1
|
Gross AR, Olson KA, Pool J, Basson A, Clewley D, Dice JL, Milne N. Spinal manipulation and mobilisation in paediatrics - an international evidence-based position statement for physiotherapists. J Man Manip Ther 2024; 32:211-233. [PMID: 38855972 PMCID: PMC11216248 DOI: 10.1080/10669817.2024.2332026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/14/2024] [Indexed: 06/11/2024] Open
Abstract
INTRODUCTION An international taskforce of clinician-scientists was formed by specialty groups of World Physiotherapy - International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) & International Organisation of Physiotherapists in Paediatrics (IOPTP) - to develop evidence-based practice position statements directing physiotherapists clinical reasoning for the safe and effective use of spinal manipulation and mobilisation for paediatric populations (<18 years) with varied musculoskeletal or non-musculoskeletal conditions. METHOD A three-stage guideline process using validated methodology was completed: 1. Literature review stage (one scoping review, two reviews exploring psychometric properties); 2. Delphi stage (one 3-Round expert Delphi survey); and 3. Refinement stage (evidence-to-decision summative analysis, position statement development, evidence gap map analyses, and multilayer review processes). RESULTS Evidence-based practice position statements were developed to guide the appropriate use of spinal manipulation and mobilisation for paediatric populations. All were predicated on clinicians using biopsychosocial clinical reasoning to determine when the intervention is appropriate.1. It is not recommended to perform:• Spinal manipulation and mobilisation on infants.• Cervical and lumbar spine manipulation on children.•Spinal manipulation and mobilisation on infants, children, and adolescents for non-musculoskeletal paediatric conditions including asthma, attention deficit hyperactivity disorder, autism spectrum disorder, breastfeeding difficulties, cerebral palsy, infantile colic, nocturnal enuresis, and otitis media.2. It may be appropriate to treat musculoskeletal conditions including spinal mobility impairments associated with neck-back pain and neck pain with headache utilising:• Spinal mobilisation and manipulation on adolescents;• Spinal mobilisation on children; or• Thoracic manipulation on children for neck-back pain only.3. No high certainty evidence to recommend these interventions was available.Reports of mild to severe harms exist; however, risk rates could not be determined. CONCLUSION Specific directives to guide physiotherapists' clinical reasoning on the appropriate use of spinal manipulation or mobilisation were identified. Future research should focus on trials for priority conditions (neck-back pain) in children and adolescents, psychometric properties of key outcome measures, knowledge translation, and harms.
Collapse
Affiliation(s)
- Anita R. Gross
- Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - Kenneth A. Olson
- Northern Rehab Physical Therapy Specialists, DeKalb, Illinois, USA
| | - Jan Pool
- HU University of Applied Sciences, Epidemiologist, Emeritus Senior Researcher, Utrecht, The Netherlands
| | - Annalie Basson
- Rehabilitation Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Derek Clewley
- Doctor of Physical Therapy Division, Duke University, Durham, USA
| | - Jenifer L. Dice
- School of Physical Therapy, Texas Woman’s University, Houston, TX, USA
| | - Nikki Milne
- THINK Paediatrics Research Group, Department of Physiotherapy, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- International Organisation of Physiotherapists in Paediatrics (IOPTP)
| |
Collapse
|
2
|
Hayton T, Gross A, Basson A, Olson K, Ang O, Milne N, Pool J. Psychometric properties of clinician-reported and performance-based outcomes cited in a scoping review on spinal manipulation and mobilization for pediatric populations with diverse medical conditions: a systematic review. J Man Manip Ther 2024; 32:255-283. [PMID: 38070150 PMCID: PMC11216262 DOI: 10.1080/10669817.2023.2269038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 10/05/2023] [Indexed: 06/29/2024] Open
Abstract
INTRODUCTION Risks and benefits of spinal manipulations and mobilization in pediatric populations are a concern to the public, policymakers, and international physiotherapy governing organizations. Clinical Outcome Assessments (COA) used in the literature on these topics are contentious. The aim of this systematic review was to establish the quality of clinician-reported and performance-based COAs identified by a scoping review on spinal manipulation and mobilization for pediatric populations across diverse medical conditions. METHOD AND ANALYSIS Electronic databases, clinicaltrials.gov and Ebsco Open Dissertations were searched up to 21 October 2022. Qualitative synthesis was performed using Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines to select studies, perform data extraction, and assess risk of bias. Data synthesis used Grading of Recommendations, Assessment, Development and Evaluations (GRADE) to determine the certainty of the evidence and overall rating: sufficient (+), insufficient (-), inconsistent (±), or indeterminate (?). RESULTS Four of 17 identified COAs (77 studies, 9653 participants) with supporting psychometric research were classified as:Performance-based outcome measures: AIMS - Alberta Infant Motor Scale (n = 51); or:Clinician-reported outcome measures: LATCH - Latch, Audible swallowing, Type of nipple, Comfort, Hold (n = 10),Cobb Angle (n = 15),Postural Assessment (n = 1).AIMS had an overall sufficient (+) rating with high certainty evidence, and LATCH had an overall sufficient (+) rating with moderate certainty of evidence. For the Cobb Angle and Postural Assessment, the overall rating was indeterminate (?) with low or very low certainty of evidence, respectively. CONCLUSION The AIMS and LATCH had sufficient evidence to evaluate the efficacy of spinal manipulation and mobilization for certain pediatric medical conditions. Further validation studies are needed for other COAs.
