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Chiropractic & Manual Therapies
Published in: Chiropractic & Manual Therapies 1/2010

Open Access 01-12-2010 | Research

Withdrawal rates as a consequence of disclosure of risk associated with manipulation of the cervical spine

Authors: Jennifer M Langworthy, Lianne Forrest

Published in: Chiropractic & Manual Therapies | Issue 1/2010

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Abstract

Background

The risk associated with cervical manipulation is controversial. Research in this area is widely variable but as yet the risk is not easily quantifiable. This presents a problem when informing the patient of risks when seeking consent and information may be withheld due to the fear of patient withdrawal from care. As yet, there is a lack of research into the frequency of risk disclosure and consequent withdrawal from manipulative treatment as a result. This study seeks to investigate the reality of this and to obtain insight into the attitudes of chiropractors towards informed consent and disclosure.

Methods

Questionnaires were posted to 200 UK chiropractors randomly selected from the register of the General Chiropractic Council.

Results

A response rate of 46% (n = 92) was achieved. Thirty-three per cent (n = 30) respondents were female and the mean number of years in practice was 10. Eighty-eight per cent considered explanation of the risks associated with any recommended treatment important when obtaining informed consent. However, only 45% indicated they always discuss this with patients in need of cervical manipulation. When asked whether they believed discussing the possibility of a serious adverse reaction to cervical manipulation could increase patient anxiety to the extent there was a strong possibility the patient would refuse treatment, 46% said they believed this could happen. Nonetheless, 80% said they believed they had a moral/ethical obligation to disclose risk associated with cervical manipulation despite these concerns. The estimated number of withdrawals throughout respondents' time in practice was estimated at 1 patient withdrawal for every 2 years in practice.

