Adverse reactions most likely for back pain patients
PainSci summary of Carlesso 2013?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★☆☆?3-star ratings are for typical studies with no more (or less) than the usual common problems. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.
In this Canadian survey, low back pain patients were generally much more likely (51%) to report some kind of unpleasant reaction to therapy than patients with a problem anywhere else in the body, generally suggesting that back pain makes people nervous, or actual harm from therapy is more common, or both. Patient expectations, for better or worse, are a major factor in what is considered a “bad reaction” to therapy. For instance, back pain patients who expected to be “sore” after therapy were somewhat less likely (8.5%) to report a serious reaction.
In 2010 Carlesso et al reported that “harms have either been neglected or poorly defined in much of the available studies on the efficacy of orthopaedic physical therapy.” This paper focusses on the patient perspective, which is totally neglected in the study of adverse events and, of course, “important to consider.” See also Carlesso 2011.
original abstract†Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
OBJECTIVES: 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.
STUDY DESIGN AND SETTING: 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.
related content
- “Adverse events associated with the use of cervical manipulation and mobilization for the treatment of neck pain in adults: A systematic review,” an article in Manual Therapy, 2010.
- “Standardization of adverse event terminology and reporting in orthopaedic physical therapy: application to the cervical spine,” an article in Journal of Orthopaedic & Sports Physical Therapy, 2010.
- “Defining adverse events in manual therapy: an exploratory qualitative analysis of the patient perspective,” an article in Manual Therapy, 2011.
- “A survey of patient's perceptions of what is "adverse" in manual physiotherapy and predicting who is likely to say so,” an article in J Clin Epidemiol, 2013.
- “Adverse events and manual therapy: a systematic review,” an article in Manual Therapy, 2010.
These three articles on PainScience.com cite Carlesso 2013 as a source:
- PS Save Yourself from Low Back Pain! — Low back pain myths debunked and all your treatment options reviewed
- PS Save Yourself from Neck Pain! — A complete guide to chronic neck pain and the disturbing sensation of a “crick”
- PS Does Spinal Manipulation Work? — Spinal manipulation, adjustment, and popping of the spinal joints and the subluxation theory of disease, back pain and neck pain
