with GP care and, to a lesser extent, also compared with PT. In the long-term, GP treatment and PT caught up with MT, and differences between the three treatment groups decreased and lost statistical significance at the 13-week and 52-week follow-up.
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Affiliation(s)
- Jan L Hoving
- Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands
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Cleland JA, Childs JD, McRae M, Palmer JA, Stowell T. Immediate effects of thoracic manipulation in patients with neck pain: a randomized clinical trial. ACTA ACUST UNITED AC 2005; 10:127-35. [PMID: 15922233 DOI: 10.1016/j.math.2004.08.005] [Citation(s) in RCA: 184] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2003] [Revised: 07/14/2004] [Accepted: 08/18/2004] [Indexed: 11/22/2022]
Abstract
Mechanical neck pain is a common occurrence in the general population resulting in a considerable economic burden. Often physical therapists will incorporate manual therapies directed at the cervical spine including joint mobilization and manipulation into the management of patients with cervical pain. Although the effectiveness of mobilization and manipulation of the cervical spine has been well documented, the small inherent risks associated with these techniques has led clinicians to frequently utilize manipulation directed at the thoracic spine in this patient population. It is hypothesized that thoracic spine manipulation may elicit similar therapeutic benefits as cervical spine manipulation while minimizing the magnitude of risk associated with the cervical technique. The purpose of this randomized clinical trial was to investigate the immediate effects of thoracic spine manipulation on perceived pain levels in patients presenting with neck pain. The results suggest that thoracic spine manipulation results in immediate analgesic effects in patients with mechanical neck pain. Further studies are needed to determine the effects of thoracic spine manipulation in patients with neck pain on long-term outcomes including function and disability.
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Affiliation(s)
- Joshua A Cleland
- Physical Therapy Program, Franklin Pierce College, 5 Chenell Drive, Concord, NH 03301, USA.
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Childs JD, Flynn TW, Fritz JM, Piva SR, Whitman JM, Wainner RS, Greenman PE. Screening for vertebrobasilar insufficiency in patients with neck pain: manual therapy decision-making in the presence of uncertainty. J Orthop Sports Phys Ther 2005; 35:300-6. [PMID: 15966541 DOI: 10.2519/jospt.2005.35.5.300] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Growing evidence supports the effectiveness of manual therapy interventions in patients with neck pain; however, considerable attention has also been afforded to the potential risks such as vertebrobasilar insufficiency (VBI). Despite the existence of guidelines advocating specific screening procedures, research does not support the ability to accurately identify patients at risk. The logical question becomes, "How does one proceed in the absence of certainty?" Given the lack of clear direction for decision making in the peer-reviewed literature, this commentary discusses the uncertainties that exist regarding the ability to identify patients at risk for VBI. The authors hope that this commentary adds additional perspective on manual therapy decision-making strategies in the presence of uncertainty.
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Affiliation(s)
- John D Childs
- US Army-Baylor University Doctoral Program in Physican Therapy, Fort Sam Houston, San Antonio, TX, USA.
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Boissonnault W, Bryan JM, Fox KJ. Joint manipulation curricula in physical therapist professional degree programs. J Orthop Sports Phys Ther 2004; 34:171-8; discussion 179-81. [PMID: 15128186 DOI: 10.2519/jospt.2004.34.4.171] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Descriptive observational survey. OBJECTIVE To describe the status of joint manipulation curricula within physical therapist professional degree programs in the United States. BACKGROUND Studies have described the evolution of manual therapy curricula, including spinal and extremity joint mobilization, in physical therapist professional programs, but minimal information exists related to joint manipulation curricula. METHODS AND MEASURES Primary faculty members responsible for teaching manual therapy curricular content at the 199 physical therapist professional degree programs located in the United States recognized by the Commission on Accreditation in Physical Therapy Education were asked to participate in this project. The survey documented joint manipulation curricula, faculty qualifications, attitudes and experience, and programs' future plans for teaching manipulation. RESULTS Of the 116 programs responding to our survey, 87 (75%) currently include joint manipulation in their curriculum or plan to soon include such content in their curriculum. Of the programs currently teaching joint manipulation, 75% taught it as part of a required integrated clinical science course. Faculty teaching manipulation content appear to be well qualified and are in clinical practice an average of 12 hours per week. The programs currently not teaching joint manipulation reported reasons, including belief that it was not an entry-level skill (45%), lack of time (26%), lack of qualified faculty (71%), and perceived lack of scientific evidence regarding efficacy (7%). CONCLUSIONS Of the responding professional degree programs, 75% are either currently teaching joint manipulation or soon plan to do so. Our research may serve as a benchmark for faculty to assess existing manual therapy curricula and as a guide for developing curricula in new or existing physical therapy programs.
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Affiliation(s)
- William Boissonnault
- Department of Orthopedics and Rehabilitation, Program in Physical Therapy, University of Wisconsin-Madison, Madison, WI 53706-1532, USA.
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Gross AR, Kay TM, Kennedy C, Gasner D, Hurley L, Yardley K, Hendry L, McLaughlin L. Clinical practice guideline on the use of manipulation or mobilization in the treatment of adults with mechanical neck disorders. MANUAL THERAPY 2002; 7:193-205. [PMID: 12419654 DOI: 10.1054/math.2002.0477] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE An evidence-based clinical practice guideline was developed to ascertain the risks and benefits for manipulation or mobilization in treating mechanical neck disorders with or without radicular findings or cerviogenic headache. Pain, function, patient satisfaction and adverse events were appraised. METHODS The practice guideline development cycle/model and Cochrane reviewing process, critiquing past reviews, randomized trials and surveys were used. RESULTS Manipulation and mobilization alone showed similar effects as placebo, wait period, or control group, and appeared similar in benefit for pain relief. While high-technology exercises were superior to manipulation alone for improving long-term pain scores, manipulation plus low-technology exercise had the same effect. Patient satisfaction scores favoured manipulation plus low-technology exercise over manipulation alone, and high-technology exercise alone. Multi-modal care including some combination of manipulation or mobilizations and exercise was superior to control, other physical medicine methods, and rest. Based on weak evidence, estimates for serious complication for manipulation ranged from one in 20,000 to five in 10,000,000. RECOMMENDATIONS Stronger evidence suggests a multi-modal management strategy using mobilization or manipulation plus exercise is beneficial for relief of mechanical neck pain. Weaker evidence suggest less benefit to either manipulation/mobilization done alone than when used with exercise. The risk rate is uncertain.
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Affiliation(s)
- A R Gross
- McMaster University, Hamilton, Ontario, Canada.
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