Knowledge and use of craniovertebral instability testing by Australian physiotherapists

Internationally, manual therapy has moved towards formalised guidelines for pre-manipulative screening of the cervical spine. A controversial aspect to emerge from this involves craniovertebral instability (CVI) testing. This study examined current practice, knowledge and attitudes of Australian physiotherapists regarding pre-manipulative testing for CVI. Members of Musculoskeletal Physiotherapy Australia were surveyed by formally validated questionnaire. Sub-group analysis was performed by post-graduate musculoskeletal qualification. The response rate was 37.8%. Respondents provided differing definitions of CVI; 46.5% describing loss of anatomical integrity and 24.9% a biomechanical problem. Over half indicated they rarely or never used stress tests for CVI screening. Of 42 published signs and symptoms associated with CVI, seven were identified by more than 50% of respondents. Of published disorders associated with CVI, four were considered worthy of testing by more than 30% of respondents. Support for inclusion of information on CVI in pre-manipulative guidelines was given by 87% of respondents. Recommendations for screening tests received less support, particularly among physiotherapists holding post-graduate musculoskeletal qualifications (p = 0.0002). These results indicate disagreement regarding the nature and presentation of CVI. Clinical testing is inconsistent, reflecting underlying confusion about CVI. Currently, there is not an appropriate level of knowledge or willingness to recommend guidelines for CVI screening.