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What’s a “bad reaction” to manual therapy

PainSci » bibliography » Carlesso et al 2011
Tags: treatment, manual therapy, harms, neck, pain problems, head/neck, spine

One page on PainSci cites Carlesso 2011: Does Spinal Manipulation Work?

PainSci commentary on Carlesso 2011: ?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 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” and the patient perspective on adverse reactions is generally neglected, making formal study difficult. How do patients define a bad reaction to therapy? By ruling out other explanations — if there’s no other obvious cause, they chalk it up to a side effect. “An overarching theme identified multiple factors that influence how the adverse event is perceived.” In other words, it’s complicated!

~ 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.

Rare, serious, and common, benign adverse events (AE) are associated with MT techniques. A proposed standard for defining AE in manual therapy (MT) practise has been published but it did not include the patient perspective. Research comparing clinician and patient reporting of AE demonstrates that several differences exist; for example, the reporting of objective versus subjective events. The objective of this study was to describe how patients define AE associated with MT techniques. A descriptive qualitative design was employed. Semi-structured interviews were used with a purposive sample of patients (n = 13) receiving MT, from physiotherapy, chiropractic and osteopathic practises in Ontario, Canada. The interview guide was informed by existing evidence and consultation with content and methodological experts. Interviews were audiotaped and transcribed verbatim. Data were analysed by two independent team members using thematic content analysis. A key finding was that patients defined mild, moderate and major AE by pain/symptom severity, functional impact, duration and by ruling out of alternative causes. An overarching theme identified multiple factors that influence how the AE is perceived. These concepts differ from the previously proposed framework for defining AE that did not include the patient perspective. Future processes to create standard definitions or measures should include the patient viewpoint to provide a broader, client-centred foundation.

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