Magarey Mary E, Rebbeck Trudy, Coughlan Brian, Grimmer Karen, Rivett Darren A, Refshauge Kathryn
Centre for Allied Health Evidence (A Collaborating Centre for the Joanna Briggs Institute), Discipline of Physiotherapy, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
Man Ther. 2004 May;9(2):95-108. doi: 10.1016/j.math.2003.12.002.
Members of the Manipulative Physiotherapists Association of Australia (now Musculoskeletal Physiotherapy Australia) were surveyed to determine their use of cervical manipulation, compliance with and attitudes to the Australian Physiotherapy Association's (APA) Protocol for Pre-manipulative Testing of the Cervical Spine, and the incidence of adverse effects from cervical manipulation. The questionnaire was mailed to 740 members and returned by 480 members (65%). Cervical manipulation (84.5%) and passive mobilization (99.8%) were used by a high percentage of respondents. Most were familiar with the protocol with 63% supporting its continued endorsement. Adverse effects were reported at a rate of one per 1000 years of practice (or 0.003/week). The most common effects were symptoms potentially related to VBI (94.4% responses), with no reported major complications. Only 37.1% of respondents always informed the patient about potential dangers of cervical manipulation and consent was sought on every occasion by 33% of respondents. The results suggest that the use and interpretation of the protocol are variable among members of MPA. The risk of adverse effects from manipulative (musculoskeletal) physiotherapy practice, including cervical manipulation, appears to be very low. Recommendations for revision of the protocol were made on the basis of results of the survey and treatment diary, in addition to a review of the literature related to testing for vertebro-basilar insufficiency, adverse incidents related to cervical mobilizing and manipulative technique, differentiating features of VBI related dizziness and vertigo related to benign paroxysmal positional vertigo (BPPV) and current issues surrounding informed consent. Finally, a summary of the content of the new Clinical Guidelines for Pre-Manipulative Testing of the Cervical Spine (APA, 2000) is provided.
对澳大利亚手法治疗师协会（现为澳大利亚肌肉骨骼治疗师协会）的成员进行了调查，以确定他们对颈椎手法治疗的使用情况、对澳大利亚理疗协会（APA）颈椎手法治疗前测试方案的遵守情况和态度，以及颈椎手法治疗的不良反应发生率。问卷邮寄给了740名成员，480名成员（65%）回复。高比例的受访者使用颈椎手法治疗（84.5%）和被动活动（99.8%）。大多数人熟悉该方案，63%的人支持继续认可该方案。不良反应报告率为每1000年治疗时间一例（或0.003/周）。最常见的不良反应是可能与椎基底动脉供血不足（VBI）相关的症状（94.4%的回复），未报告重大并发症。只有37.1%的受访者总是告知患者颈椎手法治疗的潜在风险，33%的受访者每次都寻求患者同意。结果表明，MPA成员对该方案的使用和理解存在差异。包括颈椎手法治疗在内的手法（肌肉骨骼）理疗实践产生不良反应的风险似乎非常低。除了回顾与椎基底动脉供血不足检测、与颈椎活动和手法治疗技术相关的不良事件、VBI相关头晕与良性阵发性位置性眩晕（BPPV）相关眩晕的鉴别特征以及当前围绕知情同意的问题相关的文献外，还根据调查结果和治疗日记对该方案的修订提出了建议。最后，提供了颈椎手法治疗前测试新临床指南（APA，2000）的内容摘要。
