title: Beliefs and practice patterns in spinal manipulation and spinal motion palpation reported by canadian manipulative physiotherapists.
abstract: OBJECTIVE
  This practice survey describes how Fellows of the Canadian Academy of Manipulative Physiotherapy (FCAMPT) use spinal manipulation and mobilization and how they perceive their competence in performing spinal assessment; it also quantifies relationships between clinical experience and use of spinal manipulation.
  
  
  METHODS
  A cross-sectional survey was designed based on input from experts and the literature was administered to a random sample of the FCAMPT mailing list. Descriptive (including frequencies) and inferential statistical analyses (including linear regression) were performed.
  
  
  RESULTS
  The response rate was 82% (278/338 eligible FCAMPTs). Most (99%) used spinal manipulation. Two-thirds (62%) used clinical presentation as a factor when deciding to mobilize or manipulate. The least frequently manipulated spinal region was the cervical spine (2% of patients); 60% felt that cervical manipulation generated more adverse events. Increased experience was associated with increased use of upper cervical manipulation among male respondents (14% more often for every 10 years after certification; β, 95% CI=1.37, 0.89-1.85, p<0.001) but not among female respondents. Confidence in palpation accuracy decreased in lower regions of the spine.
  
  
  CONCLUSIONS
  The use of spinal manipulation/mobilization is prevalent among FCAMPTs, but is less commonly used in the neck because of a perceived association with adverse events.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics.
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Carlesso
authors.affiliation: School of Rehabilitation Sciences ; Clinical Research Lab, Hand and Upper Limb Centre, St. Joseph's Health Centre.
authors.forename: Joy C
authors.initials: JC
authors.lastname: Macdermid
authors.affiliation: Centre for Evidence Based Medicine; McMaster University, Hamilton.
authors.forename: P Lina
authors.initials: PL
authors.lastname: Santaguida
authors.affiliation: Department of Clinical Epidemiology and Biostatistics.
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.affiliation: School of Physical Therapy.
authors.forename: Kevin
authors.initials: K
authors.lastname: Giulekas
authors.affiliation: School of Physical Therapy.
authors.forename: Leo
authors.initials: L
authors.lastname: Larocque
authors.affiliation: School of Physical Therapy.
authors.forename: James
authors.initials: J
authors.lastname: Millard
authors.affiliation: School of Physical Therapy.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Williams
authors.affiliation: School of Physical Therapy.
authors.forename: Jack
authors.initials: J
authors.lastname: Miller
authors.affiliation: School of Physical Therapy ; Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Ont.
authors.forename: Bert M
authors.initials: BM
authors.lastname: Chesworth
keywords: beliefs; palpation; spinal manipulation; utilization