Haymo Thiel

Safety of chiropractic manipulation of the cervical spine: a prospective national survey

Study Design. Prospective national survey. Objective. To estimate the risk of serious and relatively minor adverse events following chiropractic manipulation of the cervical spine by a sample of U.K. chiropractors. Summary of Background Data. The risk of a serious adverse event following chiropractic manipulation of the cervical spine is largely unknown. Estimates range from 1 in 200,000 to 1 in several million cervical spine manipulations. Methods. We studied treatment outcomes obtained from 19,722 patients. Manipulation was defined as the application of a high-velocity/low-amplitude or mechanically assisted thrust to the cervical spine. Serious adverse events, defined as “referred to hospital A&E and/or severe onset/worsening of symptoms immediately after treatment and/or resulted in persistent or significant disability/incapacity,” and minor adverse events reported by patients as a worsening of presenting symptoms or onset of new symptoms, were recorded immediately, and up to 7 days, after treatment. Results. Data were obtained from 28,807 treatment consultations and 50,276 cervical spine manipulations. There were no reports of serious adverse events. This translates to an estimated risk of a serious adverse event of, at worse ≈1 per 10,000 treatment consultations immediately after cervical spine manipulation, ≈2 per 10,000 treatment consultations up to 7 days after treatment and ≈6 per 100,000 cervical spine manipulations. Minor side effects with a possible neurologic involvement were more common. The highest risk immediately after treatment was fainting/dizziness/light-headedness in, at worse ≈16 per 1000 treatment consultations. Up to 7 days after treatment, these risks were headache in, at worse ≈4 per 100, numbness/tingling in upper limbs in, at worse ≈15 per 1000 and fainting/dizziness/light-headedness in, at worse ≈13 per 1000 treatment consultations. Conclusion. Although minor side effects following cervical spine manipulation were relatively common, the risk of a serious adverse event, immediately or up to 7 days after treatment, was low to very low.

A survey of “mental hardiness” and “mental toughness” in professional male football players

BackgroundIt is not uncommon for chiropractors to be associated with sports teams for injury prevention, treatment, or performance enhancement. There is increasing acceptance of the importance of sports psychology in the overall management of athletes. Recent findings indicate mental hardiness can be determined reliably using specific self-assessment questionnaires. This study set out to investigate the hardiness scores of professional footballers and examine the correlation between two questionnaires. It also included a mental hardiness rating of players by two coaches, and examined differences in hardiness and mental toughness between national and international players.MethodsTwo self-assessment questionnaires (modified Sports Mental Toughness Questionnaire [SMTQ-M] and Psychological Performance Inventory [PPI-A]) were completed by 20 male professional footballers. Two coaches, independently rated each player. A percentage score from each questionnaire was awarded each player and an average score was calculated ({SMTQ-M % + PPI-A %} ÷ 2). The PPI-A and SMTQ-M scores obtained for each player were analysed for correlation with Pearson’s correlation coefficient. Cohen’s kappa inter-reliability coefficient was used to determine agreement between coaches, and between the players’ hardiness scores and coaches’ ratings. The independent t-test was used to examine differences between national and international players.ResultsThe players’ scores obtained from PPI-A and SMTQ-M correlated well (r = 0.709, p < 0.001). The coaches ratings showed significant, weak to moderate agreement (Cohens kappa = 0.33). No significant agreement was found between player self-assessments and coaches’ ratings.The average ({SMTQ-M % + PPI-A %} ÷ 2) mean score was 77% (SD = 7.98) with international players scoring 7.4% (p = 0.04) higher than non-international players.ConclusionsThe questionnaires (SMTQ-M and PPI-A) correlated well in their outcome scores. These findings suggest that coaches moderately agree when assessing the level of mental hardiness of football players. There was no agreement between player self-assessment and ratings by coaches. Footballers who play or had played for national teams achieved slightly higher mental hardiness scores.Either questionnaire can offer the clinician a cost-effective, valuable measure of an individual’s psychological attributes, which could be relevant within the wider context of bio-psycho-social model of care.

