1
|
Garrett B, Caulfield T, Murdoch B, Brignall M, Kapur AK, Murphy S, Nelson E, Reardon J, Harrison M, Hislop J, Wilson‐Keates BJ, Anthony J, Loewen PS, Musoke RM, Braun J. A taxonomy of risk-associated alternative health practices: A Delphi study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1163-1181. [PMID: 34041822 PMCID: PMC9291966 DOI: 10.1111/hsc.13386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/23/2021] [Accepted: 03/08/2021] [Indexed: 06/12/2023]
Abstract
Defining alternative health care and the recording of associated adverse events and harm remains problematic. This Canadian study aimed to establish and classify risk-associated alternative health practices in a Delphi study undertaken with an interdisciplinary panel of 17 health experts in 2020. It provides a new functional definition of alternative health care and an initial taxonomy of risk-associated alternative health care practices. A number of risk-associated practices were identified and categorized into general practices that conflict with biomedical care or largely untested therapies, alternative beliefs systems, physical manipulative alternative therapies, and herbal and nutritional supplements. Some risk significant harms including major physical injuries or even death. The lack of systematic methods for recording adverse events in alternative health care makes establishing the frequency of such events challenging. However, it is important that people engaging with alternative health care understand they are not necessarily risk-free endeavours, and what those risks are.
Collapse
Affiliation(s)
- Bernie Garrett
- School of NursingUniversity of British ColumbiaVancouverBCCanada
| | - Timothy Caulfield
- Faculty of LawHealth Law InstituteUniversity of AlbertaEdmontonABCanada
| | - Blake Murdoch
- Faculty of LawHealth Law InstituteUniversity of AlbertaEdmontonABCanada
| | | | | | - Susan Murphy
- Department of Physical TherapyFaculty of MedicineUniversity of British ColumbiaVancouverBCCanada
| | - Erin Nelson
- Faculty of LawHealth Law InstituteUniversity of AlbertaEdmontonABCanada
| | - Jillian Reardon
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBCCanada
| | - Mark Harrison
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBCCanada
- Centre for Health Evaluation and Outcome Sciences (CHEOS)St. Paul’s HospitalVancouverBCCanada
| | - Jonathan Hislop
- Family MedicineUniversity of British ColumbiaVancouverBCCanada
| | | | - Joseph Anthony
- Department of Physical TherapyFaculty of MedicineUniversity of British ColumbiaVancouverBCCanada
| | - Peter S. Loewen
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBCCanada
| | - Richard M. Musoke
- School of Population and Public HealthUniversity of British ColumbiaVancouverBCCanada
| | - Joan Braun
- Bora Laskin Faculty of LawLakehead UniversityThunder BayONCanada
| |
Collapse
|
2
|
Driehuis F, Keijsers NLW, Nijhuis-van der Sanden MWG, De Bie RA, Staal JB, Hoogeboom TJ. Measurement of range-of-motion in infants with indications of upper cervical dysfunction using the Flexion-Rotation-Test and Lateral-Flexion-Test: a blinded inter-rater reliability study in a clinical practice setting. J Man Manip Ther 2020; 29:40-50. [PMID: 32282288 PMCID: PMC7889092 DOI: 10.1080/10669817.2020.1746896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: In infants with indications of upper cervical dysfunction, the Flexion-Rotation-Test and Lateral-Flexion-Test are used to indicate reduced upper cervical range-of-motion (ROM). In infants, the inter-rater reliability of these tests is unknown. Objective: To assess the inter-rater reliability of subjectively and objectively measured ROM by using the Flexion-Rotation-Test and Lateral-Flexion-Test. Methods: 36 infants (<6 months) and three manual therapists participated in this cross-sectional observational study. Pairs of two manual therapists independently assessed infants’ upper cervical ROM using the Flexion-Rotation-Test and Lateral-Flexion-Test, blinded for each other’s outcomes. Two inertial motion sensors objectively measured cervical ROM. Inter-rater reliability was determined between each pair of manual therapists. For subjective outcomes, Cohen’s kappa (ĸ) and the proportion of agreement (Pra) were calculated. For objectively measured ROM, Bland Altman plots were conducted and Limits of Agreement and Intraclass Correlation Coefficients (ICC) were calculated. Results: The inter-rater reliability of the Flexion-Rotation-Test and Lateral-Flexion-Test for subjective (ĸ: 0.077–0.727; Pra: 0.46–0.86) and objective outcomes (ICC: 0.019–0.496) varied between pairs of manual therapists. Conclusion: Assessed ROM largely depends on the performance of the assessment and its interpretation by manual therapists, leading to high variation in outcomes. Therefore, the Flexion-Rotation-Test and Lateral-Flexion-Test cannot be used solely as a reliable outcome measure in clinical practice and research context.
Collapse
Affiliation(s)
- Femke Driehuis
- IQ Healthcare, Radboud Institute of Health Sciences, Radboud University Medical Center , Nijmegen, The Netherlands
| | - Noël L W Keijsers
- Institute Research, Development & Education, Sint Maartenskliniek , Ubbergen, The Netherlands.,Department of Rehabilitation, Cognition and Behavior, Donders Institute for Brain, Radboud University Medical Center , Nijmegen, The Netherlands
| | | | - Rob A De Bie
- CAPHRI Research School, Department of Epidemiology, Maastricht University , Maastricht, The Netherlands
| | - J Bart Staal
- IQ Healthcare, Radboud Institute of Health Sciences, Radboud University Medical Center , Nijmegen, The Netherlands.,Research Group Musculoskeletal Rehabilitation, HAN University of Applied Sciences , Nijmegen, The Netherlands
| | - Thomas J Hoogeboom
- IQ Healthcare, Radboud Institute of Health Sciences, Radboud University Medical Center , Nijmegen, The Netherlands
| |
Collapse
|
3
|
Driehuis F, Hoogeboom TJ, Nijhuis-van der Sanden MWG, de Bie RA, Staal JB. Spinal manual therapy in infants, children and adolescents: A systematic review and meta-analysis on treatment indication, technique and outcomes. PLoS One 2019; 14:e0218940. [PMID: 31237917 PMCID: PMC6592551 DOI: 10.1371/journal.pone.0218940] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/12/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Studies on effectiveness and safety of specific spinal manual therapy (SMT) techniques in children, which distinguish between age groups, are lacking. OBJECTIVE To conduct a systematic review of the evidence for effectiveness and harms of specific SMT techniques for infants, children and adolescents. METHODS PubMed, Index to Chiropractic Literature, Embase, CINAHL and Cochrane Library were searched up to December 2017. Controlled studies, describing primary SMT treatment in infants (<1 year) and children/adolescents (1-18 years), were included to determine effectiveness. Controlled and observational studies and case reports were included to examine harms. One author screened titles and abstracts and two authors independently screened the full text of potentially eligible studies for inclusion. Two authors assessed risk of bias of included studies and quality of the body of evidence using the GRADE methodology. Data were described according to PRISMA guidelines and CONSORT and TIDieR checklists. If appropriate, random-effects meta-analysis was performed. RESULTS Of the 1,236 identified studies, 26 studies were eligible. Infants and children/adolescents were treated for various (non-)musculoskeletal indications, hypothesized to be related to spinal joint dysfunction. Studies examining the same population, indication and treatment comparison were scarce. Due to very low quality evidence, it is uncertain whether gentle, low-velocity mobilizations reduce complaints in infants with colic or torticollis, and whether high-velocity, low-amplitude manipulations reduce complaints in children/adolescents with autism, asthma, nocturnal enuresis, headache or idiopathic scoliosis. Five case reports described severe harms after HVLA manipulations in four infants and one child. Mild, transient harms were reported after gentle spinal mobilizations in infants and children, and could be interpreted as side effect of treatment. CONCLUSIONS Based on GRADE methodology, we found the evidence was of very low quality; this prevented us from drawing conclusions about the effectiveness of specific SMT techniques in infants, children and adolescents. Outcomes in the included studies were mostly parent or patient-reported; studies did not report on intermediate outcomes to assess the effectiveness of SMT techniques in relation to the hypothesized spinal dysfunction. Severe harms were relatively scarce, poorly described and likely to be associated with underlying missed pathology. Gentle, low-velocity spinal mobilizations seem to be a safe treatment technique in infants, children and adolescents. We encourage future research to describe effectiveness and safety of specific SMT techniques instead of SMT as a general treatment approach.
