Proposing a new algorithm for premanipulative testing in physical therapy practice.
Brent Harper, Daniel Miner, Harrison Vaughan
PMID 33281296WHAT IT FOUND
Premanipulative vascular tests like deKleyn’s do not reliably identify patients at risk for cervical artery dissection.
Screening should focus on medical history and symptoms of spontaneous events first. Mechanical tests may only assess tolerance to movement once spontaneous risks are ruled out.
Key findings
01Biomechanical arterial testing will not assist in identifying those at risk of spontaneous arterial dissection.
02Premanipulative vascular screening tests lack construct validity and have a high rate of false negatives.
03Mechanical premanipulative tests should not be used if there is suspicion of a spontaneous vascular event, but may assess tolerance after clearance.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The review was non-comprehensive and excluded non-English articles. It did not include unpublished professional conference proceedings. The proposed algorithm is based on clinical reasoning and literature synthesis, not on prospective validation in a clinical trial. The authors acknowledge that medico-legal constraints may still require premanipulative screening despite the lack of evidence supporting its diagnostic utility.
Declared interests
The authors have no conflicts of interest to disclose. Funding was not provided for this work.
The easy way to misread this
Do not interpret this paper as a directive to stop all premanipulative screening entirely. The authors acknowledge that medico-legal constraints and current professional standards often still require these tests, even if they are not diagnostically accurate for ruling out spontaneous dissection. The caution is against relying on these tests to ensure safety from spontaneous vascular events.