Collapse
Affiliation(s)
- Tricia Hayton
- School of Rehabilitation, McMaster University, Hamilton, Canada
| | - Anita Gross
- School of Rehabilitation, McMaster University, Hamilton, Canada
| | - Annalie Basson
- Faculty of Health Sciences, Physiotherapy Department, University of Witwatersrand, Johannesburg, South Africa
| | - Ken Olson
- International Federation of Orthopaedic Manipulative Physical Therapist, USA
| | - Oliver Ang
- Integrative Health and Wellbeing Research Program, Earl E. Bakken Center for Spirituality and Healing, University of Minnesota, Minneapolis, Minnesota
| | - Nikki Milne
- Doctor of Physiotherapy Program, Bond University, Queensland, Australia
| | - Jan Pool
- Institute of Human Movement Studies, University of Applied Sciences, Utretcht, The Netherlands
| |
Collapse
|
3
|
Dice JL, Brismée JM, Froment FP, Henricksen J, Sherwin R, Pool J, Milne N, Clewley D, Basson A, Olson KA, Gross AR. Spinal manipulation and mobilisation among infants, children, and adolescents: an international Delphi survey of expert physiotherapists. J Man Manip Ther 2024; 32:284-294. [PMID: 38484120 PMCID: PMC11216234 DOI: 10.1080/10669817.2024.2327782] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/04/2024] [Indexed: 06/29/2024] Open
Abstract
OBJECTIVE The aim of this study was to establish international consensus regarding the use of spinal manipulation and mobilisation among infants, children, and adolescents among expert international physiotherapists. METHODS Twenty-six international expert physiotherapists in manual therapy and paediatrics voluntarily participated in a 3-Round Delphi survey to reach a consensus via direct electronic mail solicitation using Qualtrics®. Consensus was defined a-priori as ≥75% agreement on all items with the same ranking of agreement or disagreement. Round 1 identified impairments and conditions where spinal mobilisation and manipulation might be utilised. In Rounds 2 and 3, panelists agreed or disagreed using a 4-point Likert scale. RESULTS Eleven physiotherapists from seven countries representing five continents completed all three Delphi rounds. Consensus regarding spinal mobilisation or manipulation included:Manipulation is not recommended: (1) for infants across all conditions, impairments, and spinal levels; and (2) for children and adolescents across most conditions and spinal levels.Manipulation may be recommended for adolescents to treat spinal region-specific joint hypomobility (thoracic, lumbar), and pain (thoracic).Mobilisation may be recommended for children and adolescents with hypomobility, joint pain, muscle/myofascial pain, or stiffness at all spinal levels. CONCLUSION Consensus revealed spinal manipulation should not be performed on infants regardless of condition, impairment, or spinal level. Additionally, the panel agreed that manipulation may be recommended only for adolescents to treat joint pain and joint hypomobility (limited to thoracic and/or lumbar levels). Spinal mobilisation may be recommended for joint hypomobility, joint pain, muscle/myofascial pain, and muscle/myofascial stiffness at all spinal levels among children and adolescents.