Collapse
Affiliation(s)
- Femke Driehuis
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thomas J. Hoogeboom
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Rob A. de Bie
- Caphri Research School, Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - J. Bart Staal
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- Research Group Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, the Netherlands
| |
Collapse
|
4
|
Parnell Prevost C, Gleberzon B, Carleo B, Anderson K, Cark M, Pohlman KA. Manual therapy for the pediatric population: a systematic review. Altern Ther Health Med 2019; 19:60. [PMID: 30866915 PMCID: PMC6417069 DOI: 10.1186/s12906-019-2447-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/21/2019] [Indexed: 12/14/2022]
Abstract
Background This systematic review evaluates the use of manual therapy for clinical conditions in the pediatric population, assesses the methodological quality of the studies found, and synthesizes findings based on health condition. We also assessed the reporting of adverse events within the included studies and compared our conclusions to those of the UK Update report. Methods Six databases were searched using the following inclusion criteria: children under the age of 18 years old; treatment using manual therapy; any type of healthcare profession; published between 2001 and March 31, 2018; and English. Case reports were excluded from our study. Reference tracking was performed on six published relevant systematic reviews to find any missed article. Each study that met the inclusion criteria was screened by two authors to: (i) determine its suitability for inclusion, (ii) extract data, and (iii) assess quality of study. Results Of the 3563 articles identified, 165 full articles were screened, and 50 studies met the inclusion criteria. Twenty-six articles were included in prior reviews with 24 new studies identified. Eighteen studies were judged to be of high quality. Conditions evaluated were: attention deficit hyperactivity disorder (ADHD), autism, asthma, cerebral palsy, clubfoot, constipation, cranial asymmetry, cuboid syndrome, headache, infantile colic, low back pain, obstructive apnea, otitis media, pediatric dysfunctional voiding, pediatric nocturnal enuresis, postural asymmetry, preterm infants, pulled elbow, suboptimal infant breastfeeding, scoliosis, suboptimal infant breastfeeding, temporomandibular dysfunction, torticollis, and upper cervical dysfunction. Musculoskeletal conditions, including low back pain and headache, were evaluated in seven studies. Twenty studies reported adverse events, which were transient and mild to moderate in severity. Conclusions Fifty studies investigated the clinical effects of manual therapies for a wide variety of pediatric conditions. Moderate-positive overall assessment was found for 3 conditions: low back pain, pulled elbow, and premature infants. Inconclusive unfavorable outcomes were found for 2 conditions: scoliosis (OMT) and torticollis (MT). All other condition’s overall assessments were either inconclusive favorable or unclear. Adverse events were uncommonly reported. More robust clinical trials in this area of healthcare are needed. Trial registration PROSPERA registration number: CRD42018091835
Collapse
|
5
|
Miller JE, Hanson HA, Hiew M, Lo Tiap Kwong DS, Mok Z, Tee YH. Maternal Report of Outcomes of Chiropractic Care for Infants. J Manipulative Physiol Ther 2019; 42:167-176. [PMID: 31029467 DOI: 10.1016/j.jmpt.2018.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 09/11/2018] [Accepted: 10/21/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the report by mothers of their infants' condition before and after a trial of care provided by registered chiropractic clinicians in addition to ratings of satisfaction, cost of care, and reports of any adverse events or side effects. A second purpose was to report the demographic profile of infants who presented for care to 16 chiropractic clinics in the United Kingdom. METHODS This observational study prospectively collected reports by mothers of their infants' demographic profiles and outcomes across several domains of infant behavior and their own mental state using the United Kingdom Infant Questionnaire. Participating registered chiropractors were recruited through the Royal College of Chiropractors annual meeting in January 2016, and 15 clinics and the Anglo-European College of Chiropractic University College teaching clinic volunteered to participate. RESULTS In all, 2001 mothers completed intake questionnaires and 1092 completed follow-up forms. Statistically significant (P < .05) improvements were reported across all aspects of infant behavior studied, including feeding problems, sleep issues, excessive crying, problems with supine sleep position, infant pain, restricted cervical range of motion, and time performing prone positioning. Maternal ratings of depression, anxiety, and satisfaction with motherhood also demonstrated statistically significant improvement (P < .05). In total, 82% (n = 797) reported definite improvement of their infants on a global impression of change scale. As well, 95% (n = 475) reported feeling that the care was cost-effective, and 90.9% (n = 712) rated their satisfaction 8 or higher on an 11-point scale. Minor self-limiting side effects were reported (5.8%, n = 42/727) but no adverse events. CONCLUSION In this study, mothers reported that chiropractic care for their infants was effective, safe, and cost-effective. Although the observational design makes it impossible to determine efficacy, the study's findings indicate that, on average, the changes observed by mothers were positive and may be clinically relevant.
Collapse
Affiliation(s)
- Joyce E Miller
- Outpatient Teaching Clinic, AECC University College, Bournemouth, Dorset, UK.
| | | | - Mandy Hiew
- AECC University College Teaching Clinic, Bournemouth, Dorset, UK
| | | | - Zicheng Mok
- AECC University College Teaching Clinic, Bournemouth, Dorset, UK
| | - Yun-Han Tee
- AECC University College Teaching Clinic, Bournemouth, Dorset, UK
| |
Collapse
|
6
|
Novak I, Morgan C. High-risk follow-up: Early intervention and rehabilitation. HANDBOOK OF CLINICAL NEUROLOGY 2019; 162:483-510. [PMID: 31324326 DOI: 10.1016/b978-0-444-64029-1.00023-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Early detection of childhood disability is possible using clinically available tools and procedures. Early detection of disability enables early intervention that maximizes the child's outcome, prevents the onset of complications, and supports parents. In this chapter, first we summarize the best-available tools for accurately predicting major childhood disabilities early, including autism spectrum disorder, cerebral palsy, developmental coordination disorder, fetal alcohol spectrum disorder, intellectual disability, hearing impairment, and visual impairment. Second, we provide an overview of the preclinical and clinical evidence for inducing neuroplasticity following brain injury. Third, we describe and appraise the evidence base for: (a) training-based interventions that induce neuroplasticity, (b) rehabilitation interventions not focused on inducing neuroplasticity, (c) complementary and alternative interventions, (d) environmental enrichment interventions in the neonatal intensive care and community settings, and (e) parent-child interaction interventions in the neonatal intensive care and community settings. Fourth, we explore emergent treatment options at clinical trial, designed to induce brain repair following injury. In conclusion, early diagnosis enables early intervention, which improves child and parent outcomes. We now know which interventions provide the biggest gains and the information can be used to help inform parental decision making when designing treatment plans for their children.
