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The safety of spinal manipulative therapy in children under 10 years: a rapid review
Melissa Corso1, Carol Cancelliere1, Silvano Mior1,2
1Faculty of Health Sciences, Centre for Disability Prevention and Rehabilitation, Ontario Tech University and CMCC, 2000 Simcoe St N, Oshawa, ON, L1G 0C5, Canada.
Insights
The safety of spinal manipulative therapy (SMT) in children is not well-established. While most adverse events are mild, the risk of severe harm remains unknown, necessitating further research.
Area of Science:
- Pediatric medicine
- Chiropractic care
- Evidence-based practice
Background:
- The safety of spinal manipulative therapy (SMT) in pediatric populations is a subject of ongoing debate.
- A review was mandated by the College of Chiropractors of British Columbia to examine the existing evidence on SMT safety in children.
Purpose of the Study:
- To conduct a rapid review of the safety of SMT in children under 10 years of age.
- To identify and describe adverse events associated with pediatric SMT.
- To determine the incidence of adverse events and compare the risk of SMT to other interventions.
Main Methods:
- A comprehensive literature search was performed across MEDLINE, CINAHL, and Index to Chiropractic Literature from January 1990 to August 2019.
- Rapid review methodology, as recommended by the World Health Organization, was employed.
- Eligible studies (case reports/series, cohort studies, RCTs) underwent critical appraisal, with data extracted and validated by two independent reviewers for qualitative synthesis.
Main Results:
- The majority of reported adverse events from pediatric SMT were mild, including increased crying and soreness.
- Rare severe adverse events were noted, such as a rib fracture in a neonate and indirect harm in an infant.
- The incidence of mild adverse events varied significantly, ranging from 0.3% to 22.22%.
Conclusions:
- The risk of moderate to severe adverse events associated with SMT in children remains largely unknown.
- It is currently unclear whether SMT poses an increased risk of adverse events in children under 10 years compared to other treatments.
Introduction:
The safety of spinal manipulative therapy (SMT) in children is controversial. We were mandated by the College of Chiropractors of British Columbia to review the evidence on this issue.
Objectives:
We conducted a rapid review of the safety of SMT in children (< 10 years). We aimed to: 1) describe adverse events; 2) report the incidence of adverse events; and 3) determine whether SMT increases the risk of adverse events compared to other interventions.
Evidence Review:
We searched MEDLINE, CINAHL, and Index to Chiropractic Literature from January 1, 1990 to August 1, 2019. We used rapid review methodology recommended by the World Health Organization. Eligible studies (case reports/series, cohort studies and randomized controlled trials) were critically appraised. Studies of high and acceptable methodological quality were included. The lead author extracted data. Data extraction was independently validated by a second reviewer. We conducted a qualitative synthesis of the evidence.
Findings:
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.
Conclusion:
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.
