Adverse events and manual therapy: a systematic review

Area of Science:

• Integrative Medicine
• Evidence-Based Practice
• Clinical Research

Background:

• Manual therapies are widely used, necessitating a clear understanding of their safety profiles.
• Assessing adverse events is crucial for patient safety and informed clinical decision-making.

Purpose of the Study:

• To determine the incidence and risk of adverse events associated with manual therapies.
• To compare the risk of adverse events from manual therapies with other common treatments.

Main Methods:

• A systematic literature search was conducted across major health and specialized allied medicine databases.
• Inclusion criteria focused on manual therapies by regulated practitioners with clearly described interventions and reported adverse events.
• Meta-analysis of incident estimates and random effects models were employed to synthesize data from cohort studies and randomized controlled trials (RCTs).

Main Results:

• Data from 8 prospective cohort studies and 31 manual therapy RCTs were analyzed.
• Minor to moderate transient adverse events occurred in approximately 41% (cohort studies) and 22% (RCTs) of patients.
• The incidence of major adverse events was approximately 0.13%.

Conclusions:

• Major adverse events from manual therapy are infrequent, but minor to moderate events are common, affecting roughly half of patients.
• Manual therapies present a lower relative risk of adverse events compared to drug therapies but a higher risk than usual care.