Adverse events associated with the use of cervical manipulation or mobilization and patient characteristics

0,4% 0,4% 1,3% 1,8% 1,8% 2,2% 2,8% 4,2% 4,4% 9,7% 16,3% 84,5% 88,0% 90,2% 91,1% 91,6% 99,1% 99,6% 100,0% 0,0% 50,0% 100,0% 150,0% Anxiety Income Depression Level of Education Sport Leisure time Contra Indications Riskfactors UCI Riskfactors CAD Precautions Profession Patient Profession Indication Time to Onset Type of AE Technique Signs / Symptoms Age Gender

Summary of review: Systematic search in PubMed, Embase, CINAHL, Web-of-science, AMED, and ICL up to December 2014. Initial 1043 studies, 144 studies were included, containing 227 cases. Cervical arterial dissection (CAD) was reported in 57% (P=0.21) of the cases and 45.8% had immediate onset symptoms. The overall distribution of gender for CAD is 55% (n=71) for female and therefore opposite of the total MAE.

Adverse events associated with the use of cervical spine manipulation of

mobilization and patiencharacteristics: a Systematic Review

Kranenburg, H.A.

a,b,c

_{, Schmitt, M.A.}

a,d

_{, Luijckx G.J}

b

_{, Puentedura E.J}

e

_{, Van der Schans, C.P.}

a, c

_.

a _{Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands} b _{University of Groningen University Medical Center Groningen, department of Neurology, Groningen, the Netherlands}

c _{University of Groningen, University Medical Center Groningen, Department of Rehabilitation, Groningen, the Netherlands} d _{Rotterdam University of Applied Science, Research Center Innovations in Care, Rotterdam, The Netherlands}

e _{University of Nevada Las Vegas, School of Allied Health Sciences, Department of Physical Therapy, Las Vegas, USA}

Contact details:

h.a.kranenburg@pl.hanze.nl

0 1 1 2 2 3 3 4 4 4 6 7 8 8 10 15 27 30 1 0 0 0 0 6 0 9 1 0 9 6 4 7 5 8 9 53 0 10 20 30 40 50 60 Chiari Type 1 Rupture Muscle / Tendon Intra Cranial Hypotension Sprain / Strain CWK Esophagus Tear Dislocation Dissection ECA Meninges injury Dissection Intercranial Spinal Cord Leasion Dissection BA Spinal Cord Compression Fracture Trombus Spinal Cord Swelling Dissection ICA Disc rupture Dissection VA Female Male

Type of Adverse Events by gender

Described parameters per case

Background: 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.

Aims: To identify 1) major adverse events (MAE) occurring after CSM or cervical mobilization and characteristics of 2) patients, 3) practitioners, 4) treatment process.

Conclusions: Patient characteristics were described poorly. No clear patient profile, related to the risk of AE after CSM, could be extracted. However, women seem more at risk for CAD. There seems to be under-reporting of cases. Further research should focus on a more uniform and complete registration of AE using standardized terminology.

Patiient • 117 Male_{• Age 45 (SD12)}

Professi on • Chiropractor 66% • Non-clinician 5,3% Techniq ue • Manipulation 95% • Non-specified manipulation: 63% Indicati on • Neck pain/ Stiffness: 65% • Headache: 18%

Onset • Immediate: 46%_{• < 1 week: 85%} 144 Studies

227 Cases

Highights

Adverse Events associated with the use of cervical spine manipulation or mobilization

and patientcharacteristics: a Systematic Review

Kranenburg, H.A.

a,b,c,

Schmitt, M.A.

a,d,

Luijckx G.J.

b

, Puentedura E.J.

e

, Van der Schans, C.P.

a,c

.

a Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands b University of Groningen University Medical Center Groningen, department of Neurology, Groningen, the Netherlands

c University of Groningen, University Medical Center Groningen, Department of Rehabilitation, Groningen, the Netherlands d Rotterdam University of Applied Science, Research Center Innovations in Care, Rotterdam, The Netherlands

e University of Nevada Las Vegas, School of Allied Health Sciences, Department of Physical Therapy, Las Vegas, USA

HANZE-16_624

Type of Adverse Events by gender

Described parameters per case

Technique Profession Indication Onset Patient 144 Studies 227 Cases • 117 Male • Age 45 (SD12) • Chiropractor 66% • Non-clinician 5,3% • Manipulation 95% • Non-specified manipulation: 63% • Neck pain/Stiffness: 65% • Headache: 18% • Immediate: 46% • < 1 week: 85%

Highlights