Taylor Shane H, Arnold Nicole D, Biggs Lesley, Colloca Christopher J, Mierau Dale R, Symons Bruce P, Triano John J
J Can Chiropr Assoc. 2004 Jun;48(2):152-61.
Over the past decade, mechanical adjusting devices (MADs) were a major source of debate within the Chiropractors' Association of Saskatchewan (CAS). Since Saskatchewan was the only jurisdiction in North America to prohibit the use of MADs, the CAS established a committee in 2001 to review the literature on MADs. The committee evaluated the literature on the efficacy, safety, and uses of moving stylus instruments within chiropractic practice, and the educational requirements for chiropractic practice. Following the rating criteria for the evaluation of evidence, as outlined in the Clinical Guidelines for Chiropractic Practice in Canada (1994), the committee reviewed 55 articles - all of which pertained to the Activator. Of the 55 articles, 13 were eliminated from the final study. Of the 42 remaining articles, 6 were rated as class 1 evidence; 11 were rated as class 2 evidence and 25 were rated as class 3 evidence. In this article - the second in a series of two - we review the results of uses and usage, safety and educational requirements. Of the 30 articles designated under the category of usage, 3 were rated as Class 1 evidence; 9 studies were classified as Class 2 evidence and 18 were rated as Class 3 evidence. Overall the committee reached consensus that in clinical practice, there is broad application of these procedures. A minority report was written arguing that the reviewer was unable to reach a conclusion about the use of the Activator Instrument other than it is used as a clinical and research tool. Of the 16 studies that dealt either explicitly or implicitly with safety, 4 were Class 1 evidence; 3 were Class 2 evidence and 9 were Class 3 evidence. Overall the committee reached consensus that the evidence supports that the Activator instrument is safe and has no more relative risk than do manual HVLA procedures. A minority report was written arguing that there is no evidence either to support or refute the view that MAD is safe. Of the 5 studies that dealt with educational requirements, all were Class 3 evidence. Overall the committee reached consensus that there was no evidence in the literature with respect to educational requirements to form any conclusions. A minority report was written offering opinion that there is evidence with respect to educational requirements.
在过去十年中，机械调整装置（MADs）一直是萨斯喀彻温省脊骨神经医学协会（CAS）内部争论的主要焦点。由于萨斯喀彻温省是北美唯一禁止使用MADs的司法管辖区，CAS于2001年成立了一个委员会来审查有关MADs的文献。该委员会评估了关于移动触笔仪器在脊骨神经医学实践中的功效、安全性和用途的文献，以及脊骨神经医学实践的教育要求。按照《加拿大脊骨神经医学临床实践指南》（1994年）中概述的证据评估评级标准，该委员会审查了55篇文章——所有这些文章均与激活器有关。在这55篇文章中，有13篇被排除在最终研究之外。在剩下的42篇文章中，6篇被评为1级证据；11篇被评为2级证据，25篇被评为3级证据。在本文（该系列的第二篇）中，我们回顾了使用和用法、安全性以及教育要求的结果。在指定为用法类别的30篇文章中，3篇被评为1级证据；9项研究被归类为2级证据，18篇被评为3级证据。总体而言，委员会达成共识，即在临床实践中，这些程序有广泛应用。有一份少数派报告称，除了激活器仪器被用作临床和研究工具外，审查者无法就其使用得出结论。在16项明确或隐含涉及安全性的研究中，4项为1级证据；3项为2级证据，9项为3级证据。总体而言，委员会达成共识，即证据支持激活器仪器是安全的，且与手动高速度低幅度调整（HVLA）程序相比没有更高的相对风险。有一份少数派报告称，没有证据支持或反驳MAD是安全的这一观点。在5项涉及教育要求的研究中，所有研究均为3级证据。总体而言，委员会达成共识，即文献中没有关于教育要求的证据来形成任何结论。有一份少数派报告提出观点称，有关于教育要求的证据。
