Swait Gabrielle, Finch Rob
The Royal College of Chiropractors, Chiltern Chambers, St. Peters Avenue, Reading, RG4 7DH UK.
Chiropr Man Therap. 2017 Dec 7;25:37. doi: 10.1186/s12998-017-0168-5. eCollection 2017.
Communicating to patients the risks of manual treatment to the spine is an important, but challenging element of informed consent. This scoping review aimed to characterise and summarise the available literature on risks and to describe implications for clinical practice and research.
A methodological framework for scoping reviews was followed. Systematic searches were conducted during June 2017. The quantity, nature and sources of literature were described. Findings of included studies were narratively summarised, highlighting key clinical points.
Two hundred and fifty articles were included. Cases of serious adverse events were reported. Observational studies, randomised studies and systematic reviews were also identified, reporting both benign and serious adverse events.Benign adverse events were reported to occur commonly in adults and children. Predictive factors for risk are unclear, but for neck pain patients might include higher levels of neck disability or cervical manipulation. In neck pain patients benign adverse events may result in poorer short term, but not long term outcomes.Serious adverse event incidence estimates ranged from 1 per 2 million manipulations to 13 per 10,000 patients. Cases are reported in adults and children, including spinal or neurological problems as well as cervical arterial strokes. Case-control studies indicate some association, in the under 45 years age group, between manual interventions and cervical arterial stroke, however it is unclear whether this is causal. Elderly patients have no greater risk of traumatic injury compared with visiting a medical practitioner for neuro-musculoskeletal problems, however some underlying conditions may increase risk.
Existing literature indicates that benign adverse events following manual treatments to the spine are common, while serious adverse events are rare. The incidence and causal relationships with serious adverse events are challenging to establish, with gaps in the literature and inherent methodological limitations of studies. Clinicians should ensure that patients are informed of risks during the consent process. Since serious adverse events could result from pre-existing pathologies, assessment for signs or symptoms of these is important. Clinicians may also contribute to furthering understanding by utilising patient safety incident reporting and learning systems where adverse events have occurred.
向患者告知脊柱手法治疗的风险是知情同意过程中重要但具有挑战性的环节。本综述旨在描述和总结关于风险的现有文献，并阐述其对临床实践和研究 的启示。
遵循综述的方法框架。于2017年6月进行系统检索。描述了文献的数量、性质和来源。对纳入研究的结果进行了叙述性总结，突出了关键临床要点。
纳入250篇文章。报告了严重不良事件的病例。还识别出观察性研究、随机研究和系统评价，它们报告了良性和严重不良事件。据报告，良性不良事件在成人和儿童中普遍发生。风险的预测因素尚不清楚，但对于颈部疼痛患者，可能包括更高程度的颈部功能障碍或颈椎手法治疗。在颈部疼痛患者中，良性不良事件可能导致短期预后较差，但不会影响长期预后。严重不良事件的发生率估计为每200万次手法治疗中有1例至每10,000名患者中有13例。成人和儿童中均有病例报告，包括脊柱或神经问题以及颈 动脉卒中。病例对照研究表明，在45岁以下年龄组中，手法干预与颈动脉卒中之间存在某种关联，但尚不清楚这是否存在因果关系。与因神经肌肉骨骼问题就诊的医生相比，老年患者发生创伤性损伤的风险并不更高，然而一些基础疾病可能会增加风险。
现有文献表明，脊柱手法治疗后的良性不良事件很常见，而严重不良事件很少见。严重不良事件的发生率及其因果关系难以确定，文献存在空白且研究存在固有的方法学局限性。临床医生应确保在同意过程中告知患者风险。由于严重不良事件可能由既往存在的病理状况引起，因此对这些状况的体征或症状进行评估很重要。临床医生还可以通过利用发生不良事件的患者安全事件报告和学习系统，为增进理解做出贡献。
