Cervical spinal manipulations (CSM) are frequently employed techniques to alleviate neck pain and headache. Minor and major complications following CSM have been described, though clear consensus on definition and the classification of the complications had not yet been achieved. As a result, incidence rates may be underestimated. The aim of this study was to develop a consensus-based classification of adverse events following cervical spinal manipulations which has good feasibility in clinical practice and research. Design: A three round Delphi-study. Medical specialists, manual therapists, and patients (n=30) participated in an online survey. In Round 1, participants were invited to select a classification system of adverse events. Potential complications were inventoried and detailed in accordance with the ICF and the ICD-10. In Round 2, panel members categorized the potential complications in their selected classification. During the third round, it was inquired of the participants whether they concurred with the answer of the majority of participants. Results: Thirty four complications were defined. Consensus was achieved for 29 complications for all durations [hours, days, weeks]. For the remaining five complications, consensus was reached for two of the three durations [hours, days, weeks]. Conclusions: A consensus-based classification system of adverse events after cervical spinal manipulation was developed which comprises patients’ and clinicians’ perspectives and has only a small number of categories. The classification system includes a precise description of potential adverse events and is based on international accepted classifications (ICD-10 and ICF). This classification system may be useful for utilization in both clinical practice and research.
Introduction:Major Adverse Events (MAE) following Cervical Spinal Manipulations (CSM) have been described anecdotally and are frequently discussed. Until now, exact incidence rates are unknown. Furthermore, there are doubts concerning the factors which may play a role in the occurrence of MAE.Objectives:Determine incidence rates of CSM following CSM.Inventory of patient and clinician characteristics.Introduce an incidence reporting system that fulfils all proposed criteria.Methods:A twofold prospective cohort study will be performed in The Netherlands. Underreporting is particularly likely to be present in primary care, but also likely to be present in secondary care.For this reason measurements will be done in both primary care (MCM -1 group) and secondary care (MCM – 2 group). Data will be collected from September 2016 to September 2017.Considering the sensitivity of the subject and to gain the participants trust, an independent privacy monitoring board is to be founded.Discussion:This study may be helpful in collecting incidence rates of MAE following CSM, collecting relevant factors that play a role in the occurrence of these MAE, collecting epidemiological data and gain insight in the behavior of health professionals.
Cervical spinal manipulation (CSM) and cervical mobilization are frequently used in patients with neck pain and headache. Pre-manipulative cervical instability and arterial integrity tests appear to be unreliable in identifying patients at risk at risk for adverse events. It would be valuable if patients at risk could be identified by specific characteristics during the preliminary screening.