Collapse
Affiliation(s)
- Iona Novak
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia.
| | - Catherine Morgan
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
7
|
Kaplan SL, Coulter C, Sargent B. Physical Therapy Management of Congenital Muscular Torticollis: A 2018 Evidence-Based Clinical Practice Guideline From the APTA Academy of Pediatric Physical Therapy. Pediatr Phys Ther 2018; 30:240-290. [PMID: 30277962 PMCID: PMC8568067 DOI: 10.1097/pep.0000000000000544] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Congenital muscular torticollis (CMT) is a postural deformity evident shortly after birth, typically characterized by lateral flexion/side bending of the head to one side and cervical rotation/head turning to the opposite side due to unilateral shortening of the sternocleidomastoid muscle; it may be accompanied by other neurological or musculoskeletal conditions. Infants with CMT should be referred to physical therapists to treat these postural asymmetries as soon as they are identified. PURPOSE This update of the 2013 CMT clinical practice guideline (CPG) informs clinicians and families as to whom to monitor, treat, and/or refer and when and what to treat. It links 17 action statements with explicit levels of critically appraised evidence and expert opinion with recommendations on implementation of the CMT CPG into practice. RESULTS/CONCLUSIONS The CPG addresses the following: education for prevention; referral; screening; examination and evaluation; prognosis; first-choice and supplemental interventions; consultation; discontinuation from direct intervention; reassessment and discharge; implementation and compliance audits; and research recommendations. Flow sheets for referral paths and classification of CMT severity have been updated.
Collapse
Affiliation(s)
- Sandra L Kaplan
- Department of Rehabilitation and Movement Sciences (Dr Kaplan), Rutgers, The State University of New Jersey, Newark, New Jersey; Orthotics and Prosthetics Department (Dr Coulter), Children's Healthcare of Atlanta, Atlanta, Georgia; Division of Biokinesiology and Physical Therapy at the Herman Ostrow School of Dentistry (Dr Sargent), University of Southern California, Los Angeles, California
| | | | | |
Collapse
|
8
|
Siegenthaler MH. Pediatric Patients in Swiss Chiropractic Clinics: A Questionnaire Survey. J Manipulative Physiol Ther 2017; 40:477-485. [PMID: 29079254 DOI: 10.1016/j.jmpt.2017.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 02/08/2017] [Accepted: 03/14/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate practice characteristics of chiropractors who treat pediatric patients in Swiss chiropractic clinics. METHODS An online survey questionnaire was created and tested for face and content validity. Participation by Swiss chiropractors was voluntary and anonymous and completed November to December 2015. The data were analyzed using SPSS. The analysis consisted of descriptive statistics. RESULTS The sample consisted of 144 chiropractors, which represented a 53% response rate, and 98% of the responding practitioners treated patients younger than age 18. The proportion of pediatric patients treated was 8.7%. The most common pediatric age groups were schoolchildren and adolescents, with infants younger than 6 months being the third most common. Musculoskeletal complaints were the most common conditions treated in all age groups. In children younger than 2 years old, nonmusculoskeletal conditions were well represented. Prophylactic examination was common among children 6 years and younger. A total of 61% of responding chiropractors received direct referrals from medical doctors and 56% received direct referrals from pediatricians. The most common age groups for referrals from pediatricians were schoolchildren and adolescents. Only 15% of the chiropractors wrote reports about their pediatric patients to their pediatrician often or regularly; 90% of the responding chiropractors stated they rarely or never refer to a pediatric specialist, and 80% of the chiropractors have never or have rarely been invited to attend medical congresses or to teach the pediatric health care community about chiropractic care for children. CONCLUSION The majority of chiropractors in Switzerland treat pediatric patients, most commonly schoolchildren and adolescents for musculoskeletal disorders.
Collapse
|
9
|
Young MD, Young JL. Conservative Care of Pediatric Acquired Torticollis: A Report of 2 Cases. J Chiropr Med 2017; 16:252-256. [PMID: 29097957 DOI: 10.1016/j.jcm.2017.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 03/23/2017] [Accepted: 03/28/2017] [Indexed: 01/19/2023] Open
Abstract
Objective The purpose of this case report is to describe the conservative management of 2 cases of acquired torticollis in children under 3 years of age. Clinical Features Both patients awoke with painful, stiff, twisted necks the day after play in a bouncy house. Range of motion was limited, and hypertonic muscles were palpated. Their neurologic and physical evaluation was consistent with a diagnosis of acquired torticollis of musculoskeletal origin. Intervention and Outcomes Both children were treated with chiropractic care that consisted of light myofascial release, use of an Activator instrument, and home stretching. Patients improved in pain and range of motion immediately posttreatment and returned to normal ranges in 1 or 2 visits. Conclusion Chiropractic care provided relief for these 2 young patients with acquired torticollis.
Collapse
Affiliation(s)
- Morgan D Young
- Research Department, Palmer College of Chiropractic West, San Jose, California
| | - Jessie L Young
- Los Gatos Chiropractic and Wellness Center, Los Gatos, California
| |
Collapse
|
10
|
Best Practices for Chiropractic Care of Children: A Consensus Update. J Manipulative Physiol Ther 2016; 39:158-68. [PMID: 27040034 DOI: 10.1016/j.jmpt.2016.02.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/22/2016] [Accepted: 02/23/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Chiropractic care is the most common complementary and integrative medicine practice used by children in the United States, and it is used frequently by children internationally as well. The purpose of this project was to update the 2009 recommendations on best practices for chiropractic care of children. METHODS A formal consensus process was completed based on the existing recommendations and informed by the results of a systematic review of relevant literature from January 2009 through March 2015. The primary search question for the systematic review was, "What is the effectiveness of chiropractic care, including spinal manipulation, for conditions experienced by children (<18 years of age)?" A secondary search question was, "What are the adverse events associated with chiropractic care including spinal manipulation among children (<18 years of age)?" The consensus process was conducted electronically, by e-mail, using a multidisciplinary Delphi panel of 29 experts from 5 countries and using the RAND Corporation/University of California, Los Angeles, consensus methodology. RESULTS Only 2 statements from the previous set of recommendations did not reach 80% consensus on the first round, and revised versions of both were agreed upon in a second round. CONCLUSIONS All of the seed statements in this best practices document achieved a high level of consensus and thus represent a general framework for what constitutes an evidence-based and reasonable approach to the chiropractic management of infants, children, and adolescents.
