Effect of cervical manipulation on vertebral artery and cerebral haemodynamics in patients with chronic neck pain: a crossover randomised controlled trial

Moser, Nicholas; Mior, Silvano; Noseworthy, Michael D.; Côté, Pierre; Wells, Greg D.; Behr, Michael; Triano, John J.

doi:10.1136/bmjopen-2018-025219

Cited by 16 publications

(13 citation statements)

References 55 publications

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“…In a cross randomized controlled trial published in May 2019, MRI measurements were performed to investigate the effects of cervical manipulation on vertebral arteries and cerebral perfusion. The results suggest that cervical manipulation did not cause cerebral perfusion changes compared with a neutral neck position or a maximal neck rotation, and it may not increase the risk of cerebrovascular events with a hemodynamic mechanism 13 . However, as in our case, the possible risk of injury following manipulation, especially when performed by non-professionals, cannot be ruled out.…”

Section: Discussionmentioning

confidence: 74%

An unusual occurrence of acute cerebellar infarct after self-cervical manipulation: a case report

Ademoğlu

İslam

Aksel

et al. 2020

Journal of Emergency Medicine Case Reports

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Introduction: Spinal manipulation is a widely used method in the treatment of neck pain, but it has the potential for serious complications. Although controversial, stroke can occur especially after cervical manipulation. Stroke secondary to self-cervical manipulation is rare and only a few cases have been reported. Case Report:We reported a 28-year-old male patient with complaints of dizziness, neck pain and right hemiparesthesia. Except the cerebellar gait and right hemiparesthesia, his neurological examination was normal. It was learnt that his complaints started an hour after the self-cervical manipulation. His brain computed tomography, brain and cervical computed tomography angiography were normal limits. The brain diffusion magnetic resonance imaging (MRI) revealed an acute infarction area. He was discharged without sequelae with antiaggregant treatment, after 8 days of follow-up in the hospital. Conclusion:Although it is controversial whether the risk of stroke increases after cervical manipulation, we believe the risk of stroke may increase, especially when the manipulation is performed by non-professionals. Especially in younger patients with a history of cervical manipulation and neurological complaints, stroke should be suspected even if the neurological examination is normal.

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Section: Discussionmentioning

confidence: 74%

An unusual occurrence of acute cerebellar infarct after self-cervical manipulation: a case report

Ademoğlu

İslam

Aksel

et al. 2020

Journal of Emergency Medicine Case Reports

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“…Close to half of respondents disagreed that chiropractic manipulation of the cervical spine was generally safe; however, although some observational studies have suggested a rare association with stroke [49][50][51], studies with greater methodologic safeguards against bias have failed to confirm either an association between greater utilization of chiropractic and risk of stroke [52], or an association between chiropractic care and an increased risk of stroke compared to care by primary care physicians [53,54]. The associations reported in some studies between chiropractic care and stroke may be due to patients with early dissection-related symptoms seeking care prior to developing their strokes [55][56][57].…”

Section: Relevant Literaturementioning

confidence: 99%

Attitudes towards chiropractic: a repeated cross-sectional survey of Canadian family physicians

et al. 2021

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Background Many primary care patients receive both medical and chiropractic care; however, interprofessional relations between physicians and chiropractors are often suboptimal which may adversely affect care of shared patients. We surveyed Canadian family physicians in 2010 to explore their attitudes towards chiropractic and re-administered the same survey a decade later to explore for changes in attitudes. Methods A 50-item survey administered to a random sample of Canadian family physicians in 2010, and again in 2019, that inquired about demographic variables, knowledge and use of chiropractic. Imbedded in our survey was a 20-item chiropractic attitude questionnaire (CAQ); scores could range from 0 to 80 with higher scores indicating more positive attitudes toward chiropractic. We constructed a multivariable regression model to explore factors associated with CAQ scores. Results Among eligible physicians, 251 of 685 in 2010 (37% response rate) and 162 of 2429 in 2019 (7% response rate) provided a completed survey. Approximately half of respondents (48%) endorsed a positive impression of chiropractic, 27% were uncertain, and 25% held negative views. Most respondents (72%) referred at least some patients for chiropractic care, mainly due to patient request or lack of response to medical care. Most physicians believed that chiropractors provide effective therapy for some musculoskeletal complaints (84%) and disagreed that chiropractic care was beneficial for non-musculoskeletal conditions (77%). The majority agreed that chiropractic care was a useful supplement to conventional care (65%) but most respondents (59%) also indicated that practice diversity among chiropractors presented a barrier to interprofessional collaboration. In our adjusted regression model, attitudes towards chiropractic showed trivial improvement from 2010 to 2019 (0.31 points on the 80-point CAQ; 95%CI 0.001 to 0.62). More negative attitudes were associated with older age (− 1.55 points for each 10-year increment from age 28; 95%CI − 2.67 to − 0.44), belief that adverse events are common with chiropractic care (− 1.41 points; 95% CI − 2.59 to − 0.23) and reported use of the research literature (− 6.04 points; 95% CI − 8.47 to − 3.61) or medical school (− 5.03 points; 95% CI − 7.89 to − 2.18) as sources of knowledge on chiropractic. More positive attitudes were associated with endorsing a relationship with a specific chiropractor (5.24 points; 95% CI 2.85 to 7.64), family and friends (4.06 points; 95% CI 1.53 to 6.60), or personal treatment experience (4.63 points; 95% CI 2.14 to 7.11) as sources of information regarding chiropractic. Conclusions Although generally positive, Canadian family physicians’ attitudes towards chiropractic are diverse, and most physicians felt that practice diversity among chiropractors was a barrier to interprofessional collaboration.