Collapse
Affiliation(s)
- Jenifer L. Dice
- Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- School of Physical Therapy, Texas Woman’s University, Houston, TX, USA
| | - Jean-Michel Brismée
- Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Frédéric P. Froment
- Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- President, International Academy of Musculoskeletal Physiotherapy, Paris, France
| | - Janis Henricksen
- School of Physical Therapy, University of St. Augustine, Dallas, TX, USA
| | - Rebecca Sherwin
- Physical Therapy Department, NELA Rehabilitation, West Monroe, Louisiana, USA
- Doctor of Physical Therapy Program, Hauser School of Physical Therapy, University of the Cumberlands, Williamsburg, KY, USA
| | - Jan Pool
- Institute of Movement Studies, University of Applied Sciences, Utrecht, The Netherlands
| | - Nikki Milne
- THINK Paediatrics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - Derek Clewley
- Doctor of Physical Therapy Division, Duke University, Durham, NC, USA
| | - Annalie Basson
- Faculty of Health Sciences, Physiotherapy Department, University of the Witwatersrand, Johannesburg, South Africa
| | - Kenneth A. Olson
- Private Practitioner, Northern Rehab Physical Therapy Specialists, DeKalb, IL, USA
| | - Anita R. Gross
- Rehabilitation Sciences, McMaster University, Hamilton, Canada
| |
Collapse
|
4
|
Dolbec A, Doucet C, Pohlman KA, Sobczak S, Pagé I. Assessing adverse events associated with chiropractic care in preschool pediatric population: a feasibility study. Chiropr Man Therap 2024; 32:9. [PMID: 38481318 PMCID: PMC10938841 DOI: 10.1186/s12998-024-00529-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/23/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Manual therapies are commonly used by healthcare professionals when caring for children. However, few prospective studies have evaluated their adverse events (AEs). This study aims to assess the feasibility of a pragmatic prospective study aiming to report the immediate and delayed (48-hours post-treatment) AEs associated with manual therapies in children aged 5 or younger. Preliminary data on AEs frequency are also reported. METHODS Between July 2021 and March 2022, chiropractors were recruited through purposive sampling and via a dedicated Facebook group for Quebec chiropractors interested in pediatrics. Legal guardians of patients aged 5 or younger were invited to fill out an online information and consent form. AEs were collected using the SafetyNET reporting system, which had been previously translated by the research team. Immediate AEs were collected through a questionnaire filled out by the legal guardian immediately after the treatment, while delayed AEs were collected through a questionnaire sent by email to the legal guardian 48 h after the treatment. Feasibility was assessed qualitatively through feedback from chiropractors and quantitatively through recruitment data. RESULTS Overall, a total of 28 chiropractors expressed interest following the Facebook publication, and 5 participated. An additional two chiropractors were enrolled through purposive sampling. In total, 80 legal guardians consented to their child's participation, and data from 73 children were included for the analysis of AEs. At least one AE was reported in 30% of children (22/73), and AEs were mainly observed immediately following the treatment (16/22). The most common AEs were irritability/crying (11 children) or fatigue/tiredness (11 children). Feasibility analysis demonstrated that regular communication between the research team and clinicians, as well as targeting clinicians who showed great interest in pediatrics, were key factors for successful research. CONCLUSION Results suggest that it is feasible to conduct a prospective pragmatic study evaluating AEs associated with manual therapies in private practices. Direct communication with the clinicians, a strategic clinicians' recruitment plan, and the resulting administrative burden should be considered in future studies. A larger study is required to confirm the frequency of AEs reported in the current study. TRIAL REGISTRATION ClinicalTrials.gov., NCT05409859, Registered on June 3 2022. https://clinicaltrials.gov/study/NCT05409859 .
Collapse
Affiliation(s)
- Anne Dolbec
- Département d'anatomie, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, G8Z 4M3, Trois-Rivières, Québec, Canada
- Groupe de recherche sur les affections neuromusculosquelettiques (GRAN), Université du Québec à Trois-Rivières, 3351 Boul. des Forges, G8Z 4M3, Trois-Rivières, Québec, Canada
| | - Chantale Doucet
- Département de chiropratique, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, G8Z 4M3, Trois-Rivières, Québec, Canada
| | - Katherine A Pohlman
- Research Center, Parker University, 2540 Walnut Hill Lane, 75229, Dallas, TX, USA
| | - Stéphane Sobczak
- Département d'anatomie, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, G8Z 4M3, Trois-Rivières, Québec, Canada
- Groupe de recherche sur les affections neuromusculosquelettiques (GRAN), Université du Québec à Trois-Rivières, 3351 Boul. des Forges, G8Z 4M3, Trois-Rivières, Québec, Canada
- Chaire de recherche en anatomie fonctionnelle, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, G8Z 4M3, Trois-Rivières, Québec, Canada
| | - Isabelle Pagé
- Département de chiropratique, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, G8Z 4M3, Trois-Rivières, Québec, Canada.
- Centre Interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSS-CN), 525 Boul. Wilfrid-Hamel, G1M 2S8, Québec, Québec, Canada.