Collapse
|
11
|
Dissing KB, Hartvigsen J, Wedderkopp N, Hestbæk L. Conservative care with or without manipulative therapy in the management of back and neck pain in Danish children aged 9-15. Study protocol for a randomized controlled trial. Chiropr Man Therap 2016; 24:5. [PMID: 26823970 PMCID: PMC4730742 DOI: 10.1186/s12998-016-0086-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 01/13/2016] [Indexed: 01/06/2023] Open
Abstract
Background Complaints in the musculoskeletal system often start early in life and back and neck pain in children are well-established predictors for similar problems in adulthood. Despite lack of evidence of effectiveness, manipulative therapy is one of the most commonly used treatment modalities for back and neck pain in children. The primary objective of this study is to evaluate the effectiveness of manipulative therapy when added to an approach consisting of manual soft tissue treatment, exercises and advice as needed, in children aged 9–15 complaining of back and neck pain. Method The project is nested in the Childhood Health, Activity and Motor Performance School Study, which includes around 1200 children aged 9–15, who were all invited to participate in this randomized controlled trial in case they experienced back and/or neck pain during the two year inclusion period. Parents received text messages (SMS) on a weekly basis inquiring about the child’s musculoskeletal pain. If pain was reported, the child was evaluated for inclusion into the trial and, if eligible, randomized into one of two intervention groups:Pragmatic advice, manual soft tissue treatment and exercises The above plus manipulative therapy
By the end of data collection 237 children were included in the study. The primary outcome measure is number of recurrences of back and neck pain during the follow-up period (3–27 months). Secondary outcome measures are average duration of complaint time for each episode, total duration of complaint time, global perceived effect after two weeks, and change in pain intensity after 2 weeks. Baseline information includes quality of life, expectations to treatment, expectations to future course, age, gender, social class and physical education at school. Discussion For most common non-traumatic musculoskeletal complaints no standardized and evidence based treatment strategy exists. We want to evaluate the effectiveness of manipulative therapy in addition to an approach consisting of manual soft tissue treatment, exercises and advice as needed, in children aged 9–15 complaining of back and neck pain. To our knowledge this is the first large scale randomized controlled trial investigating the effectiveness of commonly used treatments for back and neck pain in children. Trial registration ClinicalTrials NCT01504698 Electronic supplementary material The online version of this article (doi:10.1186/s12998-016-0086-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Kristina Boe Dissing
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark ; Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, DK-5230 Odense M, Denmark
| | - Niels Wedderkopp
- Institute of Regional Health Services Research, University of Southern Denmark, Winsloewparken 193, DK-5000 Odense C, Denmark ; Orthopaedic Department Hospital of Lillebaelt, Sports Medicine Clinic, Østre Hougvej 55, DK-5500 Middelfart, Denmark
| | - Lise Hestbæk
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark ; Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, DK-5230 Odense M, Denmark
| |
Collapse
|
12
|
Todd AJ, Carroll MT, Robinson A, Mitchell EKL. Adverse Events Due to Chiropractic and Other Manual Therapies for Infants and Children: A Review of the Literature. J Manipulative Physiol Ther 2014; 38:699-712. [PMID: 25439034 DOI: 10.1016/j.jmpt.2014.09.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/19/2014] [Accepted: 08/28/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to review the literature for cases of adverse events in infants and children treated by chiropractors or other manual therapists, identifying treatment type and if a preexisting pathology was present. METHOD English language, peer-reviewed journals and non-peer-reviewed case reports discussing adverse events (ranging from minor to serious) were systematically searched from inception of the relevant searchable bibliographic databases through March 2014. Articles not referring to infants or children were excluded. RESULTS Thirty-one articles met the selection criteria. A total of 12 articles reporting 15 serious adverse events were found. Three deaths occurred under the care of various providers (1 physical therapist, 1 unknown practitioner, and 1 craniosacral therapist) and 12 serious injuries were reported (7 chiropractors/doctors of chiropractic, 1 medical practitioner, 1 osteopath, 2 physical therapists, and 1 unknown practitioner). High-velocity, extension, and rotational spinal manipulation was reported in most cases, with 1 case involving forcibly applied craniosacral dural tension and another involving use of an adjusting instrument. Underlying preexisting pathology was identified in a majority of the cases. CONCLUSION Published cases of serious adverse events in infants and children receiving chiropractic, osteopathic, physiotherapy, or manual medical therapy are rare. The 3 deaths that have been reported were associated with various manual therapists; however, no deaths associated with chiropractic care were found in the literature to date. Because underlying preexisting pathology was associated in a majority of reported cases, performing a thorough history and examination to exclude anatomical or neurologic anomalies before applying any manual therapy may further reduce adverse events across all manual therapy professions.
Collapse
Affiliation(s)
- Angela J Todd
- Chiropractor, Private Practice; PhD Student, Department of Rural and Indigenous Health, Faculty of Medicine, Nursing and Health Sciences, School Of Rural Health, Moe, Victoria, Australia.
| | - Matthew T Carroll
- Senior Research Fellow, School of Rural Health-Churchill, Monash University, Churchill, Australia
| | - Anske Robinson
- Lecturer, Department of Rural and Indigenous Health, School of Rural Health, Monash University, Moe, Australia
| | - Eleanor K L Mitchell
- Lecturer, Department of Rural and Indigenous Health, School of Rural Health, Monash University, Moe, Australia; Lecturer, School of Rural Health-East Gippsland, Monash University, Bairnsdale, Australia
| |
Collapse
|
13
|
Alcantara J, Alcantara J, Alcantara J. Letters to the editor. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2013; 57:97-98. [PMID: 23476080 PMCID: PMC3581016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Joel Alcantara
- Chair of Pediatric Research Life Chiropractic College West, Hayward, CA and Research Director, the International Chiropractic Pediatric Association, Media, PA, USA
| | | | | |
Collapse
|
14
|
Physical therapy management of congenital muscular torticollis: an evidence-based clinical practice guideline: from the Section on Pediatrics of the American Physical Therapy Association. Pediatr Phys Ther 2013; 25:348-94. [PMID: 24076627 DOI: 10.1097/pep.0b013e3182a778d2] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Congenital muscular torticollis (CMT) is an idiopathic postural deformity evident shortly after birth, typically characterized by lateral flexion of the head to one side and cervical rotation to the opposite side due to unilateral shortening of the sternocleidomastoid muscle. CMT may be accompanied by other neurological or musculoskeletal conditions. KEY POINTS Infants with CMT are frequently referred to physical therapists (PTs) to treat their asymmetries. This evidence-based clinical practice guideline (CPG) provides guidance on which infants should be monitored, treated, and/or referred, and when and what PTs should treat. Based upon critical appraisal of literature and expert opinion, 16 action statements for screening, examination, intervention, and follow-up are linked with explicit levels of evidence. The CPG addresses referral, screening, examination and evaluation, prognosis, first-choice and supplemental interventions, consultation, discharge, follow-up, suggestions for implementation and compliance audits, flow sheets for referral paths and classification of CMT severity, and research recommendations.