Conclusion

The withdrawal rate from cervical manipulation as a direct consequence of the disclosure of associated serious risks appears unfounded. However, notwithstanding legal obligations, reluctance to disclose risk due to fear of increasing patient anxiety still remains, despite acknowledgement of moral and ethical responsibility.
Literature
1.
Devaney S: Autonomy rules OK. Med Law Rev. 2005, 13 (1): 102-107. 10.1093/medlaw/fwi005.CrossRef
2.
Beauchamp TL, Childress JF: Principles of Biomedical Ethics. 2001, Oxford University Press
3.
4.
Coggon J: Varied and principled understandings of autonomy in English law: justifiable inconsistency or blinkered moralism?. Health Care Anal. 2007, 15 (3): 235-255. 10.1007/s10728-007-0062-8.CrossRefPubMed
5.
Davies M, Elwyn G: Advocating mandatory patient 'autonomy' in healthcare: adverse reactions and side effects. Health Care Anal. 2008, 16 (4): 315-328. 10.1007/s10728-007-0075-3.CrossRefPubMed
6.
Langworthy J, Cambron J: Consent: its practices and implications in United Kingdom and United States chiropractic practice. J Manipulative Physiol Ther. 2007, 30 (6): 419-431. 10.1016/j.jmpt.2007.05.002.CrossRefPubMed
7.
Boggs SE: Informed consent: the patient's right to choose. J Chiropr. 1992, 29 (8): 36-42.
8.
9.
Jamison JR: Informed consent: an Australian case study. J Manipulative Physiol Ther. 1998, 21 (5): 348-355.PubMed
10.
Moreau WJ, Stoos WK: Communication central to informed consent. J Am Chiropr Assoc. 2006, 43 (3): 15-18.
11.
Hartley MA: The law of patient consent: its relevance to chiropractors and osteopaths. Australas Chiropr Osteopathy. 1996, 5 (1): 8-11.PubMedCentralPubMed
12.
13.
Walker BF, Cameron M, French S, Pollard HP, Vitiello AL, Reggars JW, Werth PD: Risk management for chiropractors and osteopaths: informed consent. A common law requirement. Australas Chiropr Osteopathy. 2004, 12 (1): 19-23.PubMedCentralPubMed
14.
Langworthy J, le Fleming C: Consent or submission? The practice of consent within UK chiropractic. J Manipulative Physiol Ther. 2005, 28 (1): 15-24. 10.1016/j.jmpt.2004.12.010.CrossRefPubMed
15.
Reggers J, French S, Walker B, Cameron M, Pollard H, Vitiello A, Werth PD: Risk management for chiropractors and osteopaths: neck manipulation and vertebrobasilar stroke. Australas Chiropr Osteopathy. 2003, 11 (1): 9-15.
16.
Haldeman S, Kohlbeck FJ, McGregor M: Risk factors and precipitating neck movements causing vertebrobasilar artery dissection after cervical trauma and spinal manipulation. Spine. 1999, 24 (8): 785-794. 10.1097/00007632-199904150-00010.CrossRefPubMed
17.
Haldman S, Carey P, Townsend M, Papadopoulos C: Clinical perceptions of the risk of vertebral artery dissection after cervical manipulation: the effect of referral bias. Spine J. 2002, 2 (5): 334-342. 10.1016/S1529-9430(02)00411-4.CrossRef
18.
Thiel HW, Bolton JE, Docherty S, Portlock JC: Safety of chiropractic manipulation of the cervical spine: a prospective national survey. Spine. 2007, 32 (21): 2375-2378. 10.1097/BRS.0b013e3181557bb1.CrossRefPubMed
19.
Hanley JA, Lippman-Hand A: If nothing goes wrong, is everything all right? Interpreting numerators. JAMA. 1983, 249 (13): 1743-1745. 10.1001/jama.249.13.1743.CrossRefPubMed
20.
Ernst E: Manipulation of the cervical spine: a systematic review of case reports of serious adverse events, 1995-2001. Med J Aust. 2002, 176 (8): 376-380.PubMed
21.
22.
Smith WS, Johnstone SC, Skalabrin EJ, Weaver M, Azari P, Albers GW, Gress DR: Spinal manipulative therapy is an independent risk factor for vertebral artery dissection. Neurology. 2003, 60 (9): 1424-1428.CrossRefPubMed
23.
Rubinstein S: Adverse events following chiropractic care for subjects with neck or low-back pain: do the benefits outweigh the risks?. J Manipulative Physiol Ther. 2008, 31 (6): 461-464. 10.1016/j.jmpt.2008.06.001.CrossRefPubMed
24.
British Medical Association: Medical Ethics Today: Its Practice and Philosophy. 2004, London: BMJ Publishing Group
25.
Beauchamp TL, Childress JF: Principles of Biomedical Ethics. 1994, Oxford: Oxford University Press
26.
Licht PB, Christensen HW, Høilund-Carlsen PF: Carotid artery blood flow during pre-manipulative testing. J Manipulative Physiol Ther. 2002, 25 (9): 568-72. 10.1067/mmt.2002.128367.CrossRefPubMed
27.
Faulder C: Whose Body Is It? The Troubling Issue of Informed Consent. 1985, London: Virago Press
28.
29.
Dictionary Oxford: 1999, Oxford University Press
30.
Dictionary Oxford: 2006, Oxford University Press
31.
Rothwell DM, Bondy SJ, Williams JI, Bousser M-G: Chiropractic manipulation and stroke: a population-based case-control study. Stroke. 2001, 32: 1054-1060.CrossRefPubMed
32.
Rubinstein S, Haldeman S, van Tulder M: An etiologic model to help explain the pathogenesis of cervical artery dissection: implications for cervical manipulation. J Manipulative Physiol Ther. 2006, 29 (4): 336-338. 10.1016/j.jmpt.2006.03.003.CrossRefPubMed
33.
Cassidy DJ, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ: Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. J Manipulative Physiol Ther. 2009, 32 (2S): S201-208. 10.1016/j.jmpt.2008.11.020.CrossRefPubMed
34.
Wynd S, Anderson T, Kawchuk G: Effect of cervical spine manipulation on a pre-existing vascular lesion within the canine vertebral artery. Cerebrovasc Dis. 2008, 26 (3): 304-309. 10.1159/000149578.CrossRefPubMed
Metadata
Title
Withdrawal rates as a consequence of disclosure of risk associated with manipulation of the cervical spine
Authors
Jennifer M Langworthy
Lianne Forrest
Publication date
01-12-2010
Publisher
BioMed Central
Published in
Chiropractic & Manual Therapies / Issue 1/2010
Electronic ISSN: 2045-709X
DOI
https://doi.org/10.1186/1746-1340-18-27

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