Alison Rushton, CPR Spine University of Birmingham, UKDarren Rivett University of Newcastle, Australia Tim Flynn Rocky Mountain University, USA Wayne Hing Bond University, Australia Lisa Carlesso McMaster University, Canada Roger Kerry University of Nottingham, UK

@CprSpine

Centre of Precision Rehabilitation for Spinal Pain School of Sport, Exercise and Rehabilitation SciencesUniversity of Birmingham, United Kingdom

Cervical Artery Dysfunction (CAD) Updating the IFOMPT Consensus Clinical Reasoning Framework for Best Practice

§ CAD is a rare event, but a critical consideration§ Vascular pathologies are generally recognisable if:

§ Appropriate questions are asked§ Patient history data are appropriately interpreted§ Physical examination is adapted to test a

potential vasculogenic hypothesis § Consensus clinical reasoning framework for best

practice published in 2012 (agreed by 22 countries)

Background

Purpose

1) Review impact/currency of the framework

2) Review contemporary research to inform analysis of the key identified issues

3) Discuss required development of the framework and its evolution to fulfil our clinical practice needs

Methods

Evaluation data Manual therapy organisations and experts in 22 countries

Discussion forum international conference - multiple short presentations - invited experts and country representatives

Iterative consultative process across 34 countries of IFOMPT

§ Evaluation and impact data analysis

§ Status of the framework

§ Medicolegal value of the framework

§ Currency of patient history data recommendations

§ Currency of physical examination data recommendations

§ Risk stratification and CAD

§ Integration of the framework into entry level programmes2016

2015

2018

§ Simplify messages § Clarity pathologies encompassed by CAD § Further clarity of 2 components to framework:

1. Examination to identify vascular event in situ or risk of vascular event

2. Decision making regarding treatment in situation where there is no vascular event in situ (all PT interventions)

§ Remove craniovertebral ligament testing § Recommendations for students acting as models § Consider adverse event data collection § Dissemination strategy to target undergraduates § Multi-professional authorship

Findings: strong support to update framework

§ Many physiotherapy interventions have empirically supported effectiveness, but are sometimes not used owing to the perceived risk of CAD

Conclusion and clinical implications

The updated framework will further inform patient assessment and management strategies

Knowledge of evidence of effectiveness and the relevant clinical features of the patient can optimise the use of physiotherapy interventions to facilitate best practice