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“…This suggests that associations reported in some studies between chiropractic care and stroke may be due to patients with early dissection-related symptoms seeking care prior to developing their strokes. [52][53][54] Musculoskeletal complaints, particularly low back pain, are common complaints in primary care. 55 Our ndings suggest that most Canadian family physicians believe chiropractors can provide effective care for some musculoskeletal complaints; however, many physicians do not believe that chiropractors treat in accordance with evidence-based practices and have concerns regarding the safety of cervical manipulation.…”

Section: Relevant Literaturementioning

confidence: 99%

Attitudes Towards Chiropractic: A Repeated Cross-Sectional Survey of Canadian Family Physicians 

Busse

Pallapothu

Vinh

et al. 2021

Preprint

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Background: Attitudes of Canadian family physicians towards chiropractic are uncertain. Methods: A 50-item survey administered to a ranmdom sample of Canadian family physcians in 2010, and again in 2019, that inquired about demographic variables, knowledge and use of chiropractic. Imbedded in our survey was an 80-point chiropractic attitude questionnaire (CAQ); higher scores indicated more positive attitudes toward chiropractic. Results: Among eligible physicians, 251 of 685 in 2010 (37% response rate) and 162 of 2,429 in 2019 (7% response rate) provided a completed survey. Approximately half of respondents (48%) endorsed a positive impression of chiropractic, with 27% expressing uncertainty and 25% holding negative views. Most respondents (72%) referred patients for chiropractic care, mainly due to patient request or lack of response to medical care. Most physicians believed that chiropractors provide effective therapy for some musculoskeletal complaints (84%) and disagreed that chiropractic care was beneficial for non-musculoskeletal conditions (77%). The majority agreed that chiropractic care was a useful supplement to conventional care (65%) but most respondents (59%) also indicated that practice diversity within the chiropractic profession presented a barrier to interprofessional collaboration. In our adjusted regression model, attitudes towards chiropractic showed trivial improvement from 2010 to 2019 (0.31 points on the CAQ; 95%CI 0.001 to 0.62). More negative attitudes were associated with older age (-1.55 points for each 10-year increment from age 28; 95%CI -2.67 to -0.44), belief that adverse events are common with chiropractic care (-1.41 points; 95% CI -2.59 to -0.23) and reported use of the research literature (-6.04 points; 95% CI -8.47 to -3.61) or medical school (-5.03 points; 95% CI = -7.89 to -2.18) as a source of knowledge on chiropractic. More positive attitudes were associated with endorsing a relationship with a specific chiropractor (5.24 points; 95% CI 2.85 to 7.64), family and friends (4.06 points; 95% CI 1.53 to 6.60), or personal treatment experience (4.63 points; 95% CI 2.14 to 7.11) as sources of information regarding chiropractic.Conclusions: Although generally positive, Canadian family physicians’ attitudes towards chiropractic are diverse, and most physicians acknowledge that practice diversity within the chiropractic profession presents a barrier to interprofessional collaboration.

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Effect of cervical manipulation on vertebral artery and cerebral haemodynamics in patients with chronic neck pain: a crossover randomised controlled trial

Cited by 16 publications

References 55 publications

An unusual occurrence of acute cerebellar infarct after self-cervical manipulation: a case report

An unusual occurrence of acute cerebellar infarct after self-cervical manipulation: a case report

Attitudes towards chiropractic: a repeated cross-sectional survey of Canadian family physicians

Attitudes Towards Chiropractic: A Repeated Cross-Sectional Survey of Canadian Family Physicians

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Effect of cervical manipulation on vertebral artery and cerebral haemodynamics in patients with chronic neck pain: a crossover randomised controlled trial

Cited by 16 publications

References 55 publications

An unusual occurrence of acute cerebellar infarct after self-cervical manipulation: a case report

An unusual occurrence of acute cerebellar infarct after self-cervical manipulation: a case report

Attitudes towards chiropractic: a repeated cross-sectional survey of Canadian family physicians

Attitudes Towards Chiropractic: A Repeated Cross-Sectional Survey of Canadian Family Physicians&nbsp;

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Attitudes Towards Chiropractic: A Repeated Cross-Sectional Survey of Canadian Family Physicians