Collapse
|
15
|
Dobson D, Lucassen PLBJ, Miller JJ, Vlieger AM, Prescott P, Lewith G. Manipulative therapies for infantile colic. Cochrane Database Syst Rev 2012; 12:CD004796. [PMID: 23235617 DOI: 10.1002/14651858.cd004796.pub2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Infantile colic is a common disorder, affecting around one in six families, and in 2001 was reported to cost the UK National Health Service in excess of £65 million per year (Morris 2001). Although it usually remits by six months of age, there is some evidence of longer-term sequelae for both children and parents.Manipulative therapies, such as chiropractic and osteopathy, have been suggested as interventions to reduce the severity of symptoms. OBJECTIVES To evaluate the results of studies designed to address efficacy or effectiveness of manipulative therapies (specifically, chiropractic, osteopathy and cranial manipulation) for infantile colic in infants less than six months of age. SEARCH METHODS We searched following databases: CENTRAL (2012, Issue 4), MEDLINE (1948 to April Week 3 2012), EMBASE (1980 to 2012 Week 17), CINAHL (1938 to April 2012), PsycINFO (1806 to April 2012), Science Citation Index (1970 to April 2012), Social Science Citation Index (1970 to April 2012), Conference Proceedings Citation Index - Science (1990 to April 2012) and Conference Proceedings Citation Index - Social Science & Humanities (1970 to April 2012). We also searched all available years of LILACS, PEDro, ZETOC, WorldCat, TROVE, DART-Europe, ClinicalTrials.gov and ICTRP (May 2012), and contacted over 90 chiropractic and osteopathic institutions around the world. In addition, we searched CentreWatch, NRR Archive and UKCRN in December 2010. SELECTION CRITERIA Randomised trials evaluating the effect of chiropractic, osteopathy or cranial osteopathy alone or in conjunction with other interventions for the treatment of infantile colic. DATA COLLECTION AND ANALYSIS In pairs, five of the review authors (a) assessed the eligibility of studies against the inclusion criteria, (b) extracted data from the included studies and (c) assessed the risk of bias for all included studies. Each article or study was assessed independently by two review authors. One review author entered the data into Review Manager software and the team's statistician (PP) reviewed the chosen analytical settings. MAIN RESULTS We identified six studies for inclusion in our review, representing a total of 325 infants. There were three further studies that we could not find information about and we identified three other ongoing studies. Of the six included studies, five were suggestive of a beneficial effect and one found no evidence that manipulative therapies had any beneficial effect on the natural course of infantile colic. Tests for heterogeneity imply that there may be some underlying difference between this study and the other five.Five studies measured daily hours of crying and these data were combined, suggesting that manipulative therapies had a significant effect on infant colic - reducing average crying time by one hour and 12 minutes per day (mean difference (MD) -1.20; 95% confidence interval (CI) -1.89 to -0.51). This conclusion is sustained even when considering only studies with a low risk of selection bias (sequence generation and allocation concealment) (MD -1.24; 95% CI -2.16 to -0.33); those with a low risk of attrition bias (MD -1.95; 95% CI -2.96 to -0.94), or only those studies that have been published in the peer-reviewed literature (MD -1.01; 95% CI -1.78 to -0.24). However, when combining only those studies with a low risk of performance bias (parental 'blinding'), the improvement in daily crying hours was not statistically significant (MD -0.57; 95% CI -2.24 to 1.09).One study considered whether the reduction in crying time was clinically significant. This found that a greater proportion of parents of infants receiving a manipulative therapy reported clinically significant improvements than did parents of those receiving no treatment (reduction in crying to less than two hours: odds ratio (OR) 6.33; 95% CI 1.54 to 26.00; more than 30% reduction in crying: OR 3.70; 95% CI 1.15 to 11.86).Analysis of data from three studies that measured 'full recovery' from colic as reported by parents found that manipulative therapies did not result in significantly higher proportions of parents reporting recovery (OR 11.12; 95% CI 0.46 to 267.52).One study measured infant sleeping time and found manipulative therapy resulted in statistically significant improvement (MD 1.17; 95% CI 0.22 to 2.12).The quality of the studies was variable. There was a generally low risk of selection bias but only two of the six studies were evaluated as being at low risk of performance bias, three at low risk of detection bias and one at low risk of attrition bias.One of the studies recorded adverse events and none were encountered. However, with only a sample of 325 infants, we have too few data to reach any definitive conclusions about safety. AUTHORS' CONCLUSIONS The studies included in this meta-analysis were generally small and methodologically prone to bias, which makes it impossible to arrive at a definitive conclusion about the effectiveness of manipulative therapies for infantile colic.The majority of the included trials appeared to indicate that the parents of infants receiving manipulative therapies reported fewer hours crying per day than parents whose infants did not, based on contemporaneous crying diaries, and this difference was statistically significant. The trials also indicate that a greater proportion of those parents reported improvements that were clinically significant. However, most studies had a high risk of performance bias due to the fact that the assessors (parents) were not blind to who had received the intervention. When combining only those trials with a low risk of such performance bias, the results did not reach statistical significance. Further research is required where those assessing the treatment outcomes do not know whether or not the infant has received a manipulative therapy.There are inadequate data to reach any definitive conclusions about the safety of these interventions.
Collapse
Affiliation(s)
- Dawn Dobson
- Complementary and Integrated Medicine Research Unit, Department of Primary Care, University of Southampton, Southampton,UK. d dobson
| | | | | | | | | | | |
Collapse
|
16
|
Gleberzon BJ, Arts J, Mei A, McManus EL. The use of spinal manipulative therapy for pediatric health conditions: a systematic review of the literature. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2012; 56:128-41. [PMID: 22675226 PMCID: PMC3364062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION This study had two purposes. These were: (i) to conduct a search of the literature between 2007 and 2011 investigating the use of spinal manipulative therapy (SMT) for pediatric health conditions and (ii) to perform a systematic review of eligible retrieved clinical trials. METHODS The Index of Chiropractic Literature and PubMed were electronically searched using appropriate search words and MeSH terms, respectively, as well as reference tracking of previous reviews. Studies that met the inclusion criteria were evaluated using an instrument that assessed their methodological quality. RESULTS Sixteen clinical trials were found that met the inclusion criteria and were scored. DISCUSSION Six clinical trials investigated the effectiveness of SMT on colic, two each on asthma and enuresis, and one each on hip extension, otitis media, suboptimal breastfeeding, autism, idiopathic scoliosis and jet lag. None investigated the effectiveness of SMT on spinal pain. CONCLUSION Studies that monitored both subjective and objective outcome measures of relevance to both patients and parents tended to report the most favorable response to SMT, especially among children with asthma. Many studies reviewed suffered from several methodological limitations. Further research is clearly required in this area of chiropractic health care, especially with respect to the clinical effectiveness of SMT on pediatric back pain.