- Groupe de recherche sur les affections neuromusculosquelettiques (GRAN), Université du Québec à Trois-Rivières, 3351 Boul. des Forges, G8Z 4M3, Trois-Rivières, Québec, Canada.
| |
Collapse
|
5
|
Keating G, Hawk C, Amorin-Woods L, Amorin-Woods D, Vallone S, Farabaugh R, Todd A, Ferrance R, Young J, O'Neill Bhogal S, Sexton H, Alevaki H, Miller J, Parkin-Smith G, Schielke A, Robinson A, Thompson R. Clinical Practice Guideline for Best Practice Management of Pediatric Patients by Chiropractors: Results of a Delphi Consensus Process. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:216-232. [PMID: 37902954 PMCID: PMC10954607 DOI: 10.1089/jicm.2023.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Objective: To build upon existing recommendations on best practices for chiropractic management of children by conducting a formal consensus process and best evidence synthesis. Design: Best practice guide based on recommendations from current best available evidence and formal consensus of a panel of experienced practitioners, consumers, and experts for chiropractic management of pediatric patients. Methods: Synthesis of results of a literature search to inform the development of recommendations from a multidisciplinary steering committee, including experts in pediatrics, followed by a formal Delphi panel consensus process. Results: The consensus process was conducted June to August 2022. All 60 panelists completed the process and reached at least 80% consensus on all recommendations after three Delphi rounds. Recommendations for best practices for chiropractic care for children addressed these aspects of the clinical encounter: patient communication, including informed consent; appropriate clinical history, including health habits; appropriate physical examination procedures; red flags/contraindications to chiropractic care and/or spinal manipulation; aspects of chiropractic management of pediatric patients, including infants; modifications of spinal manipulation and other manual procedures for pediatric patients; appropriate referral and comanagement; and appropriate health promotion and disease prevention practices. Conclusion: This set of recommendations represents a general framework for an evidence-informed and reasonable approach to the management of pediatric patients by chiropractors.
Collapse
Affiliation(s)
- Genevieve Keating
- Fielding Graduate University, Santa Barbara, CA, USA
- Private Practice, Melbourne, Australia
| | - Cheryl Hawk
- US-Clinical Compass, Lexington SC, USA
- Texas Chiropractic College, TX, USA
| | - Lyndon Amorin-Woods
- School of Allied Health, Murdoch University, Murdoch, Australia
- Private Practice, Perth, Australia
| | - Deisy Amorin-Woods
- Edith Cowan University, Joondalup, Australia
- Private Practice, Insight Counselling, Perth, Australia
| | | | - Ronald Farabaugh
- Advanced Medicine Integration Group, Columbus, OH, USA
- Clinical Compass, Columbus, OH, USA
| | - Angela Todd
- Private Practice, Sale, Australia
- Aus-ACA, Sale, Australia
| | | | | | | | | | | | - Joyce Miller
- Anglo European College of Chiropractic, Bournemouth, United Kingdom
| | - Gregory Parkin-Smith
- Private Practice, Perth, Australia
- School of Allied Health, Murdoch University, Murdoch, Australia
| | | | | | - Robyn Thompson
- Private Practice, The Thompson Method Breastfeeding, Melbourne, Australia
- Australian Catholic University, Fitzroy, Australia
| |
Collapse
|
6
|
Hayes R, Imbeau C, Pohlman KA, Blanchette MA, Doucet C. Chiropractic care and research priorities for the pediatric population: a cross-sectional survey of Quebec chiropractors. Chiropr Man Therap 2023; 31:42. [PMID: 37752493 PMCID: PMC10523689 DOI: 10.1186/s12998-023-00514-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Chiropractors commonly treat pediatric patients within their private practices. The objectives of this study were (1) to identify the treatment techniques and health advice used by Quebec chiropractors with pediatric patients; (2) to explore the research priorities of Quebec chiropractors for the pediatric population; and (3) to identify Quebec chiropractors' training in the field of pediatric chiropractics. METHODS A web-based cross-sectional survey was conducted among all licensed Quebec chiropractors (Qc, Canada). Descriptive statistics were used to analyze all quantitative variables. RESULTS The results showed that among the 245 respondents (22.8% response rate), practitioners adapted their treatment techniques based on their patients' age group, thus using softer techniques with younger pediatric patients and slowly gravitating toward techniques used with adults when patients reached the age of six. In terms of continuing education, chiropractors reported an average of 7.87 h of training on the subject per year, which mostly came from either Quebec's College of Chiropractors (OCQ) (54.7%), written articles (46.9%) or seminars and conferences (43.7%). Both musculoskeletal (MSK) and viscerosomatic conditions were identified as high research priorities by the clinicians. CONCLUSIONS Quebec chiropractors adapt their treatment techniques to pediatric patients. In light of limited sources of continuing education in the field of pediatric chiropractics, practitioners mostly rely on the training provided by their provincial college and scientific publications. According to practitioners, future research priorities for pediatric care should focus on both MSK conditions and non-MSK conditions.
