Academic Journal
Pre-treatment risk factor assessment and safe management of the cervical spine: a survey among physical therapists.
| Title: | Pre-treatment risk factor assessment and safe management of the cervical spine: a survey among physical therapists. |
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| Authors: | Hutting N; Department of Occupation and Health, School of Organization and Development, HAN University of Applied Sciences, Nijmegen, the Netherlands. Electronic address: nathan.hutting@han.nl., Mourad F; Department of Health, LUNEX University of Applied Sciences, Differdange, Luxembourg; Luxembourg Health & Sport Sciences Research Institute A.s.b.l., Differdange, Luxembourg; Facoltà Dipartimentale di Medicina e Chirurgia, Università Campus Bio-Medico di Roma, Roma, Italy. Electronic address: firas.mourad@me.com., Taylor A; Faculty of Medicine and Health Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK. Electronic address: alan.taylor@nottingham.ac.uk., Wilbrink W; School of Health Studies, HAN University of Applied Sciences, Nijmegen, the Netherlands; FysioDynamiek, Arnhem, the Netherlands. Electronic address: wilfred@fysio-dynamiek.nl., Dunning J; American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA; Montgomery Osteopractic Physical Therapy & Acupuncture Clinic, Montgomery, AL, USA. Electronic address: drjamesdunning@googlemail.com., Kerry R; Faculty of Medicine and Health Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK. Electronic address: roger.kerry@nottingham.ac.uk., Kranenburg R; Research Group on Healthy Aging, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands. Electronic address: h.a.kranenburg@pl.hanze.nl. |
| Source: | Musculoskeletal science & practice [Musculoskelet Sci Pract] 2026 Jun; Vol. 83, pp. 103542. Date of Electronic Publication: 2026 Mar 10. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Elsevier Country of Publication: Netherlands NLM ID: 101692753 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2468-7812 (Electronic) Linking ISSN: 24687812 NLM ISO Abbreviation: Musculoskelet Sci Pract Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Amsterdam : Elsevier, [2017]- |
| MeSH Terms: | Cervical Vertebrae*/injuries , Physical Therapists* , Clinical Competence*, Humans ; Female ; Cross-Sectional Studies ; Male ; Adult ; Risk Factors ; Middle Aged ; Risk Assessment ; Surveys and Questionnaires ; Physical Examination ; Manipulation, Spinal |
| Abstract: | Background: Previous research has raised the question of the extent to which physical therapists possess sufficient knowledge of cervical vascular pathologies and blood flow limitations and the clinical reasoning skills to appropriately identify a patient who is having an underlying vascular pathology. Objectives: This study aims to investigate: (1) which risk factors are assessed during patient interviews and their frequency; (2) the physical examination tests used, therapists' training in these tests, and their confidence in performing them; (3) therapists' knowledge of cervical spine treatment risks and associated risk factors; and (4) whether these outcomes differ based on therapist characteristics. Design: A cross-sectional digital survey. Methods: A combination of descriptive statistics and multivariate testing. Results/findings: 774 completed surveys were included in the data analysis. Most respondents reported routinely addressing cardiovascular risk factors, trauma history and contraindications during patient interviews. Peripheral neurological examination was most frequently used (72%), whereas auscultation (8%) and arterial pulse palpation (5%) were rarely applied. Positional testing, although no longer recommended, remained commonly used. Confidence varied, particularly for cranial nerve examination. Forty-eight percent perceived increased dissection risk after manipulation versus 15% after mobilization, and mobilization was generally considered safer. Conclusions: Respondents sufficiently addressed risk factors in the patient interview. Regarding the physical examination, improvement of physical therapists' knowledge and skills in cranial nerve examination is needed, and positional testing should be avoided as it is no longer recommended. Participants' knowledge of cervical spine treatment risks and risk factors is variable and ongoing updating of clinical knowledge is important, as conclusions may change over time. (Copyright © 2026 The Authors. Published by Elsevier Ltd.. All rights reserved.) |
| Competing Interests: | Declaration of interests Given their role as deputy editor, Nathan Hutting had no involvement in the peer review of this article and has no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to another journal editor. |
| Contributed Indexing: | Keywords: Cervical spine; Physical therapy; Physiotherapy; Risk factors; Safety |
| Entry Date(s): | Date Created: 20260317 Date Completed: 20260711 Latest Revision: 20260711 |
| Update Code: | 20260711 |
| DOI: | 10.1016/j.msksp.2026.103542 |
| PMID: | 41844093 |
| Database: | MEDLINE |
| ISSN: | 2468-7812 |
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| DOI: | 10.1016/j.msksp.2026.103542 |