Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada.
Centre for Disability Prevention and Rehabilitation at Ontario Tech University and CMCC, Oshawa, Canada.
Chiropr Man Therap. 2021 Feb 17;29(1):8. doi: 10.1186/s12998-021-00362-9.
BACKGROUND: A small proportion of chiropractors, osteopaths, and other manual medicine providers use spinal manipulative therapy (SMT) to manage non-musculoskeletal disorders. However, the efficacy and effectiveness of these interventions to prevent or treat non-musculoskeletal disorders remain controversial. OBJECTIVES: We convened a Global Summit of international scientists to conduct a systematic review of the literature to determine the efficacy and effectiveness of SMT for the primary, secondary and tertiary prevention of non-musculoskeletal disorders. GLOBAL SUMMIT: The Global Summit took place on September 14-15, 2019 in Toronto, Canada. It was attended by 50 researchers from 8 countries and 28 observers from 18 chiropractic organizations. At the summit, participants critically appraised the literature and synthesized the evidence. SYSTEMATIC REVIEW OF THE LITERATURE: We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health, and the Index to Chiropractic Literature from inception to May 15, 2019 using subject headings specific to each database and free text words relevant to manipulation/manual therapy, effectiveness, prevention, treatment, and non-musculoskeletal disorders. Eligible for review were randomized controlled trials published in English. The methodological quality of eligible studies was assessed independently by reviewers using the Scottish Intercollegiate Guidelines Network (SIGN) criteria for randomized controlled trials. We synthesized the evidence from articles with high or acceptable methodological quality according to the Synthesis without Meta-Analysis (SWiM) Guideline. The final risk of bias and evidence tables were reviewed by researchers who attended the Global Summit and 75% (38/50) had to approve the content to reach consensus. RESULTS: We retrieved 4997 citations, removed 1123 duplicates and screened 3874 citations. Of those, the eligibility of 32 articles was evaluated at the Global Summit and 16 articles were included in our systematic review. Our synthesis included six randomized controlled trials with acceptable or high methodological quality (reported in seven articles). These trials investigated the efficacy or effectiveness of SMT for the management of infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. None of the trials evaluated the effectiveness of SMT in preventing the occurrence of non-musculoskeletal disorders. Consensus was reached on the content of all risk of bias and evidence tables. All randomized controlled trials with high or acceptable quality found that SMT was not superior to sham interventions for the treatment of these non-musculoskeletal disorders. Six of 50 participants (12%) in the Global Summit did not approve the final report. CONCLUSION: Our systematic review included six randomized clinical trials (534 participants) of acceptable or high quality investigating the efficacy or effectiveness of SMT for the treatment of non-musculoskeletal disorders. We found no evidence of an effect of SMT for the management of non-musculoskeletal disorders including infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. This finding challenges the validity of the theory that treating spinal dysfunctions with SMT has a physiological effect on organs and their function. Governments, payers, regulators, educators, and clinicians should consider this evidence when developing policies about the use and reimbursement of SMT for non-musculoskeletal disorders.
背景:一小部分脊医、整骨医师和其他手法医学从业者使用脊柱手法治疗(SMT)来治疗非骨骼肌肉疾病。然而,这些干预措施预防或治疗非骨骼肌肉疾病的疗效和效果仍然存在争议。
目的:我们召集了一次全球科学家峰会,对文献进行系统评价,以确定 SMT 对非骨骼肌肉疾病的一级、二级和三级预防的疗效和效果。
全球峰会:全球峰会于 2019 年 9 月 14 日至 15 日在加拿大多伦多举行。来自 8 个国家的 50 名研究人员和来自 18 个脊骨疗法组织的 28 名观察员出席了会议。在峰会上,参与者对文献进行了批判性评估,并对证据进行了综合。
文献系统评价:我们使用特定于每个数据库的主题词和与手法/手法治疗、有效性、预防、治疗和非骨骼肌肉疾病相关的自由文本词,从 MEDLINE、Embase、Cochrane 对照试验中心注册、护理和相关健康领域累积索引以及脊骨疗法文献索引中搜索了从成立到 2019 年 5 月 15 日的文献。合格的文献为发表在英语中的随机对照试验。合格研究的方法学质量由评审员使用苏格兰校际指南网络(SIGN)随机对照试验标准独立评估。我们根据无荟萃分析(SWiM)指南,根据具有较高或可接受方法学质量的文章综合证据。最终的偏倚风险和证据表由参加全球峰会的研究人员进行了审查,其中 75%(38/50)必须批准内容以达成共识。
结果:我们检索到 4997 篇引文,剔除了 1123 篇重复引文,并筛选了 3874 篇引文。其中,32 篇文章的资格在全球峰会上进行了评估,16 篇文章纳入了我们的系统评价。我们的综合分析包括 6 项具有可接受或较高方法学质量的随机对照试验(在 7 篇文章中报告)。这些试验研究了 SMT 对婴儿绞痛、儿童哮喘、高血压、原发性痛经和偏头痛的管理效果或有效性。没有一项试验评估了 SMT 在预防非骨骼肌肉疾病发生方面的有效性。所有参加全球峰会的 50 名参与者中的 6 名(12%)对最终报告表示不认可。
结论:我们的系统评价纳入了 6 项(534 名参与者)具有可接受或较高质量的随机临床试验,调查了 SMT 治疗非骨骼肌肉疾病的疗效或有效性。我们没有发现 SMT 对非骨骼肌肉疾病治疗的效果,包括婴儿绞痛、儿童哮喘、高血压、原发性痛经和偏头痛。这一发现挑战了通过 SMT 治疗脊柱功能障碍对器官及其功能产生生理影响的理论的有效性。政府、付款人、监管机构、教育者和临床医生在制定关于 SMT 治疗非骨骼肌肉疾病的使用和报销政策时,应考虑这一证据。
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