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Cervical Manual Therapy and Adverse Events: the incidence amongst orthopaedic manual physiotherapists
Dr. Joy MacDermid, Lisa Carlesso, Dr. P. Lina Santaguida, Dr. Lehana Thabane

Abstract :

Neck pain is commonly experienced in the adult population.  Physiotherapists treat neck pain effectively with spinal mobilization or manipulation.  Manipulation has long been associated with adverse events.  Data on the rate of adverse events associated with the techniques applied by physiotherapists is scarce.  A rigorous pilot study was conducted in Ontario to describe the occurrence of adverse events associated with orthopaedic manual physiotherapy in patients with neck pain. Orthopaedic manipulative physiotherapists were emailed and asked to participate. Seventeen physiotherapists across 11 sites agreed to participate.  An electronic database was created to allow for web-based data entry. To date, 19 patients have been enrolled, short of the desired sample size of 28/group. No moderate or major adverse events have been reported.  Enrolment has taken much longer than initially anticipated due to several identified barriers. Progress on defining adverse events has been made. Managing risk and optimizing treatment for people with neck pain seeking primary care will help improve the flow and access of these patients to quality healthcare providers in local communities.  The refining of definitions of adverse events could help identify people who may not be appropriate for manual therapy and improve the efficiency of referring these individuals for appropriate care.  The pilot study has been valuable at identifying issues with recruitment and the running of the electronic database to collect data across multiple sites.  It is anticipated that this will serve to address issues that may impact on the running of the larger study, planned on an international level. 

Key Messages:

What is known

• Neck pain is commonly treated by physiotherapists using orthopaedic manual therapy techniques
• There has been a long standing association of adverse events with these techniques, cervical spine manipulation in particular
• Data on adverse events associated with application of these techniques by physiotherapists is scarce
• There is no standard for defining adverse events in manual therapy
• Establishing safety data for the profession will help ensure appropriate referral and treatment of patients with neck pain

What this study adds

• The piloting of a prospective two group cohort study identified barriers to recruitment and data collection using a web-based system
• To date no moderate or major adverse events have occurred 
• Preliminary definitions for adverse events in manual therapy have been identified
• Refining these definitions could help identify people who may not be appropriate  for manual therapy and improve the efficiency of treatment referral
• The study has identified barriers to recruitment and data collection that will be valuable when expanding the study internationally as planned

For further information, please contact:
Dr. Joy MacDermid 
macderj@mcmaster.ca

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