Systematic reviewAdverse events and manual therapy: A systematic review
Section snippets
Definitions
We defined manual therapy as: any techniques administered manually, using touch, by a trained practitioner for therapeutic purposes. Throughout our research, depending on the author descriptions, we used the following classification terms for adverse events (Carnes et al., 2010).
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‘Major’: medium to long term; moderate or severe intensity
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‘Moderate’: medium to long term; moderate intensity
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‘Minor’: short term and mild intensity
Searches and selection
We searched Medline (using OVID), Science Direct, Web of Science, PEDro
Results
There were 230 RCT articles selected for full paper review. Our searches identified 60 non-RCT articles and 36 articles on RCTs that fulfilled our inclusion criteria (Fig. 1). To maximise the quality of evidence reviewed we focused our analyses on prospective cohort studies and RCTs only. We report here data from eight prospective cohort studies (nine articles, Table 1) and 31 RCTs (five articles presented data from the same trials, Table 2). The remaining articles consisted of reviews of
Discussion
This systematic review of published RCTs and cohort studies confirms that, in line with the reports of others (Senstad et al., 1996a, Senstad et al., 1996b, Leboeuf-Yde et al., 1997, Barrett and Breen, 2000, Cagnie et al., 2004, Rubinstein et al., 2007), around half of people treated with manual therapy can expect minor to moderate adverse events after treatment, especially after the first treatment (Rubinstein et al., 2007). However, the incidence of major adverse effects is small; there were
Conclusion
Nearly half of patients after manual therapy experience adverse events that are short-lived and minor; most will occur within 24 h and resolve within 72 h. The risk of major adverse events is very low, lower than that from taking medication. We suggest that risk is inherent in all health interventions and should be weighed against patient-perceived benefit and alternative available treatments.
Competing interests
Dawn Carnes, Thomas Mars and Robert Froud are trained Osteopaths, there are no other competing interests
Contributors
Dawn Carnes was the Principle Investigator and managed the review and guarantees the scientific rigour and accuracy of the content of the paper. Tom Mars did the searches, selection of papers, data extraction and analysis with Dawn Carnes. Brenda Mullinger contributed advice and editing assistance, Martin Underwood provided expertise, advice and comments on each successive draft. Robert Froud gave statistical advice and produced the forest plots.
Funding
Funding was provided by the General Osteopathic Council (UK) via the National Council for Osteopathic Research (NCOR). All contributors had access to the original and raw data.
Ethics
No ethics approvals were required for this research.
References (63)
- et al.
How common are side effects of spinal manipulation and can these side effects be predicted?
Manual Therapy
(2004) - et al.
Defining adverse events in manual therapies: a modified Delphi consensus study
Manual Therapy
(2010) Prospective investigations into the safety of spinal manipulation
Journal of Pain and Symptom Manage
(2001)- et al.
A biomechanical model for mechanically efficient cavitation production during spinal manipulation: prethrust position and the neutral zone
Journal of Manipulative & Physiological Therapeutics
(2006) - et al.
A pilot study for a randomized clinical trial assessing chiropractic care, medical care, and self-care education for acute and sub-acute neck pain patients
Journal of Manipulative & Physiological Therapeutics
(2003) - et al.
Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain: a randomized trial
Pain
(2007) - et al.
Chiropractic care of musculoskeletal disorders in a unique population within Canadian community health centres
Journal of Manipulative & Physiological Therapeutics
(2007) - et al.
Chronic spinal pain syndromes: a clinical pilot trial comparing acupuncture, a non-steroidal anti-inflammatory drug, and spinal manipulation
Journal of Manipulative & Physiological Therapeutics
(1999) - et al.
A practice-based study of patients with acute and chronic low back pain attending primary care and chiropractic physicians: two-week to 48-month follow-up
Journal of Manipulative & Physiological Therapeutics
(2004) - et al.
Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial
Lancet
(2007)
Comparison of bioenergetic synchronization technique and customary chiropractic care for older adults with chronic musculoskeletal pain
Journal of Manipulative & Physiological Therapeutics
Comparison of physical treatments versus a brief pain-management programme for back pain in primary care: a randomised clinical trial in physiotherapy practice
Lancet
Spinal manipulative therapy versus a low force mimic manoeuvre for women with primary dysmenorrhea: a randomized, observer-blinded, clinical trial
Pain
Second prize: the effectiveness of physical modalities among patients with low back pain randomized to chiropractic care: findings from the UCLA low back pain study
Journal of Manipulative & Physiological Therapeutics
Adverse reactions to chiropractic treatment and their effects on satisfaction and clinical outcomes among patients enrolled in the UCLA neck pain study
Journal of Manipulative & Physiological Therapeutics
Cervical arterial dysfunction and manual therapy: a critical literature review to inform professional practice
Manual Therapy
Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment
Journal of Manipulative & Physiological Therapeutics
Practice-based randomized controlled-comparison clinical trial of chiropractic adjustments and brief massage treatment at sites of subluxation in subjects with essential hypertension: pilot study
Journal of Manipulative & Physiological Therapeutics
The benefits outweigh the risks for patients undergoing chiropractic care for neck pain: a prospective, multicenter, cohort study
Journal of Manipulative & Physiological Therapeutics
Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations
Spine
A feasibility study of chiropractic spinal manipulation versus sham spinal manipulation for chronic otitis media with effusion in children
Journal of Manipulative & Physiological Therapeutics
A feasibility study assessing manual therapies to different regions of the spine for patients with subacute or chronic neck pain
Journal of Chiropractic Medicine
The reporting of patient safety incidents—first experiences with the chiropractic reporting and learning system (CRLS): a pilot study
Clinical Chiropractic
A randomized controlled trial of chiropractic spinal manipulative therapy for migraine
Journal of Manipulative & Physiological Therapeutics
Specific manipulative therapy treatment for chronic lateral epicondylalgia produces uniquely characteristic hypoalgesia
Manual Therapy
European guidelines for the management of chronic non-specific low back pain
Better reporting of randomised controlled trials: the CONSORT statement
BMJ
Adverse effects of spinal manipulation
Journal of the Royal Society of Medicine
Spinal manipulation in the treatment of episodic tension-type headache: a randomized controlled trial
JAMA
A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain
Spine
Single blind randomised controlled trial of chemonucleolysis and manipulation in the treatment of symptomatic lumbar disc herniation
European Spine Journal
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