Cervical Manipulation and Informed Consent: Canadian Manipulative Physiotherapists' Opinions on Communicating Risk

Purpose: The study objective was to generate an information sheet for Canadian manipulative physical therapists (CMPTs) to use when seeking informed consent for high-velocity, low-amplitude cervical manipulation. Methods: A cervical manipulation information sheet (CMIS) was created with five sections: Introduction, Benefits, Risks, Procedures and Effectiveness. The content of the information sheet was generated using the Delphi method, followed by a mail-out survey to a random sample of CMPTs (N = 307) to determine the information sheet's acceptability and clinical utility. The proportion of CMPTs who agreed with the content of the information sheet and the proportion of CMPTs who indicated a willingness to use the sheet clinically were calculated. Results: The survey response rate was 74 per cent. The proportion (95 per cent confidence interval) of respondents who agreed with the content of the CMIS and approved its clinical acceptability was 0.95 (0.94-0.96) and 0.61 (0.58-0.64), respectively. Written comments from the CMPTs reflected concern about wording in the Risks section. Conclusions: Our results suggest that CMPTs agreed with the content of the CMIS but not how it was written. Physical therapists should consider the CMIS a proposed guideline for clinician use. Ideally, a patient version should also be created.