Background and objectives: Physiotherapists provide conservative treatment for neck pain utilizing manual therapies (MT), including spinal manipulation. Adverse events (AE) have been associated with manipulation provided mainly by other professions. Physiotherapy specific data are lacking. Definitions of AEs following MT require clear standardized criteria informed by both practitioners and patients. The objectives of this thesis were to: a) establish practice patterns of spinal manipulation in Canadian manipulative physiotherapists (CMPTs), b) establish patients’ perceptions of an AE related to MT and c) pilot the collection of AE data reported by practitioners and patients. Methods: For the first objective, multiple linear regression of survey data determined the association between experience and frequency of use of manipulation amongst CMPTs. For the second objective, Poisson regression identified predictors of patients more likely to report the occurrence of an AE. The final objective utilized descriptive statistics of patient and practitioner reported AE to assess feasibility for a future large-scale study. Results: For the first, increased experience was associated with increased use of upper cervical manipulation in males (14% more often for every 10 years after certification; beta 1.37, (95% confidence interval) (0.89,1.85) pConclusion: Manipulation by CMPTs remains a valued option as experience increases. Adverse events reported by patients are influenced by expectations. A large cohort study attempting to accurately define and measure AE rates following manipulation will be challenging to perform in private practice settings. Doctor of Philosophy (PhD)
