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Risk assessment of vascular complications following manual therapy and exercise for the cervical region : diagnostic accuracy of the International Federation of Orthopaedic Manipulative Physical Therapists framework (The Go4Safe project)

(2023) JOURNAL OF PHYSIOTHERAPY. 69(4). p.260-266
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Abstract
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. [de Best RF, Coppieters MW, van Trijffel E, Compter A, Uyttenboogaart M, Bot JC, Castien R, Pool JJM, Cagnie B, Scholten-Peeters GGM (2023) Risk assessment of vascular complications following manual therapy and exercise for the cervical region: diagnostic accuracy of the International Federation of Orthopaedic Manipulative Physical Therapists framework (The Go4Safe project). Journal of Physiotherapy 69:260-266](c) 2023 Australian Physiotherapy Association. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Keywords
Spinal manipulation, Complication, Physical therapy, Cervical artery, Validity

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@article{01HT5DW7YE3JBEMRX2P3B17S7C,
  abstract     = {{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. [de Best RF, Coppieters MW, van Trijffel E, Compter A, Uyttenboogaart M, Bot JC, Castien R, Pool JJM, Cagnie B, Scholten-Peeters GGM (2023) Risk assessment of vascular complications following manual therapy and exercise for the cervical region: diagnostic accuracy of the International Federation of Orthopaedic Manipulative Physical Therapists framework (The Go4Safe project). Journal of Physiotherapy 69:260-266](c) 2023 Australian Physiotherapy Association. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).}},
  author       = {{de Best, Rogier F. and  Coppieters, Michel W. and  van Trijffel, Emiel and  Compter, Annette and  Uyttenboogaart, Maarten and  Bot, Joost C. and  Castien, Rene and  Pool, Jan J. M. and Cagnie, Barbara and  Scholten-Peeters, Gwendolyne G. M.}},
  issn         = {{1836-9553}},
  journal      = {{JOURNAL OF PHYSIOTHERAPY}},
  keywords     = {{Spinal manipulation,Complication,Physical therapy,Cervical artery,Validity}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{260--266}},
  title        = {{Risk assessment of vascular complications following manual therapy and exercise for the cervical region : diagnostic accuracy of the International Federation of Orthopaedic Manipulative Physical Therapists framework (The Go4Safe project)}},
  url          = {{http://doi.org/10.1016/j.jphys.2023.08.008}},
  volume       = {{69}},
  year         = {{2023}},
}

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