TY - JOUR
T1 - Risk assessment of vascular complications following manual therapy and exercise for the cervical region
T2 - diagnostic accuracy of the International Federation of Orthopaedic Manipulative Physical Therapists framework (The Go4Safe project)
AU - de Best, Rogier F.
AU - Coppieters, Michel W.
AU - van Trijffel, Emiel
AU - Compter, Annette
AU - Uyttenboogaart, Maarten
AU - Bot, Joost C.
AU - Castien, Rene
AU - Pool, Jan J. M.
AU - Cagnie, Barbara
AU - Scholten-Peeters, Gwendolyne G. M.
N1 - Funding Information: Source(s) of support : This study was funded by a research grant from the Dutch Association for Manual Therapy (Nederlandse Vereniging voor Manuele Therapie) and was supported by the MSG Science Network Physiotherapy ( https://msg-sciencenetwerk.nl/ ). The funders played no role in the design, conduct, analyses, interpretation, or reporting of this study. Publisher Copyright: © 2023 Australian Physiotherapy Association
PY - 2023/10
Y1 - 2023/10
N2 - Question: What is the diagnostic accuracy of the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) framework to assess the risk of vascular complications in patients seeking physiotherapy care for neck pain and/or headache? Design: Cross-sectional diagnostic accuracy study. Participants: One hundred and fifty patients seeking physiotherapy for neck pain and/or headache in primary care. Methods: Nineteen physiotherapists performed the index test according to the IFOMPT framework. Patients were classified as having a high, intermediate or low risk of vascular complications, following manual therapy and/or exercise, derived from the estimated risk of the presence of vascular pathology. The reference test was a consensus medical decision reached by a vascular neurologist and an interventional neurologist, with input from a neuroradiologist. The neurologists had access to clinical data and magnetic resonance imaging of the cervical spine, including an angiogram of the cervical arteries. Outcome measures: Diagnostic accuracy measures were calculated for ‘no contraindication’ (ie, the low-risk category) and ‘contraindication’ (ie, the high-risk and intermediate-risk categories) for manual therapy and/or exercise. Sensitivity, specificity, predictive values, likelihood ratios and the area under the curve were calculated. Results: Manual therapy and/or exercise were contraindicated in 54.7% of the patients. The sensitivity of the IFOMPT framework was low (0.50, 95% CI 0.39 to 0.61) and its specificity was moderate (0.63, 95% CI 0.51 to 0.75). The positive and negative likelihood ratios were weak at 1.36 (95% CI 0.93 to 1.99) and 0.79 (95% CI 0.60 to 1.05), respectively. The area under the curve was poor (0.57, 95% CI 0.49 to 0.65). Conclusion: The IFOMPT framework has poor diagnostic accuracy when compared with a reference standard consisting of a consensus medical decision.
AB - Question: What is the diagnostic accuracy of the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) framework to assess the risk of vascular complications in patients seeking physiotherapy care for neck pain and/or headache? Design: Cross-sectional diagnostic accuracy study. Participants: One hundred and fifty patients seeking physiotherapy for neck pain and/or headache in primary care. Methods: Nineteen physiotherapists performed the index test according to the IFOMPT framework. Patients were classified as having a high, intermediate or low risk of vascular complications, following manual therapy and/or exercise, derived from the estimated risk of the presence of vascular pathology. The reference test was a consensus medical decision reached by a vascular neurologist and an interventional neurologist, with input from a neuroradiologist. The neurologists had access to clinical data and magnetic resonance imaging of the cervical spine, including an angiogram of the cervical arteries. Outcome measures: Diagnostic accuracy measures were calculated for ‘no contraindication’ (ie, the low-risk category) and ‘contraindication’ (ie, the high-risk and intermediate-risk categories) for manual therapy and/or exercise. Sensitivity, specificity, predictive values, likelihood ratios and the area under the curve were calculated. Results: Manual therapy and/or exercise were contraindicated in 54.7% of the patients. The sensitivity of the IFOMPT framework was low (0.50, 95% CI 0.39 to 0.61) and its specificity was moderate (0.63, 95% CI 0.51 to 0.75). The positive and negative likelihood ratios were weak at 1.36 (95% CI 0.93 to 1.99) and 0.79 (95% CI 0.60 to 1.05), respectively. The area under the curve was poor (0.57, 95% CI 0.49 to 0.65). Conclusion: The IFOMPT framework has poor diagnostic accuracy when compared with a reference standard consisting of a consensus medical decision.
KW - Cervical artery
KW - Complication
KW - Physical therapy
KW - Spinal manipulation
KW - Validity
UR - http://www.scopus.com/inward/record.url?scp=85171128623&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jphys.2023.08.008
DO - https://doi.org/10.1016/j.jphys.2023.08.008
M3 - Article
C2 - 37690959
SN - 1836-9553
VL - 69
SP - 260
EP - 266
JO - Journal of Physiotherapy
JF - Journal of Physiotherapy
IS - 4
ER -