Collapse
Affiliation(s)
- Brian J Gleberzon
- Professor & Chair, Department of Chiropractic Therapeutics, CMCC 6100 Leslie St, Toronto, Ontario. M2H 3J1
| | | | | | | |
Collapse
|
17
|
Marchand AM. Chiropractic care of children from birth to adolescence and classification of reported conditions: an internet cross-sectional survey of 956 European chiropractors. J Manipulative Physiol Ther 2012; 35:372-80. [PMID: 22627100 DOI: 10.1016/j.jmpt.2012.04.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 11/01/2011] [Accepted: 12/10/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Few studies have addressed the practice of chiropractic care of children in Europe. No systematic classification of conditions currently exists in chiropractic pediatrics. The objective of this study was to investigate characteristics of clinical chiropractic practice, including the age of pediatric patients, the number of reports of negative side effects (NSEs), the opinions of doctors of chiropractic on treatment options by patient age groups, the conditions seen and the number of treatment sessions delivered by conditions and by patient age. METHODS An Internet cross-sectional survey was conducted in 20 European countries with 4109 doctors of chiropractic invited to reply. The 19 national associations belonging to the European Chiropractic Union and the Danish Chiropractic Association were asked to participate. Respondents were asked to self-report characteristics of their practices. RESULTS Of the 956 (23.3%) participating chiropractors, 921 reported 19821 pediatric patients per month. Children represented 8.1% of chiropractors' total patient load over the last year. A total of 557 (534 mild, 23 moderate, and 0 severe) negative (adverse) side effects were reported for an estimated incidence of 0.23%. On the given treatment statements, chiropractors reported varying agreement and disagreement rates based on patient age. The 8309 answers on conditions were grouped into skeletal (57.0%), neurologic (23.7%), gastrointestinal (12.4%), infection (3.5%), genitourinary (1.5%), immune (1.4%), and miscellaneous conditions (0.5%). The number of treatment sessions delivered varied according to the condition and the patient age. CONCLUSION This study showed that European chiropractors are active in the care of pediatric patients. Reported conditions were mainly skeletal and neurologic complaints. In this survey, no severe NSEs were reported, and mild NSEs were infrequent.
Collapse
|
18
|
Ndetan H, Evans MW, Hawk C, Walker C. Chiropractic or osteopathic manipulation for children in the United States: an analysis of data from the 2007 National Health Interview Survey. J Altern Complement Med 2012; 18:347-53. [PMID: 22384933 DOI: 10.1089/acm.2011.0268] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES The aim of this study was to describe use of chiropractic and/or osteopathic manipulation by children in the United States along with the specific health conditions for which they sought care. METHODS The study was a secondary data analysis of the National Health Interview Survey 2007, Child Alternative Medicine file as well as the Child Core Sample. National population estimates were generated for reported use of chiropractic or osteopathic manipulation (C/OM) by children for specific health conditions. Odds ratios (OR) and 95% confidence intervals (CI) were generated from binary logistic regression models that assessed the likelihood that children of specific characteristics would use this therapy. RESULTS National estimates indicated that 2.3 million children (2.3%) in the United States had used C/OM in 2007. C/OM was the most common complementary and alternative medicine procedure. Children aged 12-18 years were more likely to have seen these providers than were younger age groups (OR=3.4 [95% CI, 2.1-5.5]). Homeopathy (1.2%), massage (1.0), and naturopathy (0.3%) were the next most common procedures. The most common complaints were back and neck pain. Other conditions for which children were seen included other musculoskeletal conditions, sinusitis, allergies, and nonmigraine headaches. Racial categories did not differ significantly regarding use of manipulation, but those children with both mother and father in the household were more likely to have used this form of care (OR=1.7 [95% CI, 1.1-2.6]). CONCLUSIONS C/OM is primarily used for back and neck pain, which is increasing in prevalence in children. Teens are more likely to use it than are younger children.
Collapse
|
19
|
Posadzki P, Ernst E. Is spinal manipulation effective for paediatric conditions? An overview of systematic reviews. ACTA ACUST UNITED AC 2012. [DOI: 10.1111/j.2042-7166.2011.01136.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
20
|
Complementary medicine for children and young people who have attention deficit hyperactivity disorder. Curr Opin Psychiatry 2011; 24:291-300. [PMID: 21602686 DOI: 10.1097/yco.0b013e32834776bd] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Despite effectiveness of medication in treating children and young people who have attention deficit hyperactivity disorder (ADHD), concerns about the effects of medication on children's developing brains, adverse side-effects, possibility of long-term use, and compliance issues have all contributed to the continuing search for alternative therapies. This article reviews the latest scientific evidence of the effectiveness and safety of these treatments in ADHD. RECENT FINDINGS Although there is evidence from a large randomized controlled study that neurofeedback has positive effects on reducing children's symptoms of ADHD, most recent randomized controlled trials have generally yielded negative results. Some positive results exist from a pilot study of repetitive transcranial magnetic stimulation. However, the sample size was far too small to enable any conclusions to be drawn about the evidence. Findings from the recent randomized controlled trials of supplements of essential fatty acids in children who have ADHD clearly demonstrated lack of superiority compared with placebo. SUMMARY Notwithstanding efforts made to increase the scientific rigor of previous studies, more recent studies have generally been unsuccessful in demonstrating adequate treatment effects of complementary medicine on children who have ADHD. Currently, there is no proof that complementary medicine provides a better alternative for children who have ADHD than treatments that are currently available within multimodal therapy.
Collapse
|
21
|
Vallone SA, Miller J, Larsdotter A, Barham-Floreani J. Chiropractic approach to the management of children. CHIROPRACTIC & OSTEOPATHY 2010; 18:16. [PMID: 20525200 PMCID: PMC2887887 DOI: 10.1186/1746-1340-18-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Accepted: 06/02/2010] [Indexed: 05/29/2023]
Abstract
BACKGROUND Chiropractic (Greek: done by hand) is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. There is an emphasis on manual techniques, including joint adjustment and/or manipulation, with a particular focus on joint subluxation (World Health Organization 2005) or mechanical lesion and restoring function. The chiropractor's role in wellness care, prevention and treatment of injury or illness is based on education in anatomy and physiology, nutrition, exercise and healthy lifestyle counseling as well as referral to other health practitioners. Depending on education, geographic location, scope of practice, as well as consumer preference, chiropractors may assume the role of primary care for families who are pursuing a more natural and holistic approach to health care for their families. OBJECTIVE To present a perspective on current management of the paediatric patient by members of the chiropractic profession and to make recommendations as to how the profession can safely and effectively manage the paediatric patient. DISCUSSION The chiropractic profession holds the responsibility of ethical and safe practice and requires the cultivation and mastery of both an academic foundation and clinical expertise that distinguishes chiropractic from other disciplines.Research into the effectiveness of chiropractic care for paediatric patients has lagged behind that of adult care, but this is being addressed through educational programs where research is now being incorporated into academic tracks to attain advanced chiropractic degrees. CONCLUSION Studies in the United States show that over the last several decades, chiropractors are the most common complementary and alternative medicine providers visited by children and adolescents. Chiropractors continue to seek integration with other healthcare providers to provide the most appropriate care for their paediatric patients.In the interest of what is best for the paediatric population in the future, collaborative efforts for research into the effectiveness and safety of chiropractic care as an alternative healthcare approach for children should be negotiated and are welcomed.