Post-manipulative stroke: a study of two cases

Abstract Spinal manipulative therapy to the cervical, and especially the upper cervical, spinehas been linked to stroke of the posterior circulation affecting the cerebellum and brain stem. Two cases are presented in which chiropractors manipulated patients who presented with neck pain and headaches, resulting in post-manipulative stroke in both cases. Analysis of the cases and review of the relevant literature demonstrate that these scenarios remain both extremely rare and unpredictable. Appropriate post-indicent management is a key factor in the patients prognosis.

How do chiropractors manage clinical risk? A questionnaire study

BackgroundThe literature on chiropractic safety tends to focus on adverse events and little is known about how chiropractors ensure safety and manage risk in the course of their daily practice. The purpose of this study was to investigate how chiropractors manage potentially risky clinical scenarios. We also sought to establish how chiropractors perceive the safety climate in their workplace and thus whether there is an observable culture of safety within the profession.MethodsAn online questionnaire was designed to determine which of nine management options would be chosen by the respondent in response to four defined clinical case scenarios. Safety climate within the respondent’s practice setting was measured by seeking the level of agreement with 23 statements relating to six different safety dimensions. 260 licensed chiropractors in Switzerland and 1258 UK members of The Royal College of Chiropractors were invited to complete the questionnaire. Questionnaire responses were analysed quantitatively in respect of the four clinical scenarios and the nine management options to determine the likelihood of each option being undertaken, with results recorded in terms of % likelihood. Gender differences in response to the management options for each scenario were evaluated using the Mann–Whitney U (MWU) test. Positive agreement with elements comprising each of the six safety dimensions contributed to a composite ‘% positive agreement’ score calculated for each dimension.ResultsQuestionnaire responses were received from 76% (200/260) of Swiss participants and 31% (393/1258) of UK members of The Royal College of Chiropractors. There was a general trend for Swiss and UK chiropractors to manage clinical scenarios where treatment appears not to be successful, not indicated, possibly harmful or where a patient is apparently getting worse, by re-evaluating their care. Stopping treatment and/or incident reporting to a safety incident reporting and learning system were generally found to be unlikely courses of action. Gender differences were observed with female chiropractors appearing to be more risk averse.ConclusionsSwiss and UK chiropractors tend to manage potentially risky clinical scenarios by re-evaluating the case. The unlikeliness of safety incident reporting is probably due to a range of recognised barriers, although Swiss and UK chiropractors are positive about local communication and openness which are important tenets for safety incident reporting. The observed positivity towards key aspects of clinic safety indicates a developing safety culture within the Swiss and UK chiropractic professions.

Clinical governance, clinical risk management and the chiropractic profession

Abstract Recent changes in the National Health Service (NHS) in the UK have included a major push towards improving the quality of patient care and the safety of the offered services under the mantle of clinical governance. The various elements that constitute clinical governance are, in the main, just as relevant to the chiropractic profession as they are to the NHS. Some of these elements, such as “clinical risk management” and “openness and accountability” may perhaps be more challenging to adopt by organisations and their members, as changes in organisational culture are required. These issues are discussed and an opinion on how they may relate to the chiropractic profession is offered.

Fracture of the lateral mass of atlas: a case report and literature review

Abstract This case report details diagnosis of an apparent compression fracture of the lateral mass of the atlas vertebra with an associated avulsion fracture of the medial portion of the lateral mass. Congenital abnormalities of the posterior arches of both atlas and axis were also noted. The patient, a 59-year-old Caucasian male had two previous incidents of severe cervico-cranial trauma but was asymptomatic on presentation though demonstrating reduced cervical ranges of motion. Fractures of the atlas are considered rare, and isolated fractures of the lateral mass have only been reported on seven previous occasions, seldom being visualised on plain film radiographs. None of these cases involve a compression fracture of the lateral mass which may therefore be regarded as an unique radiological finding.

Surgical and radiologic anatomy.

Dear Sir, We have read with interest the paper by Cagnie et al. [1] on ‘‘extrinsic risk factors for compromised blood flow in the vertebral artery: anatomical observations of the transverse foramina from C3 to C7’’, published in its electronic version on 20th August 2005. With their work, the authors have made a useful contribution to our understanding of the potential course of the vertebral artery in the presence of spondylosis. However, we would like to make the following comments and observations: