hi all
it is interesting the use of the word provocative for the testing of the
upper cervical spine. The Sharp Purser test is not a provocation test but a
relocation test so safe. By positioning the head in slight flexion the
weight of the head is supposed to allow the head to translate forward. to do
the manoeuvre you gently glide the skull and C1 backwards into the normal
position thus relieving any symptoms. If this test is negative then I would
use the anterior draw test which is a provocative test. This is in fact only
equivalent to a posterior anterior glide to this region. It is done with
care and good patient communication. I think it is important to remember
with these tests that when done carefully they probably put no more strain
on the neck than day to day movements. Of course a full subjective
examination should be done first. As to the reliability of these tests I
know that this information is not available but I use VBI tests and
stability tests to determine a level of safety i.e I definitely would not
use grade V manoeuvres if they were positive and would use multiple factors
in reasoning if I was to do a grade V. Grade V's are not for everyone but I
consider them relatively safe
I remember reading (no reference available) that more people die as a result
of the use of NSAIDs than from cervical treatment but how many out there
would not take NSAIDs because of the risk of dying.
Hamish Ashton
Manipulative Physiotherapist
New Zealand
----- Original Message -----
From: kevin reese <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, April 07, 2000 8:17 PM
Subject: Re: Pre Manipulative Neck Testing
> Dear Panos
>
> You may recall my input on this topic. I feel it can be summarised as
such.
> Most of the tests I have seen for the cervical spine, applicable for
serious
> pathology are seriously provocative. As you will know Sharp Pursa is one
of
> the 7 upper cervical tests I mentioned. As well as VBI I do not use these
> because of the danger the test itself holds. This is a conclusion I have
> come to on my own without the benefit of sufficient evidencing.
>
> For these reasons I do not feel confident to use velocity type or strong
> combined movts on the Cx. That is to say the tests to determine the
severity
> of the cervical problem are either too inaccurate, insensitive or
> provocative to perform; thus leaving an element of doubt in the patients
> diagnosis.
>
> I usually find there should be enough alarm bells ringing in a thorough
> subjective exam to necessitate a consultation with a neuro surgeon and
MRI.
>
> This answer is more borne out of practice than science, but I hope it has
> some value all the same
>
> Warm Regards Kevin Reese UK PT.
> -----Original Message-----
> From: Panos Barlas <[log in to unmask]>
> To: [log in to unmask] <[log in to unmask]>
> Date: 06 April 2000 17:45
> Subject: Pre Manipulative Neck Testing
>
>
> Dear all,
>
> it is with interest that I followed all the discussions on the past
> week or so on Pilates, the role of physiotherapist as a reflective
> practitioner and now with reference to pre-manipulative cervical
> spine testing.
> Coincidentally, my colleague and I are in the process of finalising a
> paper (preliminary results have been already communicated on this:
> Forrester, GA, Barlas P (1999) Reliability and validity of the
> Sharp-Purser Test in the assessment of atlanto-axial instability in
> patients with rheumatoid arthritis. Physiotherapy, 85 (7), pp. 376)
> which refers to the accuracy of physiotherapists in diagnosing
> Atlantoaxial instability on rheumatoid pain patients.
> The results of this investigation are summarised below (straight from
> the results section of the paper in question)
>
> Table 4: Overall inter-therapist reliability
>
> Overall Kappa Value Ko = 0.20
> Standard Error = 0.05
> 95% Confidence Interval = 0.09 to 0.30
> Z score = 3.72
> (significant at 0.0002 level)
>
> (Overall)
> Sensitivity Specificity PPV NPV
> 0.43 0.77 0.34 0.89
>
>
> Now, on the basis of these results, I would not like my neck to be in
> the line (literaly!).
> Althought the argument may be that these results may not be a true
> reflection of the clinical reality [we used 6 MACP therapists with >3
> years experience on 31 patients with an AAI incidence of 16% (5/31)],
> it is my belief that this should raise significant questions as to
> our beliefs of the results such tests as the Sharp-purser that was
> tested here yield. Has anyone out there have any data of Sensitivity
> and Specificity, PPV and NPV for any other tests (eg. Lachman, ULTT1
> etc)? I have tried to locate some but my efforts were fruitless.
>
> The main question I am trying to raise is this:
> How comfortable are we as therapists with our current knowledge of
> the usefulness of the tools that we use daily? If the study above is
> the tip of the iceberg (and by no means I think that we broke new
> heights of research here) how can we trust that what we do is right
> for our patients in the first instance, but from a professional
> ethics point of view also?
>
> I am not aware of the MACP guidelines on premanipulative cervical
> spine screening. I am aware however that the Sharp Purser test is one
> of the most commonly used for that purpose. So, the question to be
> asked is:
> On what basis are any guidelines produced? How much are we to believe
> them?
>
> I hope my comments are seen in their true light, which is one of
> exploration and not as personal attacks.
>
> Looking forward to your contributions,
>
> yours,
>
> Panos
>
>
>
>
>
>
>
>
>
>
> Date: Wed, 5 Apr 2000 10:22:54 +0100
> From: Ralph Hammond <[log in to unmask]>
> To: [log in to unmask]
> Subject: VBI testing
> Message-Id:
> <[log in to unmask]>
>
> Sorry to be a bit slow with this one.
>
> The Manipulation Association of Chartered Physiotherapists and the
> Society of Orthopaedic Medicine have produced guidance for
> pre-manipulative testing of the cevical spine. The reference is:
> Barker S et al (2000) Guidance for premanipulative testing of the
> cervical spine Manual Therapy 5, 1, 37 - 40
>
> Ralph Hammond MCSP
> Professional Adviser
> Research and Clinical Effectiveness Unit
> The Chartered Society of Physiotherapy
> 14 Bedford Row
> London WC1R 4ED
> UK
>
> Tel: 020 7306 6636
> Fax: 020 7306 6611
> Web: www.csp.org.uk
>
> P. Barlas, BSc(Hons) PDD, DPhil, MCSP, SRP, Lic.Ac
> Lecturer,
> Physiotherapy Subject Group,
> Coventry University,
> Priory Street,
> Coventry, CV1 5FB
> Tel: 024-76-888980
> Fax: 024-76-888020
>
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|