Pre-treatment risk factor assessment and safe management of the cervical spine: a survey among physical therapists

Previous research has raised the question of the extent to which physical therapists possess sufficient knowledge of cervical vascular pathologies and blood flow limitations and the clinical reasoning skills to appropriately identify a patient who is having an underlying vascular pathology.

This study aims to investigate: (1) which risk factors are assessed during patient interviews and their frequency; (2) the physical examination tests used, therapists' training in these tests, and their confidence in performing them; (3) therapists' knowledge of cervical spine treatment risks and associated risk factors; and (4) whether these outcomes differ based on therapist characteristics.

A cross-sectional digital survey.

A combination of descriptive statistics and multivariate testing.

774 completed surveys were included in the data analysis. Most respondents reported routinely addressing cardiovascular risk factors, trauma history and contraindications during patient interviews. Peripheral neurological examination was most frequently used (72%), whereas auscultation (8%) and arterial pulse palpation (5%) were rarely applied. Positional testing, although no longer recommended, remained commonly used. Confidence varied, particularly for cranial nerve examination. Forty-eight percent perceived increased dissection risk after manipulation versus 15% after mobilization, and mobilization was generally considered safer.

Respondents sufficiently addressed risk factors in the patient interview. Regarding the physical examination, improvement of physical therapists' knowledge and skills in cranial nerve examination is needed, and positional testing should be avoided as it is no longer recommended. Participants' knowledge of cervical spine treatment risks and risk factors is variable and ongoing updating of clinical knowledge is important, as conclusions may change over time.