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Possible adverse events in children treated by manual therapy: a review
1Professor Chiropractic Medicine, University of Zürich and University Orthopedic Hospital Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland. kim.humphreys@balgrist.ch.
Insights
Research on pediatric manual therapy adverse events is limited. While mild side effects are common in adults, serious events are rare, but more high-quality pediatric studies are needed.
Area of Science:
- Pediatric manual therapy research
- Adverse event analysis in children
- Manual therapy safety
Background:
- Pediatric manual therapy (Ped MT) is widely used by various professions for children's treatments.
- Interventions range from advice and massage to spinal manipulation.
- Evidence on adverse events associated with Ped MT is not well understood.
Purpose of the Study:
- To update the clinical research literature on adverse events in children treated by spinal manipulation.
- Focus on literature published from June 2004 to January 2010.
- Builds upon the 2007 Vohra et al. report.
Main Methods:
- Systematic review of clinical research literature.
- Searched MEDLINE, PubMed, and PubMed Central databases.
- Focused on adverse events in pediatric manual therapy cases.
Main Results:
- Limited new research identified: three clinical studies, one systematic review, and one evidence report.
- No serious or catastrophic adverse events reported in pediatric studies.
- Mild to moderate adverse events are common in adults but not well-quantified in children.
Conclusions:
- Insufficient high-quality research exists on pediatric manual therapy adverse events.
- Adult manual therapy shows rare serious adverse events, less common than prescribed medications.
- Further research is crucial to understand and mitigate risks in pediatric populations.
Background:
Pediatric manual therapy is controversial within the medical community particularly with respect to adverse events. Pediatric manual therapy (Ped MT) is commonly used by a number of professions such as chiropractors, osteopaths and naturopaths for a variety of treatments in children. Ped MT interventions range from advice, light touch, massage, through to mobilisation and high velocity spinal manipulation. However, current evidence related to adverse events associated with Ped MT is not well understood.
Objective:
To update the clinical research literature from the 2007 report by Vohra, Johnston, Cramer and Humphreys on possible adverse events in children treated by spinal manipulation.
Methods:
A review of the clinical research literature from June 2004 until January 2010 as reported in MEDLINE, PubMed and PubMed Central for adverse events specifically related to the treatment of pediatric cases by manual therapy.
Results:
Only three new clinical studies, one systematic review with meta-analysis and one evidence report were identified. Two clinical studies reported on chiropractic care and one on osteopathic spinal manipulation in children. The systematic review investigated all studies of adverse events and manual therapy and was not specific for pediatric patients. The evidence review focused on effectiveness of spinal manipulation in a variety of musculoskeletal conditions. No serious or catastrophic adverse events were reported in the clinical studies or systematic review. However for adults, it has been estimated that between 0.003% and 0.13% of manual therapy treatments may result in a serious adverse event. Although mild to moderate adverse events are common in adults, an accurate estimate from high quality pediatric studies is currently not available.
Conclusions:
There is currently insufficient research evidence related to adverse events and manual therapy. However, clinical studies and systematic reviews from adult patients undergoing manual therapy, particularly spinal manipulation report that mild to moderate adverse events are common and self limiting. However serious adverse events are rare and much less than for medication commonly prescribed for these problems. More high quality research specifically addressing adverse events and pediatric manual therapy is needed.
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