Defining adverse events in manual therapies: a modified Delphi consensus study.

Area of Science:

• Manual Therapy
• Clinical Practice
• Patient Safety

Background:

• Lack of a standardized definition for adverse events in manual therapy hinders research on incidence and prevalence.
• Previous studies have not established a consensus on what constitutes an adverse event in this field.

Purpose of the Study:

• To identify and describe adverse events associated with manual therapy.
• To achieve a consensus definition for adverse events in manual therapy.

Main Methods:

• A focus group identified key issues and generated questionnaire content.
• A modified Delphi consensus survey was conducted with 50 expert panelists over three rounds.
• Consensus was defined as greater than 74% agreement.

Main Results:

• A layered, pragmatic definition for adverse events was agreed upon.
• Adverse events were categorized as 'Major' (medium-long term, moderate-severe, unacceptable, requiring further treatment), 'Moderate' (similar to major but moderate severity), and 'Mild'/'Not Adverse' (short-term, mild, transient, non-serious).
• Response rates across the three consensus rounds were 50%, 62%, and 55% respectively.

Conclusions:

• Classifying adverse events in manual therapy is challenging without specific context and detail.
• The proposed taxonomy and descriptions can potentially improve the classification of adverse events.
• A consensus definition is essential for consistent reporting and research in manual therapy adverse events.