Collapse
Affiliation(s)
- Sharon A Vallone
- Private Practice, Connecticut, USA
- Kentuckiana Children's Center, Louisville, KY, USA
- Post Graduate Faculty, International College of Chiropractic Pediatrics, Arlington, VA 22201, USA
| | - Joyce Miller
- Lead Tutor MSc Advanced Practice Paediatrics, Bournemouth University, UK
| | | | | |
Collapse
|
22
|
Humphreys BK. Possible adverse events in children treated by manual therapy: a review. CHIROPRACTIC & OSTEOPATHY 2010; 18:12. [PMID: 20525194 PMCID: PMC2890687 DOI: 10.1186/1746-1340-18-12] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 06/02/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND Pediatric manual therapy is controversial within the medical community particularly with respect to adverse events. Pediatric manual therapy (Ped MT) is commonly used by a number of professions such as chiropractors, osteopaths and naturopaths for a variety of treatments in children. Ped MT interventions range from advice, light touch, massage, through to mobilisation and high velocity spinal manipulation. However, current evidence related to adverse events associated with Ped MT is not well understood. OBJECTIVE To update the clinical research literature from the 2007 report by Vohra, Johnston, Cramer and Humphreys on possible adverse events in children treated by spinal manipulation. METHODS A review of the clinical research literature from June 2004 until January 2010 as reported in MEDLINE, PubMed and PubMed Central for adverse events specifically related to the treatment of pediatric cases by manual therapy. RESULTS Only three new clinical studies, one systematic review with meta-analysis and one evidence report were identified. Two clinical studies reported on chiropractic care and one on osteopathic spinal manipulation in children. The systematic review investigated all studies of adverse events and manual therapy and was not specific for pediatric patients. The evidence review focused on effectiveness of spinal manipulation in a variety of musculoskeletal conditions. No serious or catastrophic adverse events were reported in the clinical studies or systematic review. However for adults, it has been estimated that between 0.003% and 0.13% of manual therapy treatments may result in a serious adverse event. Although mild to moderate adverse events are common in adults, an accurate estimate from high quality pediatric studies is currently not available. CONCLUSIONS There is currently insufficient research evidence related to adverse events and manual therapy. However, clinical studies and systematic reviews from adult patients undergoing manual therapy, particularly spinal manipulation report that mild to moderate adverse events are common and self limiting. However serious adverse events are rare and much less than for medication commonly prescribed for these problems. More high quality research specifically addressing adverse events and pediatric manual therapy is needed.
Collapse
Affiliation(s)
- B Kim Humphreys
- Professor Chiropractic Medicine, University of Zürich and University Orthopedic Hospital Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland.
| |
Collapse
|
23
|
Karpouzis F, Bonello R, Pollard H. Chiropractic care for paediatric and adolescent Attention-Deficit/Hyperactivity Disorder: A systematic review. CHIROPRACTIC & OSTEOPATHY 2010; 18:13. [PMID: 20525195 PMCID: PMC2891800 DOI: 10.1186/1746-1340-18-13] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 06/02/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Psychostimulants are first line of therapy for paediatric and adolescent AD/HD. The evidence suggests that up to 30% of those prescribed stimulant medications do not show clinically significant outcomes. In addition, many children and adolescents experience side-effects from these medications. As a result, parents are seeking alternate interventions for their children. Complementary and alternative medicine therapies for behavioural disorders such as AD/HD are increasing with as many as 68% of parents having sought help from alternative practitioners, including chiropractors. OBJECTIVE The review seeks to answer the question of whether chiropractic care can reduce symptoms of inattention, impulsivity and hyperactivity for paediatric and adolescent AD/HD. METHODS Electronic databases (Cochrane CENTRAL register of Controlled Trials, Cochrane Database of Systematic reviews, MEDLINE, PsycINFO, CINAHL, Scopus, ISI Web of Science, Index to Chiropractic Literature) were searched from inception until July 2009 for English language studies for chiropractic care and AD/HD. Inclusion and exclusion criteria were applied to select studies. All randomised controlled trials were evaluated using the Jadad score and a checklist developed from the CONSORT (Consolidated Standards of Reporting Trials) guidelines. RESULTS The search yielded 58 citations of which 22 were intervention studies. Of these, only three studies were identified for paediatric and adolescent AD/HD cohorts. The methodological quality was poor and none of the studies qualified using inclusion criteria. CONCLUSIONS To date there is insufficient evidence to evaluate the efficacy of chiropractic care for paediatric and adolescent AD/HD. The claim that chiropractic care improves paediatric and adolescent AD/HD, is only supported by low levels of scientific evidence. In the interest of paediatric and adolescent health, if chiropractic care for AD/HD is to continue, more rigorous scientific research needs to be undertaken to examine the efficacy and effectiveness of chiropractic treatment. Adequately-sized RCTs using clinically relevant outcomes and standardised measures to examine the effectiveness of chiropractic care verses no-treatment/placebo control or standard care (pharmacological and psychosocial care) are needed to determine whether chiropractic care is an effective alternative intervention for paediatric and adolescent AD/HD.
Collapse
Affiliation(s)
- Fay Karpouzis
- Department of Chiropractic, Faculty of Science, Macquarie University, Sydney, NSW 2109, Australia
- Macquarie Injury Management Group, Macquarie University, Sydney, NSW 2109, Australia
| | - Rod Bonello
- Department of Chiropractic, Faculty of Science, Macquarie University, Sydney, NSW 2109, Australia
- Macquarie Injury Management Group, Macquarie University, Sydney, NSW 2109, Australia
| | - Henry Pollard
- Department of Chiropractic, Faculty of Science, Macquarie University, Sydney, NSW 2109, Australia
- Macquarie Injury Management Group, Macquarie University, Sydney, NSW 2109, Australia
| |
Collapse
|
24
|
French SD, Walker BF, Perle SM. Chiropractic care for children: too much, too little or not enough? CHIROPRACTIC & OSTEOPATHY 2010; 18:17. [PMID: 20525201 PMCID: PMC2890688 DOI: 10.1186/1746-1340-18-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 06/02/2010] [Indexed: 01/15/2023]
Abstract
This editorial provides an overview of this Thematic Series of the journal titled Chiropractic Care for Children. In commissioning this series of articles we aimed to bring the busy clinician up to date with the current best evidence in key aspects of evaluation and management of chiropractic care for children. Individual articles address a chiropractic approach to the management of children, chiropractic care of musculoskeletal conditions in children and adolescents, chiropractic care of non-musculoskeletal conditions in children and adolescents, chiropractic care for attention-deficit/hyperactivity disorder and possible adverse effects from chiropractic management of children. The final article by Charlotte Leboeuf-Yde and Lise Hestbæk is an overview of the current state of the evidence and future research opportunities for chiropractic care for children. We conclude this editorial discussing the strengths and weaknesses of contemporary research relevant to chiropractic care of children and the implications for chiropractic practice.
