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Framework for Examination of the Cervical Region f

International Framework for Examination of the Cervical Region for potential of Cervical Arterial Dysfunction prior to Orthopaedic Manual Therapy Intervention.

This consensus document presents a clinical reasoning framework for best practice developed by an international collaboration of the Standards Committee of the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) and international subject matter experts.

This framework was informed by the consensus forum at the IFOMPT International Conference in Rotterdam (June 2008) where nominated experts from each Member Organisation of IFOMPT were invited to participate. Prior to this forum, the issues central to this document were explored through oral presentations and discussion at the World Confederation for Physical Therapy (WCPT) International Congress (June 2007, Vancouver) and in Rotterdam. Drafts of the document have been developed since 2008 through an iterative consultative process with experts and Member Organisations.

This document has been developed as a resource to educate members of the Member Organisations of IFOMPT, physical therapists internationally, and through physical therapists, the public. The framework has subsequently been agreed on by all Member Organisations of IFOMPT. It has been a challenging process to produce an international agreed document, emphasising the need for Member Organisations of IFOMPT to operationalise the framework in line with their national legislation / practice

Two MACP members were intrumental in the initiation and development of this documentation, Dr Ali Rushton FMACP, Chair of the IFOMPT Standards Committee and Roger Kerry FMACP. Our grateful thanks go to them for their efforts in producing this extremely helpful guidance.

Key principles of the international framework
 The framework provides guidance for the assessment of the cervical spine region for potential of Cervical Artery Dysfunction (CAD) in advance of planned OMT interventions
 Although events and presentations of CAD are rare, they are an important consideration as part of an OMT assessment
 The framework is based on best available evidence and is intended to be informative and not prescriptive
 The framework enhances the physical therapist's clinical reasoning as part of the process of patient assessment and treatment
 An important underlying principle of the framework is that physical therapists cannot rely on the results of only one test to draw conclusions, and therefore development of an understanding of the patient's presentation following an informed, planned and individualised assessment is essential
 The framework is designed to be an aid to patient-centred clinical reasoning
 The framework requires effective clinical reasoning to enable effective, efficient and safe assessment and management of the cervical region
 The physical therapist's aim during the patient history is to make the best judgment on the probability of serious pathology and contraindications to treatment based on available information
 A process of planning the physical examination to interpret the data from the patient history and define the main hypotheses is essential to an effective physical examination
 It is important that the tests within the physical examination provide reliable and valid data to enable evaluation of the main hypotheses
 A risk versus benefit model is advocated to provide a simple framework for decision-making through consideration of risk factors, predicted benefit of OMT intervention, and analysis of possible action
 A flowchart of clinical reasoning is provided
 Informed consent must be obtained prior to treatment interventions, following adequate disclosure of information
 Key considerations are provided for the physical therapist during the selection and application of cervical manipulation as a treatment intervention
 Guidance is provided on alternative approaches to direct cervical treatment, frequency of treatment, minimising end-range cervical techniques, force minimisation, and monitoring for adverse effects
 Guidance is provided for those teaching cervical assessment and management to students

The link to the documentation can be found here;

http://www.ifompt.com/site/ifompt/files/pdf/Standards%20Committee/Standards%20Committee%20Documents//IFOMPT%20Examination%20cervical%20spine%20doc%20September%202012%20definitive.pdf

Dr Chris McCarthy PhD, FCSP, FMACP

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