Pierre Côté1,2,3,4, Jan Hartvigsen5,6, Iben Axén7,8, Charlotte Leboeuf-Yde9, Melissa Corso10,11, Heather Shearer11,12, Jessica Wong10,11,13, Andrée-Anne Marchand14, J David Cassidy13, Simon French15, Gregory N Kawchuk16, Silvano Mior11,17, Erik Poulsen5, John Srbely18, Carlo Ammendolia12,19, Marc-André Blanchette14, Jason W Busse20, André Bussières14,21, Carolina Cancelliere10,11, Henrik Wulff Christensen6, Diana De Carvalho22, Katie De Luca15, Alister Du Rose23, Andreas Eklund7, Roger Engel15, Guillaume Goncalves24, Jeffrey Hebert25, Cesar A Hincapié26, Maria Hondras27, Amanda Kimpton28, Henrik Hein Lauridsen5, Stanley Innes29, Anne-Laure Meyer24, David Newell30, Søren O'Neill9,31, Isabelle Pagé14, Steven Passmore32, Stephen M Perle33, Jeffrey Quon34, Mana Rezai11, Maja Stupar17, Michael Swain15, Andrew Vitiello35, Kenneth Weber36, Kenneth J Young37, Hainan Yu10,11. 1. Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada. pierre.cote@uoit.ca. 2. Centre for Disability Prevention and Rehabilitation at Ontario Tech University and CMCC, Oshawa, Canada. pierre.cote@uoit.ca. 3. Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. pierre.cote@uoit.ca. 4. IHPME, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. pierre.cote@uoit.ca. 5. Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. 6. Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark. 7. Intervention & Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. 8. ELIB - et liv i bevegelse, Oslo, Norway. 9. Department for Regional Health Research, University of Southern Denmark, Odense, Denmark. 10. Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada. 11. Centre for Disability Prevention and Rehabilitation at Ontario Tech University and CMCC, Oshawa, Canada. 12. IHPME, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. 13. Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. 14. Department de Chiropractique, Université du Québec à Trois-Rivières, Trois-Rivières, Canada. 15. Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia. 16. Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada. 17. Canadian Memorial Chiropractic College, Toronto, Canada. 18. Department of Human Health & Nutritional Sciences, University of Guelph, Guelph, Canada. 19. Rebecca MacDonald Centre, Mount Sinai Hospital, Toronto, Canada. 20. Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada. 21. School of Physical & Occupational Therapy, McGill University, Montreal, Canada. 22. Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada. 23. Faculty of Life Sciences and Education University of South Wales, Cardiff, UK. 24. Institut Franco-Européen de Chiropraxie, Ivry-Sur-Seine, France. 25. Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada. 26. Department of Chiropractic Medicine, Faculty of Medicine, University of Zurich & Balgrist University Hospital, Zurich, Switzerland. 27. Department of Anesthesiology, University of Kansas Medical Center, Kansas City, USA. 28. RMIT University, Melbourne, Australia. 29. College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Australia. 30. AECC University College, Bournemouth, UK. 31. Spine Center of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark. 32. Faculty of Kinesiology & Recreation Management University of Manitoba, Winnipeg, Canada. 33. School of Chiropractic, University of Bridgeport, Bridgeport, USA. 34. School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada. 35. School of Health, Medical and Applied Sciences, CQ University, Sydney, Australia. 36. Stanford University School of Medicine, Stanford University, Stanford, USA. 37. School of Sport and Health Sciences, University of Central Lancashire, Preston, England.