Collapse
Affiliation(s)
- Simon D French
- Primary Care Research Unit, The University of Melbourne, Australia.
| | | | | |
Collapse
|
25
|
Ferrance RJ, Miller J. Chiropractic diagnosis and management of non-musculoskeletal conditions in children and adolescents. CHIROPRACTIC & OSTEOPATHY 2010; 18:14. [PMID: 20525197 PMCID: PMC2891801 DOI: 10.1186/1746-1340-18-14] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 06/02/2010] [Indexed: 01/15/2023]
Abstract
Background A great deal has been published in the chiropractic literature regarding the response, or lack thereof, of various common pediatric conditions to chiropractic care. The majority of that literature is of low scientific value (that is, case reports or case series). The purpose of this review is to summarize the literature from the point of view of clinicians, rather than researchers, and to discuss some additional detail of the conditions themselves. Methods Databases searched were PubMed, Mantis, Index to Chiropractic Literature, and CINAHL. Keywords were chiropractic paired with colic, crying infant, nocturnal enuresis, asthma, otitis media and attention deficit hyperactivity disorder. Results Most of the published literature centers around case reports or series. The more scientifically rigorous studies show conflicting results for colic and the crying infant, and there is little data to suggest improvement of otitis media, asthma, nocturnal enuresis or attention deficit hyperactivity disorder. Discussion The efficacy of chiropractic care in the treatment of non-musculoskeletal disorders has yet to be definitely proven or disproven, with the burden of proof still resting upon the chiropractic profession.
Collapse
Affiliation(s)
- Randy J Ferrance
- Hospitalist and Medical Director of Hospital-Based Quality, Riverside Tappahannock Hospital, Tappahannock, VA, USA.
| | | |
Collapse
|
26
|
Bronfort G, Haas M, Evans R, Leininger B, Triano J. Effectiveness of manual therapies: the UK evidence report. CHIROPRACTIC & OSTEOPATHY 2010; 18:3. [PMID: 20184717 PMCID: PMC2841070 DOI: 10.1186/1746-1340-18-3] [Citation(s) in RCA: 274] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Accepted: 02/25/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND The purpose of this report is to provide a succinct but comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal conditions. METHODS The conclusions are based on the results of systematic reviews of randomized clinical trials (RCTs), widely accepted and primarily UK and United States evidence-based clinical guidelines, plus the results of all RCTs not yet included in the first three categories. The strength/quality of the evidence regarding effectiveness was based on an adapted version of the grading system developed by the US Preventive Services Task Force and a study risk of bias assessment tool for the recent RCTs. RESULTS By September 2009, 26 categories of conditions were located containing RCT evidence for the use of manual therapy: 13 musculoskeletal conditions, four types of chronic headache and nine non-musculoskeletal conditions. We identified 49 recent relevant systematic reviews and 16 evidence-based clinical guidelines plus an additional 46 RCTs not yet included in systematic reviews and guidelines.Additionally, brief references are made to other effective non-pharmacological, non-invasive physical treatments. CONCLUSIONS Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain. The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and it is not effective for infantile colic and asthma when compared to sham manipulation.Massage is effective in adults for chronic low back pain and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome. In children, the evidence is inconclusive for asthma and infantile colic.
Collapse
Affiliation(s)
- Gert Bronfort
- Northwestern Health Sciences University, Bloomington, MN, USA.
| | | | | | | | | |
Collapse
|
27
|
Developmental delay syndromes: psychometric testing before and after chiropractic treatment of 157 children. J Manipulative Physiol Ther 2010; 32:660-9. [PMID: 19836603 DOI: 10.1016/j.jmpt.2009.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 05/27/2009] [Accepted: 06/08/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study presents a case series of 157 children with developmental delay syndromes, including the conditions such as dyspraxia, dyslexia, attention-deficit hyperactivity disorder, and learning disabilities who received chiropractic care. CLINICAL FEATURES A consecutive sample of 157 children aged 6 to 13 years (86 boys and 71 girls) with difficulties in reading, learning, social interaction, and school performance who met these inclusion criteria were included. INTERVENTION AND OUTCOMES Each patient received a multimodal chiropractic treatment protocol, applied kinesiology chiropractic technique. The outcome measures were a series of 8 standardized psychometric tests given to the children by a certified speech therapist pre- and posttreatment, which evaluate 20 separate areas of cognitive function, including patient- or parent-reported improvements in school performance, social interaction, and sporting activities. Individual and group data showed that at the end of treatment, the 157 children showed improvements in the 8 psychometric tests and 20 areas of cognitive function compared with their values before treatment. Their ability to concentrate, maintain focus and attention, and control impulsivity and their performance at home and school improved. CONCLUSIONS This report suggests that a multimodal chiropractic method that assesses and treats motor dysfunction reduced symptoms and enhanced the cognitive performance in this group of children.
Collapse
|
28
|
Hestbaek L, Jørgensen A, Hartvigsen J. A description of children and adolescents in Danish chiropractic practice: results from a nationwide survey. J Manipulative Physiol Ther 2010; 32:607-15. [PMID: 19836596 DOI: 10.1016/j.jmpt.2009.08.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 06/11/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to describe Danish chiropractic patients younger than 18 years. METHODS Questionnaires were mailed to all chiropractic clinics in Denmark during a randomly assigned month between September 2007 and September 2008. All patients younger than 18 years or their parents were asked to complete a questionnaire collecting information on age, presenting complaint, duration and consequences of this complaint, referral mode, and use of pain medication. RESULTS Babies were the most common pediatric patients with about one third being between 0 and 4 months of age. Infantile colic was the most common presenting complaint in this age group. For the older children, musculoskeletal problems were the most dominant complaint, ranging from 33% among the preschool children to 75% among the teenagers. These complaints were often chronic and about a third of the children older than 2 years had experienced symptoms for more than 1 year before seeing the chiropractor. These health complaints were reported to restrict activity as well as alter mood, and 39% of the 2- to 17-year olds used analgesics. There was limited referral of patients from other health care professionals. CONCLUSIONS Babies made up most of the Danish chiropractic patients younger than 18 years. Among the older children and the adolescents, musculoskeletal complaints were most common and mostly of a chronic nature. The large number of pediatric patients in chiropractic practices and the paucity of evidence of treatment effectiveness indicate the need for further research in these age groups.
Collapse
Affiliation(s)
- Lise Hestbaek
- Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark.
| | | | | |
Collapse
|
29
|
Hartvigsen J, Hestbaek L. Children and Chiropractic Care: A Window of Opportunity. J Manipulative Physiol Ther 2009; 32:603-5. [DOI: 10.1016/j.jmpt.2009.08.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Indexed: 10/20/2022]
|
30
|
Hawk C, Schneider M, Ferrance RJ, Hewitt E, Van Loon M, Tanis L. Best Practices Recommendations for Chiropractic Care for Infants, Children, and Adolescents: Results of a Consensus Process. J Manipulative Physiol Ther 2009; 32:639-47. [DOI: 10.1016/j.jmpt.2009.08.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 07/10/2009] [Indexed: 11/25/2022]
|
31
|
Dobson D, Lucassen PLBJ, Sampler S. Manipulative therapy for infantile colic. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2003. [DOI: 10.1002/14651858.cd004796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|