title: A survey of patient's perceptions of what is "adverse" in manual physiotherapy and predicting who is likely to say so.
abstract: OBJECTIVE
  The primary objective was to describe the patient perspective regarding the identification and occurrence of adverse responses related to manual therapy. A secondary objective evaluated predictors of the incidence rate of adverse responses identified by patients receiving manual physiotherapy.
  
  
  METHODS
  A cross-sectional survey of patients receiving manual physiotherapy recruited by physiotherapists in Canada was conducted. The survey included questions about the symptoms patients identified as adverse, causal associations with treatment, and the impact of contextual factors. Descriptive statistics are reported, and Poisson modeling predicted factors associated with identification of adverse responses.
  
  
  RESULTS
  A response rate of 76.2% (324 of 425) was obtained. Having lumbar spine dysfunction was a significant predictor of all adverse responses (incidence rate ratio [IRR] 95% confidence interval [CI] = 1.513 [1.025, 2.235], P = 0.037) and was associated with 51% greater identification of adverse responses compared with those with an extremity disorder. Expectation of soreness was "protective" against identifying major adverse responses (IRR [95% CI] = 0.915 [0.838, 0.999], P = 0.047); they had an 8.5% lower rate of identifying major adverse responses relative to those without this expectation.
  
  
  CONCLUSIONS
  The patient perspective is important to consider if a comprehensive framework for defining adverse responses in manual therapies is to be developed.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada N1H 1T8, USA. lccarlesso@gmail.com
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Carlesso
authors.forename: Joy C
authors.initials: JC
authors.lastname: MacDermid
authors.forename: P Lina
authors.initials: PL
authors.lastname: Santaguida
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D002170:Canada; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000009:adverse effects*; D012307:Risk Factors; D055815:Young Adult
keywords: Adverse responses; Classification; Manual therapy; Patient beliefs; Physiotherapy; Survey