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Thoomes M1,2, Thoomes E1, Carlesso L3, Kerry R4, Rushton A5
1Fysio-Experts, Research Department, Hazerswoude, Netherlands, 2Erasmus MC University Medical Center Rotterdam, Department of General Practice, Rotterdam, Netherlands, 3Université de Montréal, Centre de Recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Canada, 4University of Nottingham, Department of Philosophy, Nottingham, United Kingdom, 5University of Birmingham, Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, Birmingham, United Kingdom
Background: Physical therapists (PTs) use a range of manual therapy techniques. These techniques have been developed to an advanced level through postgraduate orthopaedic manipulative physical therapy (OMPT) programmes. The aim of this study was to describe the adverse effects experienced by students after having techniques performed on them as part of their OMPT training. Educational standards for postgraduate OMPT programmes are set and monitored by the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) across its 22 Member Organisations (countries). The IFOMPT Educational Standards provide a template for educational programmes in learning institutions internationally. Learning and assessment of practical skills commonly involves students practising manual therapy techniques on healthy peers in an educational setting under both tutor supervision and student organised self-directed practice sessions. Practising, by definition, implies that techniques will not always be performed correctly, as students work to develop expertise within these skills. Unlike many areas of medicine, OMPT is generally considered low risk, with few reported adverse effects.
Purpose: The purpose of this project was:
1] To describe any adverse effects experienced by OMPT students after having manual therapy techniques (e.g. manipulation, mobilisation, specific exercise, neurodynamic techniques, etc.) performed on them as part of their OMPT training.
2] To evaluate any long-term adverse effects (minor, moderate or major) experienced by this population in order to inform future educational OMPT strategies.
Methods: A descriptive online survey of current students and recent graduates (≤5 years) of OMPT programmes across the 22 Member Organisations of the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT).
Results: The questionnaire was completed by 1640 respondents across 22 countries (1263 graduates, 377 students. Some 60% of respondents reported never having experienced adverse effects during their manual therapy training. Of the 40% who did, 66.4% reported neck pain, 50.9% headache and 32% low back pain. Most reports of neck pain started after a manipulation and/or mobilisation, of which 53.4% lasted ≤24 hours, 38.1% >24 hours but 3 months and 13.7% still experienced neck pain to date. A small percentage of respondents (3.3%) reported knowing of a fellow student experiencing a major adverse effect.
Conclusion(s): Mild to moderate adverse effects after practising manual therapy techniques are commonly reported, but usually resolve within 24 hours. However, this survey has identified the reported occurrence of major adverse effects that warrant further investigation.
Implications: While minor and transient adverse responses to OMPT procedures are common, a meaningful understanding of the true nature and prevalence of moderate and major adverse responses (although uncommon), is lacking. A screening tool, such as the IFOMPT framework for risk assessment, should be further validated for use in educational settings and consistency of its used promoted. Additionally, a consistent informed consent process should be developed with region-specific medico-legal legitimacy. Also, a mechanism for reporting of moderate to major adverse effects should be developed.
Keywords: Manual Therapy, Adverse Effects, Education
Funding acknowledgements: This work was not funded
Purpose: The purpose of this project was:
1] To describe any adverse effects experienced by OMPT students after having manual therapy techniques (e.g. manipulation, mobilisation, specific exercise, neurodynamic techniques, etc.) performed on them as part of their OMPT training.
2] To evaluate any long-term adverse effects (minor, moderate or major) experienced by this population in order to inform future educational OMPT strategies.
Methods: A descriptive online survey of current students and recent graduates (≤5 years) of OMPT programmes across the 22 Member Organisations of the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT).
Results: The questionnaire was completed by 1640 respondents across 22 countries (1263 graduates, 377 students. Some 60% of respondents reported never having experienced adverse effects during their manual therapy training. Of the 40% who did, 66.4% reported neck pain, 50.9% headache and 32% low back pain. Most reports of neck pain started after a manipulation and/or mobilisation, of which 53.4% lasted ≤24 hours, 38.1% >24 hours but 3 months and 13.7% still experienced neck pain to date. A small percentage of respondents (3.3%) reported knowing of a fellow student experiencing a major adverse effect.
Conclusion(s): Mild to moderate adverse effects after practising manual therapy techniques are commonly reported, but usually resolve within 24 hours. However, this survey has identified the reported occurrence of major adverse effects that warrant further investigation.
Implications: While minor and transient adverse responses to OMPT procedures are common, a meaningful understanding of the true nature and prevalence of moderate and major adverse responses (although uncommon), is lacking. A screening tool, such as the IFOMPT framework for risk assessment, should be further validated for use in educational settings and consistency of its used promoted. Additionally, a consistent informed consent process should be developed with region-specific medico-legal legitimacy. Also, a mechanism for reporting of moderate to major adverse effects should be developed.
Keywords: Manual Therapy, Adverse Effects, Education
Funding acknowledgements: This work was not funded
Topic: Musculoskeletal; Education: methods of teaching & learning; Professional practice: other
Ethics approval required: No
Institution: CCMO
Ethics committee: National Dutch Central Committee on Research Involving Human Subjects
Reason not required: review from a Medical Ethical Committee for this project was not required
All authors, affiliations and abstracts have been published as submitted.
