“脊柱推拿的不良反应：一项系统评价”研究的重复验证
A replication of the study 'Adverse effects of spinal manipulation: a systematic review'.
作者信息
Tuchin Peter
机构信息
Macquarie University, Bld E5A Rm 355, Waterloo Rd, North Ryde, Sydney, NSW, 2109, Australia.
出版信息
Chiropr Man Therap. 2012 Sep 21;20(1):30. doi: 10.1186/2045-709X-20-30.
OBJECTIVE
To assess the significance of adverse events after spinal manipulation therapy (SMT) by replicating and critically reviewing a paper commonly cited when reviewing adverse events of SMT as reported by Ernst (J Roy Soc Med 100:330-338, 2007).
METHOD
Replication of a 2007 Ernst paper to compare the details recorded in this paper to the original source material. Specific items that were assessed included the time lapse between treatment and the adverse event, and the recording of other significant risk factors such as diabetes, hyperhomocysteinemia, use of oral contraceptive pill, any history of hypertension, atherosclerosis and migraine.
RESULTS
The review of the 32 papers discussed by Ernst found numerous errors or inconsistencies from the original case reports and case series. These errors included alteration of the age or sex of the patient, and omission or misrepresentation of the long term response of the patient to the adverse event. Other errors included incorrectly assigning spinal manipulation therapy (SMT) as chiropractic treatment when it had been reported in the original paper as delivered by a non-chiropractic provider (e.g. Physician).The original case reports often omitted to record the time lapse between treatment and the adverse event, and other significant clinical or risk factors. The country of origin of the original paper was also overlooked, which is significant as chiropractic is not legislated in many countries. In 21 of the cases reported by Ernst to be chiropractic treatment, 11 were from countries where chiropractic is not legislated.
CONCLUSION
The number of errors or omissions in the 2007 Ernst paper, reduce the validity of the study and the reported conclusions. The omissions of potential risk factors and the timeline between the adverse event and SMT could be significant confounding factors. Greater care is also needed to distinguish between chiropractors and other health practitioners when reviewing the application of SMT and related adverse effects.
目的
通过复制并批判性地回顾一篇在脊柱推拿疗法（SMT）不良事件综述中经常被引用的论文（由恩斯特报道，《英国皇家医学会杂志》100:330 - 338，2007年），来评估脊柱推拿疗法后不良事件的重要性。
方法
复制一篇2007年恩斯特的论文，将该论文中记录的细节与原始资料进行比较。评估的具体项目包括治疗与不良事件之间的时间间隔，以及其他重要风险因素的记录，如糖尿病、高同型半胱氨酸血症、口服避孕药的使用、任何高血压、动脉粥样硬化和偏头痛病史。
结果
对恩斯特讨论的32篇论文的综述发现，原始病例报告和病例系列存在大量错误或不一致之处。这些错误包括患者年龄或性别的改变，以及患者对不良事件的长期反应的遗漏或错误表述。其他错误包括当原始论文报道脊柱推拿疗法（SMT）由非整脊治疗师（如医生）实施时，却错误地将其归类为整脊治疗。原始病例报告常常遗漏记录治疗与不良事件之间的时间间隔以及其他重要的临床或风险因素。原始论文的来源国也被忽视了，这一点很重要，因为在许多国家整脊疗法并未立法。在恩斯特报道为整脊治疗的21个病例中，有11个来自整脊疗法未立法的国家。
结论
2007年恩斯特论文中的错误或遗漏数量降低了该研究及其报道结论的有效性。潜在风险因素以及不良事件与脊柱推拿疗法之间时间线的遗漏可能是重要的混杂因素。在回顾脊柱推拿疗法的应用及其相关不良反应时，还需要更加谨慎地区分整脊治疗师和其他健康从业者。
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