This systematic review was aimed at determining if there has been a change in the reporting of adverse events associated with spinal manipulation in randomized clinical trials (RCTs) since 2016.
Databases were searched from March 2016 to May 2022: MEDLINE (Ovid), Embase, CINAHL, ICL, PEDro, and Cochrane Library. The following search terms and their derivatives were adapted for each platform: spinal manipulation; chiropractic; osteopathy; physiotherapy; naprapathy; medical manipulation and clinical trial.
Domains of interest (pertaining to adverse events) included: completeness and location of reporting; nomenclature and description; spinal location and practitioner delivering manipulation; methodological quality of the studies and details of the publishing journal. Frequencies and proportions of studies reporting on each of these domains were calculated. Univariable and multivariable logistic regression models were fitted to examine the effect of potential predictors on the likelihood of studies reporting on adverse events.
There were 5399 records identified by the electronic searches, of which 154 (2.9%) were included in the analysis. Of these, 94 (61.0%) reported adverse events with only 23.4% providing an explicit description of what constituted an adverse event. Reporting of adverse events in the abstract had increased (n=29, 30.9%) while reporting in the results section had decreased (n=83, 88.3%) over the past 6 years. Spinal manipulation was delivered to 7518 participants in the included studies. No serious adverse events were reported in any of these studies.
The authors concluded that, while the current level of reporting of adverse events associated with spinal manipulation in RCTs has increased since our 2016 publication on the same topic, the level remains low and inconsistent with established standards. As such, it is imperative for authors, journal editors and administrators of clinical trial registries to ensure there is more balanced reporting of both benefits and harms in RCTs involving spinal manipulation.
In fact, it is an ethical imperative to accurately report adverse effects. Not reporting adverse effects amounts to a violation of medical research ethics. Adverse effects of spinal manipulation occur in about 50% of all patients. This means that investigators reporting significantly lower figures are likely guilty of under-reporting. And under-reporting of adverse events is also a breach of ethical standards.
My conclusion thus is that the vast majority of trials of spinal manipulation are unethical and should be discarded.
25 Responses to Adverse events associated with spinal manipulation
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The most lucrative study for analysts on chiropractic spinal manipulation safety was funded by the Australian Victorian government. 99.6% of interventions were recorded to be beneficial by parents or caregivers and zero insurance pediatric claims were made.
This alarming claim on the damage caused by spinal manipulation does not further the study of pediatric manual spinal therapy.
Much insightful information can be read below which speaks volumes about the public’s experience of pediatric chiropractic care.
https://www.safercare.vic.gov.au/sites/default/files/2019-10/20191024-Final%20Chiropractic%20Spinal%20Manipulation.pdf
https://www.cjaonline.com.au/index.php/cja/article/view/312/144
EE: My conclusion thus is that the vast majority of trials of spinal manipulation are unethical and should be discarded.
Does that apply to other areas of study? It seems that may involve plenty of discarding.
Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis
“In total, 20 unique studies provided enough information about the number and relatedness of adverse effects occurring during the intervention period.”
https://www.bmj.com/content/376/bmj-2021-067718
Reporting of Adverse Events in Published and Unpublished Studies of Health Care Interventions: A Systematic Review
“The median percentage of published documents with adverse events information was 46%…”
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002127
Analysis and reporting of adverse events in randomised controlled trials: a review
“Sixty-two per cent reported some form of spontaneous AE collection but only 29% included details of specific prompts used to ascertain AE data.”
https://bmjopen.bmj.com/content/9/2/e024537
it applies to all studies of treatments known to be associated with serious risks.
And therein lies the rub.
Bogus “studies” only muddy the waters. And like they say, “Statistics are like a Bikini…what the reveal is interesting but what they conceal is vital”.
When there is substantial risk of harm and no real or lasting benefit…WHY “treat” a patient using the rapid upper neck manipulation? Given all we know for certain, it seems akin to studying why there are injuries to the human body, following a car crash.
I have yet to hear anyone explain exactly what it is that they are trying to achieve, specifically, with this dangerous neck manipulation and more importantly WHY they insist on its use in particular.
