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Adverse reactions most likely for back pain patients

PainSci » bibliography » Carlesso et al 2013
Tags: treatment, manual therapy, harms, radiculopathy, chiropractic, physical therapy, pain problems, neuropathy, pain, spine, controversy, debunkery

Three articles on PainSci cite Carlesso 2013: 1. The Complete Guide to Low Back Pain2. The Complete Guide to Neck Pain & Cricks3. Does Spinal Manipulation Work?

PainSci commentary on Carlesso 2013: ?This page is one of thousands in the 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 wherever possible.

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.

~ Paul Ingraham

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.

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