Abstract
BACKGROUND: A small proportion of chiropractors, osteopaths, and other manual medicine providers use spinal manipulative therapy (SMT) to manage non-musculoskeletal disorders. However, the efficacy and effectiveness of these interventions to prevent or treat non-musculoskeletal disorders remain controversial. OBJECTIVES: We convened a Global Summit of international scientists to conduct a systematic review of the literature to determine the efficacy and effectiveness of SMT for the primary, secondary and tertiary prevention of non-musculoskeletal disorders. GLOBAL SUMMIT: The Global Summit took place on September 14-15, 2019 in Toronto, Canada. It was attended by 50 researchers from 8 countries and 28 observers from 18 chiropractic organizations. At the summit, participants critically appraised the literature and synthesized the evidence. SYSTEMATIC REVIEW OF THE LITERATURE: We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health, and the Index to Chiropractic Literature from inception to May 15, 2019 using subject headings specific to each database and free text words relevant to manipulation/manual therapy, effectiveness, prevention, treatment, and non-musculoskeletal disorders. Eligible for review were randomized controlled trials published in English. The methodological quality of eligible studies was assessed independently by reviewers using the Scottish Intercollegiate Guidelines Network (SIGN) criteria for randomized controlled trials. We synthesized the evidence from articles with high or acceptable methodological quality according to the Synthesis without Meta-Analysis (SWiM) Guideline. The final risk of bias and evidence tables were reviewed by researchers who attended the Global Summit and 75% (38/50) had to approve the content to reach consensus. RESULTS: We retrieved 4997 citations, removed 1123 duplicates and screened 3874 citations. Of those, the eligibility of 32 articles was evaluated at the Global Summit and 16 articles were included in our systematic review. Our synthesis included six randomized controlled trials with acceptable or high methodological quality (reported in seven articles). These trials investigated the efficacy or effectiveness of SMT for the management of infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. None of the trials evaluated the effectiveness of SMT in preventing the occurrence of non-musculoskeletal disorders. Consensus was reached on the content of all risk of bias and evidence tables. All randomized controlled trials with high or acceptable quality found that SMT was not superior to sham interventions for the treatment of these non-musculoskeletal disorders. Six of 50 participants (12%) in the Global Summit did not approve the final report. CONCLUSION: Our systematic review included six randomized clinical trials (534 participants) of acceptable or high quality investigating the efficacy or effectiveness of SMT for the treatment of non-musculoskeletal disorders. We found no evidence of an effect of SMT for the management of non-musculoskeletal disorders including infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. This finding challenges the validity of the theory that treating spinal dysfunctions with SMT has a physiological effect on organs and their function. Governments, payers, regulators, educators, and clinicians should consider this evidence when developing policies about the use and reimbursement of SMT for non-musculoskeletal disorders.
BACKGROUND: A small proportion of chiropractors, osteopaths, and other manual medicine providers use spinal manipulative therapy (SMT) to manage non-musculoskeletal disorders. However, the efficacy and effectiveness of these interventions to prevent or treat non-musculoskeletal disorders remain controversial. OBJECTIVES: We convened a Global Summit of international scientists to conduct a systematic review of the literature to determine the efficacy and effectiveness of SMT for the primary, secondary and tertiary prevention of non-musculoskeletal disorders. GLOBAL SUMMIT: The Global Summit took place on September 14-15, 2019 in Toronto, Canada. It was attended by 50 researchers from 8 countries and 28 observers from 18 chiropractic organizations. At the summit, participants critically appraised the literature and synthesized the evidence. SYSTEMATIC REVIEW OF THE LITERATURE: We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health, and the Index to Chiropractic Literature from inception to May 15, 2019 using subject headings specific to each database and free text words relevant to manipulation/manual therapy, effectiveness, prevention, treatment, and non-musculoskeletal disorders. Eligible for review were randomized controlled trials published in English. The methodological quality of eligible studies was assessed independently by reviewers using the Scottish Intercollegiate Guidelines Network (SIGN) criteria for randomized controlled trials. We synthesized the evidence from articles with high or acceptable methodological quality according to the Synthesis without Meta-Analysis (SWiM) Guideline. The final risk of bias and evidence tables were reviewed by researchers who attended the Global Summit and 75% (38/50) had to approve the content to reach consensus. RESULTS: We retrieved 4997 citations, removed 1123 duplicates and screened 3874 citations. Of those, the eligibility of 32 articles was evaluated at the Global Summit and 16 articles were included in our systematic review. Our synthesis included six randomized controlled trials with acceptable or high methodological quality (reported in seven articles). These trials investigated the efficacy or effectiveness of SMT for the management of infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. None of the trials evaluated the effectiveness of SMT in preventing the occurrence of non-musculoskeletal disorders. Consensus was reached on the content of all risk of bias and evidence tables. All randomized controlled trials with high or acceptable quality found that SMT was not superior to sham interventions for the treatment of these non-musculoskeletal disorders. Six of 50 participants (12%) in the Global Summit did not approve the final report. CONCLUSION: Our systematic review included six randomized clinical trials (534 participants) of acceptable or high quality investigating the efficacy or effectiveness of SMT for the treatment of non-musculoskeletal disorders. We found no evidence of an effect of SMT for the management of non-musculoskeletal disorders including infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. This finding challenges the validity of the theory that treating spinal dysfunctions with SMT has a physiological effect on organs and their function. Governments, payers, regulators, educators, and clinicians should consider this evidence when developing policies about the use and reimbursement of SMT for non-musculoskeletal disorders.
