Exploring practice & clinical evidence with pre-manipulative testing for cervical arterial dysfunction amongst musculoskeletal physiotherapists within a Welsh Health Board

Boots, Madeline C., Button, Kate ORCID: https://orcid.org/0000-0003-1073-9901 and Bundy, Christine ORCID: https://orcid.org/0000-0002-5981-3984 2017. Exploring practice & clinical evidence with pre-manipulative testing for cervical arterial dysfunction amongst musculoskeletal physiotherapists within a Welsh Health Board. Physiotherapy 103 (1) , e110. 10.1016/j.physio.2017.11.088

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Abstract

Purpose: Debate surrounds cervical arterial dysfunction (CAD) & the risk of catastrophic events associated with Cervical manipulation (CM). A legal duty exists for clinicians to interpret evidence and guidelines effectively to justify clinical reasoning therefore this study investigated how pre-manipulative tests were utilised in practice and how clinical decisions were made based on current evidence. Methods: 12 Musculoskeletal physiotherapists volunteered via purposive sampling for semi-structured interviews to explore the use of pre-manipulative tests, clinical thinking and perception of evidence relating to CM. Data was analysed using literal, interpretive and reflexive methods. Ethical approval was granted by ABHB Research Risk Review Committee and Middlesex University Ethics Subcommittee (Health Studies). Results: No adverse events following CM were reported but insufficient event reporting mechanisms were acknowledged. Frequency of CM was declining due to risk. Pre-manipulative tests were rarely used due to perceived risks; mid-range CM techniques were preferred. Expert opinion was heavily relied upon via literature reviews & guidance subject. Written consent was welcomed to aid clinicians although informed consent was currently practiced. Conclusion(s): Good awareness of haemodynamics associated with CAD existed; accurate reflections of risk factors, sign and symptoms. Implications: This demonstrates the need for clinicians to remain aware of current evidence, clinical guidelines and the risks associated with clinical techniques and to critically reflect on their own practice to minimise risk. Funding acknowledgements: There was considered to be no conflict of interest and no funding was received towards this research from the health board or any other source.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Healthcare Sciences
Publisher:	Elsevier
ISSN:	0031-9406
Date of First Compliant Deposit:	17 August 2023
Date of Acceptance:	7 June 2017
Last Modified:	08 Nov 2023 13:15
URI:	https://orca.cardiff.ac.uk/id/eprint/161855

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