This week, the newspaper Kvällsposten reported on a patient who suffered a stroke following naprapathic treatment. According to reports, the patient fell ill approximately four weeks after the treatment. The patient reported the incident to the Health and Social Care Inspectorate (IVO), which is responsible for the supervision of health and medical care.
The Health and Social Care Inspectorate (IVO) concluded that the medical condition could not be linked to the treatment, but that the naprapath in question had failed to inform the patient about the potential risks associated with manipulation therapy.
When it comes to treatment complications, the most important thing is, of course, the patient's recovery. In this specific case, it is also important to note the findings of the IVO: that they could NOT find a link between the manipulation therapy and the onset of the stroke, but that they DID find shortcomings regarding informed consent.
Informing patients about potential risks associated with medical interventions and obtaining their consent is a responsibility held by all licensed therapists, regardless of whether this is done in writing or verbally. As an educational institution, the School of Naprapathy believes that the clearest approach for both patients and the treating therapist—in this case, the college's students—is for this to be done in writing, with the patient signing a document that is then attached to their medical records.
The School of Naprapathy reached the following conclusion in 2016.“Based on current research and knowledge, it cannot be proven that there is a causal link between this treatment method and the risk of vascular injury, nor can such a link be ruled out.
Given the current state of evidence, it is further suggested that this treatment technique should not be based on students practicing on other students (due to risk-benefit considerations). The risk, to the extent that one exists, is likely very small but must be weighed against proven benefits and the application of the precautionary principle. Furthermore, there is no reliable way to clinically rule out individual high-risk patients. Until further research can establish or exclude whether a causal link exists and/or demonstrate a clear benefit that outweighs a potential risk, manipulation of the cervical spine, in the absence of a specific treatment indication, shall not be performed on students by other students or instructors. This means that this decision may be subject to change if new research findings provide cause for it.”
The Swedish Naprapathic Association (SNF) issued the following statement in a newsletter to all members regarding the patient case in question.“What do we know about cervical spine manipulation and serious treatment complications? We know there is a statistical correlation between neck manipulation and vascular dissections in the area. This is also true for a number of other factors, such as high blood pressure, migraines, certain diseases, young age, etc. Unfortunately, it is very difficult to conduct research in this area to clarify the risks, so there is currently no scientific evidence that neck manipulation could cause such an injury, but neither is there evidence that it cannot.
In this context, it is important to understand the difference between a correlation—where one can observe that manipulation therapy occurred shortly before a vascular dissection—and a direct cause, where the manipulation actually caused the dissection. There is scientific support for the former, but not for the latter. Stroke caused by vascular injury is rare, occurring in approximately 3–4 cases per 100,000 people per year, and there can be many causes for such an injury. One of these causes could theoretically be neck manipulation, but as stated, we do not know if this is the case.
It is, however, very important to be aware that common symptoms of a vascular injury in the neck area include neck and head pain, which may be the reason the patient seeks care, and that manipulation is used as a treatment tool. In such a case, it is possible that a vascular injury is already present when the patient seeks care. The fact that there are, albeit rare, documented cases where it is suspected that neck manipulation may have caused or exacerbated a vascular injury in the neck means that we must be very diligent when assessing, examining, and treating patients with the symptoms mentioned above.
As licensed therapists who use manipulation as a tool, we must naturally be aware of these correlations and always put patient safety at the center, where the benefits of the planned treatment must be weighed against any potential risks.”
