Carnes Dawn, Mars Thomas S, Mullinger Brenda, Froud Robert, Underwood Martin
Barts and The London School of Medicine and Dentistry, Centre for Health Sciences, 2 Newark St, London E1 2AT, UK.
Man Ther. 2010 Aug;15(4):355-63. doi: 10.1016/j.math.2009.12.006. Epub 2010 Jan 22.
To explore the incidence and risk of adverse events with manual therapies.
The main health electronic databases, plus those specific to allied medicine and manual therapy, were searched. Our inclusion criteria were: manual therapies only; administered by regulated therapists; a clearly described intervention; adverse events reported. We performed a meta-analysis using incident estimates of proportions and random effects models.
Eight prospective cohort studies and 31 manual therapy RCTs were accepted. The incidence estimate of proportions for minor or moderate transient adverse events after manual therapy was approximately 41% (CI 95% 17-68%) in the cohort studies and 22% (CI 95% 11.1-36.2%) in the RCTs; for major adverse events approximately 0.13%. The pooled relative risk (RR) for experiencing adverse events with exercise, or with sham/passive/control interventions compared to manual therapy was similar, but for drug therapies greater (RR 0.05, CI 95% 0.01-0.20) and less with usual care (RR 1.91, CI 95% 1.39-2.64).
The risk of major adverse events with manual therapy is low, but around half manual therapy patients may experience minor to moderate adverse events after treatment. The relative risk of adverse events appears greater with drug therapy but less with usual care.
探讨手法治疗不良事件的发生率及风险。
检索主要的健康电子数据库，以及联合医学和手法治疗的特定数据库。我们的纳入标准为：仅手法治疗；由注册治疗师实施；干预措施描述清晰；报告了不良事件。我们使用比例事件估计值和随机效应模型进行了荟萃分析。
纳入了8项前瞻性队列研究和31项手法治疗随机对照试验。队列研究中，手法治疗后轻微或中度短暂不良事件的比例发生率估计约为41%（95%置信区间17 - 68%），随机对照试验中为22%（95%置信区间11.1 - 36.2%）；严重不良事件约为0.13%。与手法治疗相比，运动、假治疗/被动治疗/对照干预出现不良事件的合并相对风险（RR）相似，但药物治疗的相对风险更高（RR 0.05，95%置信区间0.01 - 0.20），常规护理的相对风险更低（RR 1.91，95%置信区间1.39 - 2.64）。
手法治疗严重不良事件的风险较低，但约一半的手法治疗患者在治疗后可能会经历轻微至中度不良事件。药物治疗不良事件的相对风险似乎更高，而常规护理的相对风险更低。