In my wife’s (chiropractic victim) case, Sandy Nette had no health complaints or issues. She was merely following the advice of her long time Chiropractor. “Routine Maintenance” he called it.
Again, I would like to know SPECIFICALLY, and SCIENTIFICALLY, exactly what Chiropractic Neck Manipulations provide in the way of healing or maintaining ones health. I mean besides playing Russian Roulet.
What evidence would convince you that the benefit outweighs the risk?
DC:
In all fairness and given our own personal experience …I am not sure.
Indeed, the growing abundance of firsthand knowledge from other victims of Chiropractic, continue to convince us that change from within the profession must take place. From our perspective we have seen far too much needless carnage and lives destroyed. We have no issues with the profession as a whole but look forward to the day when upper neck manipulation is abolished.
There are many days when I wish we could fade away from the spotlight, but our legal case and mass media coverage over the years continues to pull us in.
To this very day we continue to hear from stroke victims all over the world who have been injured immediately following neck manipulations. They reach out to us for encouragement and support. We are not at liberty to discuss the details of our settlement with those that do reach out, but we can share empathy and provide the names of excellent local Doctors and Therapists to aid in their recovery process. (Sandy Nette spent six months in the U of A Hospital along with an additional six months at the Glenrose Rehabilitation Centre.)
I very much appreciate sites like this that focus on scientific truths. And I am glad you are on this site exchanging views DC. Continued dialogue may just be what breaks through this glass ceiling but from what I see there is just a stubborn unwillingness to accept the truth.
I can relate as I have my own experience with a similar event, albeit indirectly.
Obviously I have an interest in the topic of VAD. I have a social media group (mostly chiropractors) devoted specifically to discussing research on the topic. I have been asked to create an educational class on the topic. I have a research proposal sitting on my desk looking to see if hormonal status, specifically estrogen, could be a factor in some cases of VAD. There are several drugs that affect estrogen levels and may have an association with VAD in which case, as manual therapists, we may be advised to avoid cSMT in those cases. etc.
There are things we know, things we don’t know. But I have to look at feasibility and, based upon the current evidence, abolishing cSMT isn’t going to happen.
DC,
Please provide link to the social media group that you are referring to.
You have talked about proposals sitting on your desk before. How do we know what you are saying is true? Your words don’t have credibility unless you reveal yourself and provide details of your group. If you are so active in your field, you should not have problem revealing yourself.
Talker: How do we know what you are saying is true?
You don’t. You can either believe me or not believe me.
Or you can support your statements with evidence like the red banner above asks you to. It wouldn’t be that hard to do if you are telling the truth.
Unfortunately, this exchange truly says it all!
It’s amazing how Cockroaches flee when the lights are turned on.
Nevertheless…we press on and will continue to hope for open and honest dialogue.
When truth is being spoken, there really should be no need to hide. Except perhaps from accountability.
The problem with telling “stories”, is those darn facts keep getting in the way.
Yes it would be easy to do. But I have reasons for not revealing my identity.
You don’t believe my statements without evidence. OK.
Now we can stick to discussing the research, or lack of it, or not.
@DC
It is quite possible that your real-world credibility will be tarnished by your online trollish behavior.
Yet, another evasive maneuver on your part to avoid answering questions. I don’t see why anyone would need to take you seriously, you have proven to be a master BS peddler. You barely have any credibility left on here.
QUOTE
Philosopher Harry Frankfurt, in his essay On Bullshit, attempts a rigorous philosophical definition of bullshit. For Frankfurt, this consists of drawing a sharp distinction between a bullshitter and a liar; the difference being that a liar cares enough about the truth to state known falsehoods — or, at a minimum, respects reality enough to feel a need to evade it. A bullshitter, on the other hand, does not care about whether statements are true or false, because some other goal is paramount — and truth is a secondary consideration, if it is granted any relevance at all. “Liars at least acknowledge that it matters what is true. By virtue of this,” Frankfurt writes, “bullshit is a greater enemy of the truth than lies are.”
https://rationalwiki.org/wiki/Bullshit
END OF QUOTE
QUOTE
On BULLSHIT
Published Thursday 05 August 2021
Harry G Frankfurt published his delightful booklet ‘ON BULLSHIT‘ in 2005 (in case you don’t know it, I highly recommend you read it). Since then, the term ‘bullshit’ has become accepted terminology even in polite discourse. But what exactly is bullshit? Frankfurt explains that is something between a lie and a bluff, perhaps more like the latter than the former.
