Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.
PLoS One. 2022 Jul 15;17(7):e0270671. doi: 10.1371/journal.pone.0270671. eCollection 2022.
Spinal and peripheral joint manipulation and mobilization are interventions used by many healthcare providers to manage musculoskeletal conditions. Although there are many reports of adverse events (or undesirable outcomes) following such interventions, there is no common definition for an adverse event or clarity on any severity classification. This impedes advances of patient safety initiatives and practice. This scoping review mapped the evidence of adverse event definitions and classification systems following spinal and peripheral joint manipulation and mobilization for musculoskeletal conditions in adults.
An electronic search of the following databases was performed from inception to February 2021: MEDLINE, EMBASE, CINAHL, Scopus, AMED, ICL, PEDro, Cochrane Library, Open Grey and Open Theses and Dissertations. Studies including adults (18 to 65 years old) with a musculoskeletal condition receiving spinal or peripheral joint manipulation or mobilization and providing an adverse event definition and/or classification were included. All study designs of peer-reviewed publications were considered. Data from included studies were charted using a standardized data extraction form and synthesised using narrative analysis.
From 8248 identified studies, 98 were included in the final synthesis. A direct definition for an adverse event and/or classification system was provided in 69 studies, while 29 provided an indirect definition and/or classification system. The most common descriptors to define an adverse event were causality, symptom severity, onset and duration. Twenty-three studies that provided a classification system described only the end anchors (e.g., mild/minor and/or serious) of the classification while 26 described multiple categories (e.g., moderate, severe).
A vast array of terms, definition and classification systems were identified. There is no one common definition or classification for adverse events following spinal and peripheral joint manipulation and mobilization. Findings support the urgent need for consensus on the terms, definition and classification system for adverse events related to these interventions.
脊柱和外周关节的推拿和松动是许多医疗保健提供者用于治疗肌肉骨骼疾病的干预措施。尽管有许多关于此类干预措施后出现不良事件（或不良后果）的报告，但对于不良事件或任何严重程度分类都没有一个通用的定义。这阻碍了患者安全计划和实践的进展。本范围综述绘制了有关成人肌肉骨骼疾病接受脊柱和外周关节推拿和松动后不良事件定义和分类系统的证据。
从创建到 2021 年 2 月，对以下数据库进行了电子搜索：MEDLINE、EMBASE、CINAHL、Scopus、AMED、ICL、PEDro、Cochrane 图书馆、Open Grey 和开放论文和学位论文。纳入了包括 18 至 65 岁患有肌肉骨骼疾病的成年人在内的研究，这些成年人接受了脊柱或外周关节的推拿或松动，并提供了不良事件的定义和/或分类。考虑了所有同行评审出版物的研究设计。使用标准化的数据提取表对纳入研究的数据进行图表绘制，并使用叙述性分析进行综合。
从 8248 项已识别的研究中，有 98 项最终纳入综合分析。69 项研究提供了不良事件的直接定义和/或分类系统，而 29 项研究提供了间接定义和/或分类系统。定义不良事件最常用的描述符是因果关系、症状严重程度、发病和持续时间。提供分类系统的 23 项研究仅描述了分类的终点（例如，轻度/轻微和/或严重），而 26 项研究描述了多个类别（例如，中度、重度）。
确定了大量的术语、定义和分类系统。对于脊柱和外周关节推拿和松动后不良事件，没有一个通用的定义或分类系统。研究结果支持迫切需要就这些干预措施相关不良事件的术语、定义和分类系统达成共识。
