Inter-Examiner Agreement and Reliability of an Internationally Endorsed Screening Framework for Cervical Vascular Risks Following Manual Therapy and Exercise: The Go4Safe Project

Objective: Clinicians are recommended to use the clinical reasoning framework developed by the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) to provide guidance regarding assessment of the cervical spine and potential of Cervical Artery Dysfunction (CAD) prior to manual therapy and exercise. However, the inter-examiner agreement and reliability of this framework is unknown. This study aimed to estimate the inter-examiner agreement and reliability of the IFOMPT framework among physical therapists in primary care. Methods: Ninety-six patients who consulted a physical therapist for neck pain or headache were included in the study. Each patient was tested independently by 2 physical therapists, from a group of 17 physical therapists (10 pairs) across The Netherlands. Patients and examiners were blinded to the test results. The overall inter-examiner agreement, specific agreement per risk category (high-, intermediate- and low-risk) and inter-examiner reliability (weighted kappa) were calculated. Results: Overall agreement was 71% (specific agreement in high-risk category: 63%; specific agreement in intermediate-risk category: 38%; specific agreement in low-risk category: 84%). Overall reliability was moderate (weighted kappa 0.39; 95% CI = 0.21–0.57) and varied considerably between pairs of physical therapists (kappa: 0.14–1.00). Conclusion: The IFOMPT- framework showed an insufficient inter-examiner agreement and fair inter-examiner reliability among physical therapists when screening the increased risks for vascular complications following manual therapy and exercise prior to treatment. Impact: The IFOMPT framework contributes to the safety of manual therapy and exercise. It is widely adopted in clinical practice and educational programs, but the measurement properties are unknown. This project describes the agreement and reliability of the IFOMPT framework.