Authors: J J Wong; P Côté; D A Sutton; K Randhawa; H Yu; S Varatharajan; R Goldgrub; M Nordin; D P Gross; H M Shearer; L J Carroll; P J Stern; A Ameis; D Southerst; S Mior; M Stupar; T Varatharajan; A Taylor-Vaisey Journal: Eur J Pain Date: 2016-10-06 Impact factor: 3.931
Authors: Per Kjaer; Alice Kongsted; Jan Hartvigsen; Alexander Isenberg-Jørgensen; Berit Schiøttz-Christensen; Bolette Søborg; Charlotte Krog; Christian Martin Møller; Christine Marie Bækø Halling; Henrik Hein Lauridsen; Inge Ris Hansen; Jesper Nørregaard; Karsten Juhl Jørgensen; Lars Valentin Hansen; Marie Jakobsen; Martin Bach Jensen; Martin Melbye; Peter Duel; Steffan W Christensen; Tina Myung Povlsen Journal: Eur Spine J Date: 2017-05-18 Impact factor: 3.134
Authors: Pierre Côté; Jessica J Wong; Deborah Sutton; Heather M Shearer; Silvano Mior; Kristi Randhawa; Arthur Ameis; Linda J Carroll; Margareta Nordin; Hainan Yu; Gail M Lindsay; Danielle Southerst; Sharanya Varatharajan; Craig Jacobs; Maja Stupar; Anne Taylor-Vaisey; Gabrielle van der Velde; Douglas P Gross; Robert J Brison; Mike Paulden; Carlo Ammendolia; J David Cassidy; Patrick Loisel; Shawn Marshall; Richard N Bohay; John Stapleton; Michel Lacerte; Murray Krahn; Roger Salhany Journal: Eur Spine J Date: 2016-03-16 Impact factor: 3.134
Authors: Silvano Mior; Jessica Wong; Deborah Sutton; Peter J H Beliveau; André Bussières; Sheilah Hogg-Johnson; Simon French Journal: BMJ Open Date: 2019-08-26 Impact factor: 2.692
Authors: Pierre Côté; Jan Hartvigsen; Iben Axén; Charlotte Leboeuf-Yde; Melissa Corso; Heather Shearer; Jessica Wong; Andrée-Anne Marchand; J David Cassidy; Simon French; Gregory N Kawchuk; Silvano Mior; Erik Poulsen; John Srbely; Carlo Ammendolia; Marc-André Blanchette; Jason W Busse; André Bussières; Carolina Cancelliere; Henrik Wulff Christensen; Diana De Carvalho; Katie De Luca; Alister Du Rose; Andreas Eklund; Roger Engel; Guillaume Goncalves; Jeffrey Hebert; Cesar A Hincapié; Maria Hondras; Amanda Kimpton; Henrik Hein Lauridsen; Stanley Innes; Anne-Laure Meyer; David Newell; Søren O'Neill; Isabelle Pagé; Steven Passmore; Stephen M Perle; Jeffrey Quon; Mana Rezai; Maja Stupar; Michael Swain; Andrew Vitiello; Kenneth Weber; Kenneth J Young; Hainan Yu Journal: Chiropr Man Therap Date: 2021-03-08
Authors: Casper G Nim; Aron Downie; Søren O'Neill; Gregory N Kawchuk; Stephen M Perle; Charlotte Leboeuf-Yde Journal: Sci Rep Date: 2021-12-03 Impact factor: 4.379