Spinal manipulation and adverse event reporting in the pregnant patient limits estimation of relative risk: a narrative review.

OBJECTIVE: To describe variability in spinal manipulation technique details and adverse event (AE) documentation of spinal manipulation during pregnancy. METHODS: Five databases were searched for peer-reviewed investigations of spinal manipulation during pregnancy. Criteria for inclusion was as follows: high velocity, low amplitude thrust manipulation performed, subjects pregnant during manipulation, and English language. Studies were excluded when participants were not currently pregnant, and when the manipulation performed was not high-velocity, low-amplitude thrust. Data extraction included study design, number of participants, gestational age, spinal region, number of manipulations, manipulation technique details, profession of manipulator, AE reporting (Yes vs. No), type, and number of AE. RESULTS: Out of 18 studies included in the review, only three provide details of the spinal manipulation technique. The reported variables include patient position, practitioner position, and direction of thrust. Fourteen studies documented AE; however, only seven provide AE details. DISCUSSION: Reporting of spinal manipulation techniques and AE during pregnancy were inconsistent. Replication of methods in future investigations is limited without more detailed documentation of manipulation techniques performed. Furthermore, determining the relative risk and safety of spinal manipulation during pregnancy is not possible without more detailed reporting of AE. Due to these inconsistencies, a checklist is proposed for standardized reporting of spinal manipulation techniques and AE. With more consistent reporting of these parameters, results of future investigations may allow for more definitive and generalizable safety recommendations on spinal manipulation during pregnancy.

Pro-Bono Service Through Student-Run Clinics: How Does Physical Therapy Measure Up?

PURPOSE: The objectives of this paper were to evaluate pre- to post-treatment outcomes of patients attending a student-run free physical therapy clinic in order to provide new evidence concerning patient response to student care. We hypothesize improved functional and quality of life scores as measured by outcome scales. METHODS: Twenty-eight patients were included in this retrospective chart review. Data were analyzed through SPSS Statistical software (ver. 13) using paired t-tests to compare baseline and follow-up data for the following measures: blood pressure, numeric pain rating scale (NPRS), quality of life visual analog scale, SF-8 quality of life scale, and population demographics. RESULTS: Most of the patient population was between the ages of 30 and 59 yrs (78.4%) with an unemployment rate of 75%. Significant changes (p<0.05) were exhibited in both the physical health portion of the SF-8 survey and the NPRS. Although not statistically significant, the mental health portion of the SF-8 survey showed notable improvement. CONCLUSION: Service learning provides opportunities for students to serve the community while expanding clinical experience. The results demonstrated the effectiveness of student-run pro-bono physical therapy clinics in improving the quality of life for both physical and pain measures.