颈椎区域手法治疗和运动后血管并发症风险评估：国际骨科学会手法治疗与物理治疗联盟框架的诊断准确性（Go4Safe 项目）。

Risk assessment of vascular complications following manual therapy and exercise for the cervical region: diagnostic accuracy of the International Federation of Orthopaedic Manipulative Physical Therapists framework (The Go4Safe project).

机构信息

Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.

Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Menzies Health Institute Queensland, School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, Australia.

出版信息

J Physiother. 2023 Oct;69(4):260-266. doi: 10.1016/j.jphys.2023.08.008. Epub 2023 Sep 9.

DOI:10.1016/j.jphys.2023.08.008

PMID:37690959

Abstract

QUESTION

What is the diagnostic accuracy of the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) framework to assess the risk of vascular complications in patients seeking physiotherapy care for neck pain and/or headache?

DESIGN

Cross-sectional diagnostic accuracy study.

PARTICIPANTS

One hundred and fifty patients seeking physiotherapy for neck pain and/or headache in primary care.

METHODS

Nineteen physiotherapists performed the index test according to the IFOMPT framework. Patients were classified as having a high, intermediate or low risk of vascular complications, following manual therapy and/or exercise, derived from the estimated risk of the presence of vascular pathology. The reference test was a consensus medical decision reached by a vascular neurologist and an interventional neurologist, with input from a neuroradiologist. The neurologists had access to clinical data and magnetic resonance imaging of the cervical spine, including an angiogram of the cervical arteries.

OUTCOME MEASURES

Diagnostic accuracy measures were calculated for 'no contraindication' (ie, the low-risk category) and 'contraindication' (ie, the high-risk and intermediate-risk categories) for manual therapy and/or exercise. Sensitivity, specificity, predictive values, likelihood ratios and the area under the curve were calculated.

RESULTS

Manual therapy and/or exercise were contraindicated in 54.7% of the patients. The sensitivity of the IFOMPT framework was low (0.50, 95% CI 0.39 to 0.61) and its specificity was moderate (0.63, 95% CI 0.51 to 0.75). The positive and negative likelihood ratios were weak at 1.36 (95% CI 0.93 to 1.99) and 0.79 (95% CI 0.60 to 1.05), respectively. The area under the curve was poor (0.57, 95% CI 0.49 to 0.65).

CONCLUSION

The IFOMPT framework has poor diagnostic accuracy when compared with a reference standard consisting of a consensus medical decision.

摘要

问题

国际物理治疗联合会（IFoMPT）框架评估因颈部疼痛和/或头痛寻求物理治疗的患者发生血管并发症风险的诊断准确性如何？

设计

横断面诊断准确性研究。

参与者

150 名因颈部疼痛和/或头痛在初级保健机构寻求物理治疗的患者。

方法

19 名物理治疗师根据 IFOMPT 框架进行了指标测试。根据手动治疗和/或运动的估计存在血管病理学的风险，将患者分为血管并发症高、中、低风险。参考标准是血管神经病学家和介入神经病学家达成的共识医疗决策，同时还征求了神经放射科医生的意见。神经病学家可以访问临床数据和颈椎磁共振成像，包括颈动脉造影。

结果测量

计算了“无禁忌症”（即低风险类别）和“禁忌症”（即高风险和中风险类别）的手动治疗和/或运动的诊断准确性指标。计算了敏感性、特异性、预测值、似然比和曲线下面积。

结果

54.7%的患者的手动治疗和/或运动被认为是禁忌的。IFoMPT 框架的敏感性较低（0.50，95%CI 0.39 至 0.61），特异性中等（0.63，95%CI 0.51 至 0.75）。阳性和阴性似然比分别为 1.36（95%CI 0.93 至 1.99）和 0.79（95%CI 0.60 至 1.05），均较弱。曲线下面积较差（0.57，95%CI 0.49 至 0.65）。