MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

A team of chiropractic researchers conducted a review of the safety of spinal manipulative therapy (SMT) in children under 10 years. They aimed to:

1) describe adverse events;

2) report the incidence of adverse events;

3) determine whether SMT increases the risk of adverse events compared to other interventions.

They searched MEDLINE, CINAHL, and Index to Chiropractic Literature from January 1, 1990 to August 1, 2019. Eligible studies were case reports/series, cohort studies and randomized controlled trials. Studies of high and acceptable methodological quality were included.

Most adverse events are mild (e.g., increased crying, soreness). One case report describes a severe adverse event (rib fracture in a 21-day-old) and another an indirect harm in a 4-month-old. The incidence of mild adverse events ranges from 0.3% (95% CI: 0.06, 1.82) to 22.22% (95% CI: 6.32, 54.74). Whether SMT increases the risk of adverse events in children is unknown.

The authors concluded that the risk of moderate and severe adverse events is unknown in children treated with SMT. It is unclear whether SMT increases the risk of adverse events in children < 10 years.

Thanks to their ingenious methodology, the authors managed to miss 11 of the 13 studies included in the review by Vohra et al which reported 9 serious adverse events and 20 cases of delayed diagnosis associated with SMT. Another review reported 15 serious adverse events and 775 mild to moderate adverse events following manual therapy. As far as I can see, the authors of the new review make just one reasonable point:

We recommend the implementation of a population-based active surveillance program to measure the incidence of severe and serious adverse events following SMT treatment in this population.

In the absence of such a surveillance system, any incidence figures are not just guess-work but also a depiction of the tip of a much bigger iceberg. So, why do the authors of this review not make this point clearly and powerfully? Why does the review read mostly like an attempt to white-wash a thorny subject? Why do they not provide a breakdown of the adverse events according to profession? The answer to these questions can be found at the very end of the paper:

This study was supported by the College of Chiropractors of British Columbia to Ontario Tech University. The College of Chiropractors of British Columbia was not involved in the design, conduct or interpretation of the research that informed the research. This research was undertaken, in part, thanks to funding from the Canada Research Chairs program to Pierre Côté who holds the Canada Research Chair in Disability Prevention and Rehabilitation at Ontario Tech University, and from the Canadian Chiropractic Research Foundation to Carol Cancelliere who holds a Research Chair in Knowledge Translation in the Faculty of Health Sciences at Ontario Tech University.

This study was supported by the College of Chiropractors of British Columbia to Ontario Tech University. The College of Chiropractors of British Columbia was not involved in the design, conduct or interpretation of the research that informed the research. This research was undertaken, in part, thanks to funding from the Canada Research Chairs program to Pierre Côté who holds the Canada Research Chair in Disability Prevention and Rehabilitation at Ontario Tech University, and funding from the Canadian Chiropractic Research Foundation to Carol Cancelliere who holds a Research Chair in Knowledge Translation in the Faculty of Health Sciences at Ontario Tech University.

I have often felt that chiropractic is similar to a cult. An investigation by cult members into the dealings of a cult is not the most productive of concepts, I guess.

12 Responses to The risks of (chiropractic) spinal manipulative therapy in children under 10 years

  • ” I have often felt that chiropractic is similar to a cult. An investigation by cult members into the dealings of a cult is not the most productive of concepts, I guess.” … I agree… lets call for drug testing to be carried by independent researchers blinded to the drug companies…

  • “We recommend the implementation of a population-based active surveillance program to measure the incidence of severe and serious adverse events following SMT treatment in this population.“

    Why? Because severe and serious AE appear to be so rare they won’t be picked up in a feasible RCT.

    • Also, they are not picked up because so many trialists do not even bother to mention AEs (as documented many times), thus violating research ethics and displaying the ethical standards in chiropractic.

      • Based upon the evidence we have, serious AE appear to be too rare to be picked up in a reasonable RCT.

        But yes, researchers in this area need to pick up their game and report all events.

  • I see that all the authors claim an affiliation with the Canadian Memorial Chiropractic College (CMCC) and Ontario Tech University (OTU). Ouch!

    And this from the

    A new articulation agreement between the University of Ontario Institute of Technology (UOIT) and the Canadian Memorial Chiropractic College (CMCC) will enable qualified students to complete a Bachelor of Health Sciences (Honours) in Kinesiology degree and a Doctor of Chiropractic degree in seven years, instead of eight. For individuals who identify their career path early, this agreement seamlessly bridges a foundational degree into a professional degree in chiropractic.

    It looks like OTU is deep into woo.

  • Prof. Ernst, Be brave, comment on this in a totally impartial way, especially the medical management of colic in children e.g. Proton pump inhibitors. Do not hide behind your mantra of not commenting upon medical issues as that is not in your level of expertise.

    https://bmjopen.bmj.com/content/bmjopen/10/2/e035405.full.pdf?fbclid=IwAR3lA1CAcNqI3UaJAGkbvqpCjBPJ6UXsvwSsz9Ogo1iDeRMOhwxd60uVuAY

    • @Kiwi Giblet Giblet,
      Why not, instead, provide a scrap of evidence for the efficacy of chiro for kids for anything?

      Also, provide a link to your website so the realists can disembowel your claims? The Prof is completely open about his quals, history, and evidence, why not you?

      • Frank, you obviously did not read the article. Reread it and then comment, especially about what comprises manual therapy and the efficacy of proton pump inhibitors.

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