Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
Doctor of Physical Therapy Program, Robbins College of Health and Human Sciences, One Bear Place #97303. Waco, Texas, 76798-7303, USA.
Musculoskelet Sci Pract. 2020 Dec;50:102251. doi: 10.1016/j.msksp.2020.102251. Epub 2020 Sep 8.
The perceived relative safety of thoracic thrust joint manipulation (TTJM) has contributed to a growth in evidence supporting use in practice. Yet adverse events (AE) have been documented following TTJM. Knowledge of current practice is therefore required to support further research.
To investigate TTJM knowledge and pre-TTJM examination across IFOMPT Member Organisations (MO) and Registered Interest Groups (RIG).
An e-survey was designed based on existing evidence and piloted. Eligibility criteria: physiotherapists from member countries of the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) who use TTJM. Recruitment was through IFOMPT networks (May 2018-March 2019). Data analyses included descriptive analyses and content analysis for free text data.
Respondents (n = 363) from 20 countries. Pre-TTJM examination included patient history (22%, n = 81) and physical examination (69%, n = 248). Across presentations (>80% threshold of agreement) contraindications included osteomyelitis, fracture and metastatic disease. Spinal deformity, respiratory disease, serious joint disease and hypermobility achieved >60% agreement as precautions. Consent was obtained by 93% respondents (n = 250). Preferred technique was PA/AP thrust (61%, n = 144). Perception of primary effect was neurophysiological (52%, n = 134), biomechanical (42%, n = 109) and placebo (3%, n = 8). From those who reported AE (n = 100), these included fractures (36%, n = 42) and cord signs/symptoms (6%, n = 7).
Pre-TTJM examination is common, although bias towards physical examination. Differential testing for upper versus lower thoracic spine is limited. Inconsistencies across knowledge of contraindications and precautions, and beliefs for biomechanical effect were found. Findings highlight the importance of high levels of clinical reasoning during patient history for TTJM.
胸椎推按关节手法（TTJM）被认为相对安全，这促成了越来越多的证据支持其在实践中的应用。然而，TTJM 后也有不良事件（AE）的记录。因此，需要了解当前的实践情况，以支持进一步的研究。
调查 IFOMPT 成员组织（MO）和注册利益集团（RIG）中 TTJM 的知识和 TTJM 前检查。
根据现有证据设计电子调查问卷，并进行试点。合格标准：来自国际骨科手法物理治疗师联合会（IFOMPT）成员国、使用 TTJM 的物理治疗师。通过 IFOMPT 网络招募（2018 年 5 月至 2019 年 3 月）。数据分析包括描述性分析和自由文本数据的内容分析。
来自 20 个国家的 363 名受访者。TTJM 前检查包括病史（22%，n=81）和体检（69%，n=248）。在（超过 80%的一致性阈值）的表现中，禁忌症包括骨髓炎、骨折和转移性疾病。脊柱畸形、呼吸疾病、严重关节疾病和高机动性得到了超过 60%的一致性，作为预防措施。93%的受访者（n=250）获得了同意。首选技术为 PA/AP 推力（61%，n=144）。对主要效果的感知是神经生理学（52%，n=134）、生物力学（42%，n=109）和安慰剂（3%，n=8）。在报告 AE（n=100）的人中，这些包括骨折（36%，n=42）和脊髓征/症状（6%，n=7）。
TTJM 前检查很常见，尽管偏向于体检。对上胸部和下胸部的检查存在差异。在禁忌症和预防措施的知识以及对生物力学效果的看法方面存在不一致。这些发现强调了在 TTJM 过程中，对患者病史进行高水平临床推理的重要性。
