“…Performing a screening examination in patients with neck pain is an important decision-making priority, 5,33,47,56,72 particularly given the frequency with which manual therapy interventions are utilized in these patients, 33,46 and a legitimate concern to minimize the risk of harm. Unfortunately, although VBI screening guidelines exist, 45,46 there is currently no clinical prediction rule that can accurately identify patients at risk for VBI and there is little evidence substantiating the accuracy of historical information, physical examination screening procedures, or diagnostic imaging to accurately identify patients at risk for VBI prior to manual therapy inter ventions.…”