Outcomes indicators and a risk classification system for spinal manipulation under anesthesia: a narrative review and proposal
Abstract Over a period of decades chiropractors have utilized spinal manipulation under anesthesia (SMUA) to treat chronic back and neck pain. As an advanced form of manual therapy, SMUA is reserved for the patient whose condition has proven refractory to office-based manipulation and other modes of...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2018-03-01
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| Series: | Chiropractic & Manual Therapies |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12998-018-0177-z |
| _version_ | 1818961016910774272 |
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| author | Dennis DiGiorgi John L. Cerf Daniel S. Bowerman |
| author_facet | Dennis DiGiorgi John L. Cerf Daniel S. Bowerman |
| author_sort | Dennis DiGiorgi |
| collection | DOAJ |
| description | Abstract Over a period of decades chiropractors have utilized spinal manipulation under anesthesia (SMUA) to treat chronic back and neck pain. As an advanced form of manual therapy, SMUA is reserved for the patient whose condition has proven refractory to office-based manipulation and other modes of conservative care. Historically, the protocols and guidelines put forth by chiropractic MUA proponents have served as the clinical compass for directing MUA practice. With many authors and MUA advocates having focused primarily on anticipated benefit, the published literature contains no resource dedicated to treatment precautions and contraindications. Also absent from current relevant literature is acknowledgement or guidance on the preliminary evidence that may predict poor clinical outcomes with SMUA. This review considers risk and unfavorable outcomes indicators in therapeutic decision making for spinal manipulation under anesthesia. A new risk classification system is proposed that identifies patient safety and quality of care interests for a procedure that remains without higher-level research evidence. A scale which categorizes risk and outcome potential for SMUA is offered for the chiropractic clinician, which aims to elevate the standard of care and improve patient selection through the incorporation of specific indices from existing medical literature. |
| first_indexed | 2024-12-20T12:06:44Z |
| format | Article |
| id | doaj.art-6fd3403b3c2745d4bc8771955718d3ee |
| institution | Directory Open Access Journal |
| issn | 2045-709X |
| language | English |
| last_indexed | 2024-12-20T12:06:44Z |
| publishDate | 2018-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Chiropractic & Manual Therapies |
| spelling | doaj.art-6fd3403b3c2745d4bc8771955718d3ee2022-12-21T19:41:22ZengBMCChiropractic & Manual Therapies2045-709X2018-03-0126111110.1186/s12998-018-0177-zOutcomes indicators and a risk classification system for spinal manipulation under anesthesia: a narrative review and proposalDennis DiGiorgi0John L. Cerf1Daniel S. Bowerman2Consultant Practice- WhitestoneClinical and Consultant Practice- Jersey CityClinical and Consultant Practice- PhiladelphiaAbstract Over a period of decades chiropractors have utilized spinal manipulation under anesthesia (SMUA) to treat chronic back and neck pain. As an advanced form of manual therapy, SMUA is reserved for the patient whose condition has proven refractory to office-based manipulation and other modes of conservative care. Historically, the protocols and guidelines put forth by chiropractic MUA proponents have served as the clinical compass for directing MUA practice. With many authors and MUA advocates having focused primarily on anticipated benefit, the published literature contains no resource dedicated to treatment precautions and contraindications. Also absent from current relevant literature is acknowledgement or guidance on the preliminary evidence that may predict poor clinical outcomes with SMUA. This review considers risk and unfavorable outcomes indicators in therapeutic decision making for spinal manipulation under anesthesia. A new risk classification system is proposed that identifies patient safety and quality of care interests for a procedure that remains without higher-level research evidence. A scale which categorizes risk and outcome potential for SMUA is offered for the chiropractic clinician, which aims to elevate the standard of care and improve patient selection through the incorporation of specific indices from existing medical literature.http://link.springer.com/article/10.1186/s12998-018-0177-zManipulation under anesthesiaSpineMedical evidenceRiskContraindicationsPrecautions |
| spellingShingle | Dennis DiGiorgi John L. Cerf Daniel S. Bowerman Outcomes indicators and a risk classification system for spinal manipulation under anesthesia: a narrative review and proposal Chiropractic & Manual Therapies Manipulation under anesthesia Spine Medical evidence Risk Contraindications Precautions |
| title | Outcomes indicators and a risk classification system for spinal manipulation under anesthesia: a narrative review and proposal |
| title_full | Outcomes indicators and a risk classification system for spinal manipulation under anesthesia: a narrative review and proposal |
| title_fullStr | Outcomes indicators and a risk classification system for spinal manipulation under anesthesia: a narrative review and proposal |
| title_full_unstemmed | Outcomes indicators and a risk classification system for spinal manipulation under anesthesia: a narrative review and proposal |
| title_short | Outcomes indicators and a risk classification system for spinal manipulation under anesthesia: a narrative review and proposal |
| title_sort | outcomes indicators and a risk classification system for spinal manipulation under anesthesia a narrative review and proposal |
| topic | Manipulation under anesthesia Spine Medical evidence Risk Contraindications Precautions |
| url | http://link.springer.com/article/10.1186/s12998-018-0177-z |
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