Award Date


Degree Type


Degree Name

Doctor of Physical Therapy (DPT)


Physical Therapy

Advisor 1

Tiffany Barrett

First Committee Member

Merrill Landers

Second Committee Member

Daniel Young

Number of Pages



Background and Purpose: Acute neck pain is a worldwide epidemic that physical therapists treat with cervical spine manipulation (CSM). While the mechanical and neurological effects of CSM are important, it is possible that the patient’s perception of the therapist’s skill level may also play a role in patient outcomes. Along with the patient’s perception of the practitioner, evidence suggests that patient expectation for intervention efficacy may also alter patient outcomes. The implication is that special consideration must be taken when practitioners choose their words when describing both themselves and their interventions. The purpose of this study is to examine if and how patient expectation of the benefit and safety of CSM can be affected by the patient-therapist interactions, specifically looking at positive or negative descriptions of CSM by the practitioner and by practitioner stated experience performing CSM. Subjects: The study included 60 subjects from 18 to 37 years old (mean age 22.34±3.35 years), with no current neck pain greater than 2/10 and without undergoing CSM within the last 5 years. Methods: Subjects completed the Neck Disability Index (NDI) and the Neck Pain Medical Screening Questionnaire (NPMSQ), as a way of screening subjects for inclusion or exclusion for the study. The subjects then took a Pre-CSM survey measuring expectations of the safety and benefits of CSM. A Physical Therapist (PT) or Physical Therapy Student (PTS) then introduced themselves as either an experienced or novice practitioner. The PT(S) then recited either a positive or negative script describing the manipulation. Next, the subjects received an upslope CSM. The subjects then took a Post-CSM survey aimed to measure if there was a change in subjects’ opinions on the safety and benefits of CSM. Results: The results of this study suggest that a positive or negative description of CSM may affect the change in subject expectation of adverse reactions such as stiffness or soreness following CSM. The subjects provided a positive description had a significantly larger change in composite score on survey questions designed to measure the subjects’ expectation of adverse effects following CSM than subjects who were provided a negative description of CSM (mean change when given positive description=77.33±41.27; mean change when given negative description=36.70±54.59; F=10.582; p-value=0.002) No additional significant differences were found between the experienced and novice groups or instructional set groupings. Discussion: Therapists must be mindful of their word choice when describing CSM. In order to provide patients with optimum outcomes and expectations from CSM as a treatment, therapists should use positive language when introducing the intervention.


Patient-Therapist Interaction; Patient-Clinician Interaction; Patient-Therapist Relationship; Therapeutic Bond; Patient Expectation; Patient Expectancy; Cervical Spine; Cervical Spine Manipulation (CSM); Spinal Manipulation; Clinical Level Of Experience; Positive Expectancy; Physical Therapy; Physical Therapist; Manual Therapy; High Velocity Low Amplitude Thrust (HVLA); Expectation Of Benefit; Expectancy; Positive Language


Medicine and Health Sciences | Physical Therapy | Rehabilitation and Therapy

File Format


File Size

1.794 KB

Degree Grantor

University of Nevada, Las Vegas




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