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    The global summit on the efficacy and effectiveness of spinal manipulative therapy for the prevention and treatment of non-musculoskeletal disorders: a systematic review of the literature

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    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.
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    https://aecc.archive.knowledgearc.net/handle/123456789/140
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    • AECC University College Research Collection
    Date
    2021
    Author
    Côté, Pierre
    Hartvigsen, Jan
    Axén, Iben
    Leboeuf-Yde, Charlotte
    Corso, Melissa
    Shearer, Heather
    Wong, Jessica
    Marchand, Andrée-Anne
    Cassidy, J David
    French, Simon
    Kawchuk, Gregory N
    Mior, Silvano
    Poulsen, Erik
    Srbely, John
    Ammedolia, Carlo
    Blanchette, Marc-André
    Busse, Jason W
    Bussières, André
    Cancelliere, Carolina
    Christensen, Henrik Wulff
    De Carvalho, Diana
    de Luca, Katie
    du Rose, Alister
    Eklund, Andreas
    Engel, Roger
    Goncalves, Guillaume
    Hebert, Jeffrey
    Hincapié, Cesar A
    Hondras, Maria
    Kimpton, Amanda
    Lauridsen, Henrik Hein
    Innes, Stanley
    Meyer, Anne-Laure
    Newell, Dave
    O'Neill, Søren
    Pagé, Isabelle
    Passmore, Steven
    Perle, Stephen M
    Quon, Jeffrey
    Rezai, Mana
    Stupar, Maja
    Swain, Michael
    Vitello, Andrew
    Weber, Kenneth
    Young, Kenneth J
    Yu, Hainan
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