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What is 'manipulation'? A reappraisal.

David W Evans1, Nicholas Lucas

  • 1Research Centre, British School of Osteopathy, London SE1 1JE, UK. dwe@spinalmanipulation.org.uk <dwe@spinalmanipulation.org.uk>

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Summary

The term "manipulation" in healthcare is vague and can be associated with adverse events. This study proposes empirically-derived features for a precise definition of manipulation, distinguishing practitioner actions from patient mechanical responses.

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Area of Science:

  • Healthcare Interventions
  • Clinical Terminology
  • Biomechanical Analysis

Background:

  • The term 'manipulation' lacks a precise definition in healthcare, leading to potential confusion and association with adverse events, especially in cervical spine interventions.
  • A clear, valid definition is crucial for distinguishing manipulation from other healthcare interventions and ensuring patient safety.

Purpose of the Study:

  • To identify empirically-derived features necessary and sufficient for a valid definition of manipulation.
  • To differentiate between the practitioner's action and the recipient's mechanical response in manipulation.

Main Methods:

  • Analysis of existing literature to identify key features of manipulation.
  • Categorization of proposed features into 'action' and 'mechanical response' components.
  • Presentation of arguments for and against the inclusion of specific features.

Main Results:

  • Proposed features for defining manipulation include force application, force line of action, joint motion induction, articular surface separation, and cavitation.
  • Features are explicitly divided into the practitioner's action and the recipient's mechanical response.
  • A final, definitive statement is not offered, but arguments for feature inclusion are presented.

Conclusions:

  • The colloquial use of 'manipulation' is inadequate for precise clinical distinction.
  • Empirically-derived features are essential for developing a valid definition of manipulation.
  • Differentiating the action and mechanical response is key to a comprehensive definition.