Peters Renske, Schmitt Maarten, Mutsaers Bert, Buyl Ronald, Verhagen Arianne, Pool-Goudzwaard Annelies, Koes Bart
SOMT, University of Physiotherapy, Amersfoort, The Netherlands; Erasmus Medical Centre, Department of General Practice, Rotterdam, The Netherlands.
Rotterdam Hogeschool, University of Applied Science, Rotterdam, The Netherlands.
Arch Phys Med Rehabil. 2023 Feb;104(2):277-286. doi: 10.1016/j.apmr.2022.08.007. Epub 2022 Aug 28.
To compare prevalence rates of serious and non-serious adverse events after manipulation and mobilization and to identify risk factors of serious and non-serious adverse events following 4 types of manual therapy treatment in patients with neck pain.
A prospective cohort study in primary care manual therapy practice.
Patients with neck pain (N=686) provided data on adverse events after 1014 manipulation treatments, 829 mobilization treatments, 437 combined manipulation and mobilization treatments, and 891 treatments consisting of "other treatment modality".
Usual care manual therapy.
A chi-square test was performed to explore differences in prevalence rates. Logistic regression analysis was performed within the 4 treatment groups. A priori we defined associations between patient-characteristics and adverse events of odds ratio (OR)>2 or OR<0.5 as clinically relevant.
No serious adverse events, such as cervical artery dissection or stroke, were reported. With regard to non-serious adverse events, we found that these are common after manual therapy treatment: prevalence rates are ranging from 0.3% to 64.7%. We found a statistically significant difference between the 4 types of treatments, detrimental to mobilization treatment. Logistic regression analysis resulted in 3 main predictors related to non-serious adverse events after manual therapy treatment: smoking (OR ranges from 2.10 [95% confidence interval [CI] 1.37-3.11] to 3.33 [95% CI 1.83-5.93]), the presence of comorbidity (OR ranges from 2.32 [95% CI 1.22-4.44] to 3.88 [95% CI 1.62-9.26]), and female sex (OR ranges from 0.22 [95% CI 0.11-0.46] to 0.49 [95% CI 0.28-0.86]).
There is a significant difference in the occurrence of non-serious adverse events after mobilization compared with manipulation or a combination of manipulation and mobilization. Non-serious adverse events in manual therapy practice are common and are associated with smoking and the presence of comorbidity. In addition, women are more likely to report non-serious adverse events.
比较手法治疗和松动治疗后严重及非严重不良事件的发生率，并确定颈痛患者接受4种手法治疗后严重及非严重不良事件的风险因素。
在初级保健手法治疗实践中的一项前瞻性队列研究。
颈痛患者（N = 686）提供了1014次手法治疗、829次松动治疗、437次手法与松动联合治疗以及891次“其他治疗方式”治疗后不良事件的数据。
常规护理手法治疗。
进行卡方检验以探讨发生率的差异。在4个治疗组内进行逻辑回归分析。我们事先将患者特征与比值比（OR）>2或OR<0.5的不良事件之间的关联定义为具有临床相关性。
未报告严重不良事件，如颈动脉夹层或中风。关于非严重不良事件，我们发现这些在手法治疗后很常见：发生率在0.3%至64.7%之间。我们发现4种治疗类型之间存在统计学上的显著差异，对松动治疗不利。逻辑回归分析得出与手法治疗后非严重不良事件相关的3个主要预测因素：吸烟（OR范围从2.10 [95%置信区间（CI）1.37 - 3.11]至3.33 [95% CI 1.83 - 5.93]）、合并症的存在（OR范围从2.32 [95% CI 1.22 - 4.44]至3.88 [95% CI 1.62 - 9.26]）以及女性（OR范围从0.22 [95% CI 0.11 - 0.46]至0.49 [95% CI 0.28 - 0.86]）。
与手法治疗或手法与松动联合治疗相比，松动治疗后非严重不良事件的发生率存在显著差异。手法治疗实践中的非严重不良事件很常见，且与吸烟和合并症的存在有关。此外，女性更有可能报告非严重不良事件。
