Evaluating the IFOMPT framework
The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) developed and endorsed a clinical reasoning framework to support clinicians to gauge the level of risk for vascular pathology following manual therapy or exercise to the cervical spine.
Physiotherapists from The Netherlands, Australia and Belgium examined the diagnostic accuracy of this framework.
Authors Rogier de Best, Michel Coppieters and Wendy Scholten- Peeters answer some questions about the study.
What specific question did your study seek to answer?
We investigated the diagnostic accuracy of the IFOMPT framework to determine the level of risk of serious vascular complications following manual therapy and/or exercise applied to the cervical spine.
The reference test was a consensus medical decision regarding the level of risk reached by a vascular neurologist and an interventional neurologist who had access to all clinical data, an MRI of the cervical spine and an angiogram (MRA) of the cervical blood vessels, including the MRA report prepared by a neuroradiologist.
The index test consisted of the level of risk determined by titled musculoskeletal physiotherapists using the IFOMPT framework.
The participating therapists had received additional theoretical and practical training in using the IFOMPT framework.
Which patients were enrolled in the study?
Patients (N=150) with neck pain and/or headache seeking primary care physiotherapy.
How was the diagnostic accuracy of the IFOMPT framework?
Overall the IFOMPT framework has poor diagnostic accuracy when compared to a consensus medical decision.
What about the sensitivity, specificity and likelihood ratios?
The sensitivity of the IFOMPT framework was low (0.50; 95 per cent CI: 0.39–0.61).
In other words, there is a 50 per cent chance of correctly identifying patients with a high risk of vascular complications following manual therapy and/or exercise applied to the cervical spine.
The specificity was moderate (0.63; 95 per cent CI: 0.51–0.75).
The positive and negative likelihood ratios were weak (1.36; 95 percent CI: 0.93–1.99 and 0.79; 95 per cent CI: 0.60–1.05, respectively).
And the area under the curve?
The area under the curve was also poor (0.57; 95 per cent CI: 0.49–0.65), indicating that the IFOMPT framework has a poor discriminatory ability.
Rogier De Best
Dr Michel Coppieters
Dr Wendy Scholten-Peeters
Rogier de Best is a clinical epidemiologist and a PhD student in the Faculty of Behavioural and Movement Sciences at Vrije Universiteit Amsterdam, The Netherlands. He also works as a musculoskeletal physiotherapist in private practice and is a teacher in manual therapy. firstname.lastname@example.org
Dr Michel Coppieters is a professor at Griffith University, where he directs the Musculoskeletal Health and Persistent Pain research lab. Michel’s research interests include the development and evaluation
of better diagnostic and management approaches and working mechanisms of musculoskeletal physiotherapy. email@example.com
Dr Wendy Scholten-Peeters is an associate professor in the Faculty of Behavioural and Movement Sciences at Vrije Universiteit Amsterdam, The Netherlands, and program director of the Musculoskeletal Health program at the Amsterdam Movement Sciences research institute. Her research focuses on cost-effectiveness, safety and working mechanisms of musculoskeletal physiotherapy. firstname.lastname@example.org
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