File
N. Hutting1, R. Kranenburg2, R. Kerry3
1HAN University of Applied Sciences, Research Group Occupation & Health, Nijmegen, Netherlands, 2Hanze University of Applied Sciences, Research Group on Healthy Aging, Groningen, Netherlands, 3University of Nottingham, Division of Physiotherapy and Rehabilitation Sciences, Nottingham, United Kingdom
Background: Positional testing for vertebrobasilar insufficiency (VBI) is often used by physiotherapists and manual therapists as part of their pre-treatment screening protocols. Although the validity of the VBI tests has been questioned for decades, the tests continue to be taught to some students, carried out in daily clinical practice, and recommended in several practice guidelines. With regard to the prevention of major adverse events, identifying a possible vasculogenic contribution to the complaints is important. This is not only important before conducting manipulation techniques, as identifying a possible vasculogenic contribution to the complaints is also important to identify before conducting mobilisation or exercise.
Purpose: The purpose of this professional issue is to provide an overview of the current evidence with regard to the VBI tests.
Methods: This is an expert based professional issue.
Results: Based on a previous systematic review, VBI tests do not seem to be important in pre-manipulative screening, due to the low sensitivity and low pre-test probability. The aim of VBI tests is to unilaterally compress an artery to test the collateral blood supply. In such as case, haemodynamics in that artery must change, which can be measured via blood flow volume. Because the VBI tests are not able to consistently produce a decreased blood flow in the contralateral vertebral artery in (healthy) people, the underlying mechanism of the test may not be a valid construct because the collateral circulation will not be challenged and tested. There are also many case-reports describing false-negative results of the VBI tests. VBI tests do not have a role in assessing the risk of serious neurovascular pathology, such as cervical arterial dissection. VBI tests do also not have a role in assessing the risk of VBI, because signs and symptoms associated with VBI are clear red flags for any treatment by a physiotherapist of manual therapist. The patient interview is crucial for detecting these symptoms of VBI, and cranial nerve examination seems more appropriate, as VBI can result in cranial nerve dysfunction.
Conclusion(s): The VBI tests do not seem to be important in the pre-treatement screening. The rationale and value of the VBI tests should be questioned. VBI tests are not able to predict major adverse events and therefore seem not to have any added value to the patient interview with regard to detecting VBI or another vascular pathology. A negative VBI test can also easily be wrongly interpreted as ‘safe to manipulate’ or 'safe to perform other treatments'. The use of the VBI tests cannot be recommended and should be abandoned.
Implications: Based on the existing scientific evidence, the use of the VBI tests cannot be recommended. Physiotherapists and manual therapists should not use the VBI tests in practice. Therapists should put more emphazis on the on the patient interview in which identifying a possible vasculogenic contribution to the complaints or other serious pathology, determining whether there is an indication or contraindication for treatment, and assessing the presence of any potential risk factors associated with a potential major adverse events are important.
Funding, acknowledgements: n/a
Keywords: VBI tests, Pre-treatment screening, Major adverse events
Topic: Musculoskeletal: spine
Did this work require ethics approval? No
Institution: n/a
Committee: n/a
Reason: This is an expert based professional issue.
All authors, affiliations and abstracts have been published as submitted.
