title: Screening for vertebrobasilar insufficiency in patients with neck pain: manual therapy decision-making in the presence of uncertainty.
abstract: Growing evidence supports the effectiveness of manual therapy interventions in patients with neck pain; however, considerable attention has also been afforded to the potential risks such as vertebrobasilar insufficiency (VBI). Despite the existence of guidelines advocating specific screening procedures, research does not support the ability to accurately identify patients at risk. The logical question becomes, "How does one proceed in the absence of certainty?" Given the lack of clear direction for decision making in the peer-reviewed literature, this commentary discusses the uncertainties that exist regarding the ability to identify patients at risk for VBI. The authors hope that this commentary adds additional perspective on manual therapy decision-making strategies in the presence of uncertainty.
authors.affiliation: US Army-Baylor University Doctoral Program in Physican Therapy, Fort Sam Houston, San Antonio, TX, USA. childsjd@sbcglobal.net
authors.forename: John D
authors.initials: JD
authors.lastname: Childs
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Flynn
authors.forename: Julie M
authors.initials: JM
authors.lastname: Fritz
authors.forename: Sara R
authors.initials: SR
authors.lastname: Piva
authors.forename: Julie M
authors.initials: JM
authors.lastname: Whitman
authors.forename: Robert S
authors.initials: RS
authors.lastname: Wainner
authors.forename: Philip E
authors.initials: PE
authors.lastname: Greenman
mesh_terms: D006801:Humans; D019547:Neck Pain / Q000628:therapy*; D026761:Physical Therapy Specialty / Q000379:methods*; D010818:Practice Patterns, Physicians'; D035501:Uncertainty; D014481:United States; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis*