title: International framework for examination of the cervical region for potential of Cervical Arterial Dysfunction prior to Orthopaedic Manual Therapy intervention.
abstract: A consensus clinical reasoning framework for best practice for the examination of the cervical spine region has been developed through an iterative consultative process with experts and manual physical therapy organisations. The framework was approved by the 22 member countries of the International Federation of Orthopaedic Manipulative Physical Therapists (October 2012). The purpose of the framework is to provide guidance to clinicians for the assessment of the cervical region for potential of Cervical Arterial Dysfunction in advance of planned management (inclusive of manual therapy and exercise interventions). The best, most recent scientific evidence is combined with international expert opinion, and is presented with the intention to be informative, but not prescriptive; and therefore as an aid to the clinician's clinical reasoning. Important underlying principles of the framework are that 1] although presentations and adverse events of Cervical Arterial Dysfunction are rare, it is a potentially serious condition and needs to be considered in musculoskeletal assessment; 2] manual therapists cannot rely on the results of one clinical test to draw conclusions as to the presence or risk of Cervical Arterial Dysfunction; and 3] a clinically reasoned understanding of the patient's presentation, including a risk:benefit analysis, following an informed, planned and individualised assessment, is essential for recognition of this condition and for safe manual therapy practice in the cervical region. Clinicians should also be cognisant of jurisdictionally specific requirements and obligations, particularly related to patient informed consent, when intending to use manual therapy in the cervical region.
authors.affiliation: School of Sport, Exercise and Rehabilitation Science, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. Electronic address: a.b.rushton@bham.ac.uk.
authors.forename: A
authors.initials: A
authors.lastname: Rushton
authors.affiliation: School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Rivett
authors.affiliation: University Health Network, Toronto Western Research Institute, Toronto, Ontario M5T 2S8, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Carlesso
authors.affiliation: Rocky Mountain University of Health Professions, 561 East 1860 South, Provo, UT 84606, USA.
authors.forename: T
authors.initials: T
authors.lastname: Flynn
authors.affiliation: Bond University, Faculty of Health Sciences and Medicine, Bond University Institute of Health and Sport, Gold Coast, Robina, Queensland 4226, Australia.
authors.forename: W
authors.initials: W
authors.lastname: Hing
authors.affiliation: Division of Physiotherapy Education, School of Health Sciences, University of Nottingham, Nottingham NG5 1PB, United Kingdom.
authors.forename: R
authors.initials: R
authors.lastname: Kerry
mesh_terms: D002340:Carotid Artery Diseases / Q000175:diagnosis* / Q000453:epidemiology; D002574:Cervical Vertebrae / Q000098:blood supply* / Q000503:physiopathology; D032921:Consensus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D038622:Internationality; D007593:Joint Instability / Q000175:diagnosis / Q000534:rehabilitation; D008297:Male; D020393:Manipulation, Spinal / Q000009:adverse effects / Q000379:methods*; D008487:Medical History Taking; D026201:Musculoskeletal Manipulations / Q000009:adverse effects / Q000379:methods; D019547:Neck Pain / Q000175:diagnosis / Q000534:rehabilitation*; D061214:Patient Safety; D010808:Physical Examination / Q000379:methods*; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis* / Q000453:epidemiology
keywords: Arterial; Cervical; Examination; Manual therapy