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Rushton A.1, Rivett D.2, Flynn T.3, Hing W.4, Carlesso L.5, Kerry R.6
1University of Birmingham, School of Sport, Exercise and Rehabilitation Sciences, Birmingham, United Kingdom, 2University of Newcastle, Callaghan, Australia, 3Rocky Mountain University of Health Professions, South Provo, United States, 4Bond University, Gold Coast, Australia, 5McMaster University, Hamilton, Canada, 6University of Nottingham, Nottingham, United Kingdom
Background: Cervical Arterial Dysfunction (CAD) in patients presenting with neck complaints is a rare event. It is however, a critical consideration as part of a comprehensive musculoskeletal assessment of the cervical region. Vascular pathologies, such as arterial dissection, are generally recognisable if appropriate questions are asked, data are appropriately interpreted during the patient history, and if the physical examination is adapted to test a potential vasculogenic diagnostic hypothesis. Best clinical practice was however unclear.
A consensus clinical reasoning framework for best practice for the examination of the cervical spine region was developed through an iterative consultative process with international experts and manual physical therapy organisations. It was agreed by 22 countries and made freely available from 2012.
A consensus clinical reasoning framework for best practice for the examination of the cervical spine region was developed through an iterative consultative process with international experts and manual physical therapy organisations. It was agreed by 22 countries and made freely available from 2012.
Purpose: 1] To review impact and currency of the cervical framework using evaluation data invited from 22 countries.
2] Review contemporary research to inform analysis of the key identified issues.
3] Discuss required development of the framework and its evolution to fulfil our clinical practice needs.
2] Review contemporary research to inform analysis of the key identified issues.
3] Discuss required development of the framework and its evolution to fulfil our clinical practice needs.
Methods: Data were collected from manual therapy organisations and experts in 22 countries to inform a discussion forum at an international conference in 2016. The following areas were critically explored through short focused presentations integrated with discussion and analysis from the panel members, invited experts, and manual therapy organisation representatives.
i. Evaluation and impact data analysis
ii. The status of the framework
iii. Medicolegal value of the framework- insights from New Zealand
iv. Currency of patient history data recommendations
v. Currency of physical examination data recommendations
vi. Risk stratification and CAD
vii. Integration of the framework into entry level criteria
Issues arising from the evaluation data and the discussion forum were analysed to inform the revision plan for updating the consensus clinical reasoning framework.
Results: There was strong support for updating the framework. The revision plan includes:
· Simplify key messages
· Clarity at start re the range of potential pathologies that CAD encompasses
· Clarity re two components to the framework 1] examination to identify vascular event in situ or risk of vascular event 2] decision making regarding treatment in situation where there is no vascular event in situ
· Remove craniovertebral ligament testing
· Update consent section
· Clarity re recommendations for students acting as models
· Consider establishment of adverse event data collection through IFOMPT for students / patients
· Include a dissemination strategy to ensure, in particular, that undergraduate programmes are targeted
· Multiprofessional authorship as goes across all manual therapy professions
Conclusion(s): CAD is an area of increasing interest and the evidence base continues to develop. The data will inform the update of the framework, implementation plan and strategic analysis of priorities for research.
Implications: Many manual therapy interventions have empirically supported effectiveness, but are sometimes not used owing to the perceived risk of CAD. Knowledge of both external evidence of effectiveness and the relevant clinical features of the patient can optimise the use of physical therapy interventions to facilitate best practice. The update of this framework will further assist physical therapists in patient assessment and management strategies.
Funding acknowledgements: None
Topic: Musculoskeletal: spine
Ethics approval: Not applicable
All authors, affiliations and abstracts have been published as submitted.
