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Adverse events following cervical manual physical therapy techniques

PhD ceremony:Mr H.A. (Rik) Kranenburg
When:January 08, 2020
Supervisor:prof. dr. C.P. (Cees) van der Schans
Co-supervisors:dr. M.A. Schmitt, dr. G.J.R. Luijckx
Where:Academy building RUG
Faculty:Medical Sciences / UMCG
Adverse events following cervical manual physical therapy

The goal of this thesis is to gain insight in the nature and scale of potential adverse events following manual therapy techniques applied to the cervical spine to patients with neck pain and/ or headache.

This thesis describes that most of the patients visiting a manual therapist in a private setting in The Netherlands, does this with complaints of the neck. This research also shows that Dutch manual therapists experience treatments of the upper cervical spine as riskier compared to the rest of the cervical spine. In this thesis potential adverse events have been defined and linked to known classifications. Subsequently, these potential adverse events have been systematically reviewed in published literature. Therewith, it was tried to gain insight in characteristics of involved patients and clinicians. The most frequent described adverse event is a dissection of a cervical artery. Since no profile of patients with an increased or decreased risk could be established, a case control study between patients with a cervical dissection and neck patients without one. No clinically relevant significant differences were established. A systematic literature review has been performed to identify the effect of neck and head positions on cervical blood flow. The findings suggest that neck positions do not alter blood flow as much as previously expected. Finally, treatments and adverse events were nationally inventoried for 12 months. The incidence of major adverse events in The Netherlands is estimated at 1:2,869,020 cervical manipulations.