Not least due to Frankfurt’s book, there is today plenty of research on the subject of bullshit. As much of it relates to so-called alternative medicine (SCAM), allow me to present here just 5 of the most recent papers on bullshit.
…
Yes, bullshit seems to be an active area of research. And rightly so! There is so much of it about. Those who regularly read the comments sections of this blog will probably agree with some of the writing above. The statement that ‘bullshitting can be an effective means of influence when arguments are weak’ rang particularly true, I thought. ‘Communication characterised by an intent to be convincing or impressive without concern for truth’ might perhaps also remind us of a few notorious commentators on this blog.
https://edzardernst.com/2021/08/on-bullshit/
END OF QUOTE
David. As I have mentioned before…
In other forums where my identity was known I received death threats, threats against my family, threats of violence, threats to burn down my clinic, threats to file boards complaints, false online reviews, etc.
Why? Because I dared to challenge pseudo skeptics claims, accusations and views. I suspect the same actions from some folks who read this blog.
You want to call that hiding? Fine.
I call it….I’m protecting myself from nut jobs.
Take care.
Maintenance of what?
maintenance of his bank balance, no doubt.
Mojo wrote: “Maintenance of what?”
I addressed that in the following (tortuous) comment thread that David started here:
https://edzardernst.com/2022/11/high-velocity-low-amplitude-techniques-are-not-superior-to-no-treatment-in-the-management-of-tension-type-headache/#comment-141758
Especially in this subthread:
https://edzardernst.com/2022/11/high-velocity-low-amplitude-techniques-are-not-superior-to-no-treatment-in-the-management-of-tension-type-headache/#comment-141767
It’s interesting that I am considered the bad guy. Who else do you know that wants to investigate if certain drugs may increase the risk of VAD with cSMT? And that this mechanism may be due to the drugs possible affect on endothelial dysfunction via estrogen?
“From the 81 drugs or drug classes considered, we could attribute the highest level of evidence of association for 7 (erythropoietin, oral estrogens hormone replacement therapy, oral and vaginal ring estrogens contraception, bevacizumab, tamoxifen, and antipsychotics)…”
https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.033272
But hey, that would be trolling as this blog seems to be only concerned with the “what”, not the “why”.
Take care.
You know why, DC. Many examples of your trolling have been discussed at length in the past by EE and Pete Attkins.
https://edzardernst.com/2023/05/more-evidence-to-suggest-that-chiropractic-is-useless/#comment-146372
https://edzardernst.com/2022/04/comments-by-a-chiropractor-insights-into-quasi-religious-zeal/
But hey, you are free to erect a straw man and knock it off all the while ignoring plethora of evidence as to why people on this blog consider you a troll.
Besides, if you are going to stay anonymous and behave like a troll, it would not serve your interests to make statements regarding your background and expertise such as the following and cry crocodile tears when someone brings up the fact that you are anonymous and that your statements are unverifiable.
How come DC has never published any of these glorious projects?
Maybe those proposals that he very much loves to wield on his critics, are still sitting on DCs desk?
Enough about DC. I too have a stack of folders full of research proposals sitting on my desk and I run several groups online and offline on various topics. I too have been asked to prepare training material. In addition, I have been asked to speak at many conferences on various topics. My identity is not relevant here and it is okay if you don’t believe my statements without evidence, yet I would love to discuss these various topics that I am supposedly an expert on.
My comment was directed to David to let him know there are chiropractors who have an interest in researching and educating peers on the topic.
Here is one example
https://www.researchgate.net/profile/Lindsay-Gorrell
@DC
You are posting on a public forum where anyone can respond to your comments.
In your original comment that was directed at David, you were talking about yourself being interested in researching and educating others on the topic. That rightfully leads to folks questioning who you are and if you have published anything on the topic. You declined to identify yourself and offered up someone else in your profession as a distraction. However, the question remains, have you published anything on the topic? If so we would love to read about your research.
LOLOLOL!!!!!