Collapse
Affiliation(s)
- Rebecca Hayes
- Département de Chiropratique, Université du Québec à Trois-Rivières (UQTR), 3351, Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada.
| | - Camille Imbeau
- Département de Chiropratique, Université du Québec à Trois-Rivières (UQTR), 3351, Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
| | | | - Marc-André Blanchette
- Département de Chiropratique, Université du Québec à Trois-Rivières (UQTR), 3351, Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
| | - Chantale Doucet
- Département de Chiropratique, Université du Québec à Trois-Rivières (UQTR), 3351, Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
| |
Collapse
|
7
|
Milne N, Longeri L, Patel A, Pool J, Olson K, Basson A, Gross AR. Spinal manipulation and mobilisation in the treatment of infants, children, and adolescents: a systematic scoping review. BMC Pediatr 2022; 22:721. [PMID: 36536328 PMCID: PMC9762100 DOI: 10.1186/s12887-022-03781-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To i) identify and map the available evidence regarding effectiveness and harms of spinal manipulation and mobilisation for infants, children and adolescents with a broad range of conditions; ii) identify and synthesise policies, regulations, position statements and practice guidelines informing their clinical use. DESIGN Systematic scoping review, utilising four electronic databases (PubMed, Embase, CINHAL and Cochrane) and grey literature from root to 4th February 2021. PARTICIPANTS Infants, children and adolescents (birth to < 18 years) with any childhood disorder/condition. INTERVENTION Spinal manipulation and mobilisation OUTCOME MEASURES: Outcomes relating to common childhood conditions were explored. METHOD Two reviewers (A.P., L.L.) independently screened and selected studies, extracted key findings and assessed methodological quality of included papers using Joanna Briggs Institute Checklist for Systematic Reviews and Research Synthesis, Joanna Briggs Institute Critical Appraisal Checklist for Text and Opinion Papers, Mixed Methods Appraisal Tool and International Centre for Allied Health Evidence Guideline Quality Checklist. A descriptive synthesis of reported findings was undertaken using a levels of evidence approach. RESULTS Eighty-seven articles were included. Methodological quality of articles varied. Spinal manipulation and mobilisation are being utilised clinically by a variety of health professionals to manage paediatric populations with adolescent idiopathic scoliosis (AIS), asthma, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), back/neck pain, breastfeeding difficulties, cerebral palsy (CP), dysfunctional voiding, excessive crying, headaches, infantile colic, kinetic imbalances due to suboccipital strain (KISS), nocturnal enuresis, otitis media, torticollis and plagiocephaly. The descriptive synthesis revealed: no evidence to explicitly support the effectiveness of spinal manipulation or mobilisation for any condition in paediatric populations. Mild transient symptoms were commonly described in randomised controlled trials and on occasion, moderate-to-severe adverse events were reported in systematic reviews of randomised controlled trials and other lower quality studies. There was strong to very strong evidence for 'no significant effect' of spinal manipulation for managing asthma (pulmonary function), headache and nocturnal enuresis, and inconclusive or insufficient evidence for all other conditions explored. There is insufficient evidence to draw conclusions regarding spinal mobilisation to treat paediatric populations with any condition. CONCLUSION Whilst some individual high-quality studies demonstrate positive results for some conditions, our descriptive synthesis of the collective findings does not provide support for spinal manipulation or mobilisation in paediatric populations for any condition. Increased reporting of adverse events is required to determine true risks. Randomised controlled trials examining effectiveness of spinal manipulation and mobilisation in paediatric populations are warranted.
Collapse
Affiliation(s)
- Nikki Milne
- grid.1033.10000 0004 0405 3820Department of Physiotherapy, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia ,International Organisation of Physiotherapists in Paediatrics, World Physiotherapy Subgroup, Queensland, Australia
| | - Lauren Longeri
- grid.1033.10000 0004 0405 3820Department of Physiotherapy, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
| | - Anokhi Patel
- grid.1033.10000 0004 0405 3820Department of Physiotherapy, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
| | - Jan Pool
- grid.5477.10000000120346234Research Group Lifestyle and Health, Institute of Human Movement Studies, University of Applied Sciences, Utrecht, The Netherlands
| | - Kenneth Olson
- International Federation of Orthopaedic Manipulative Physical Therapy and Northern Rehab Physical Therapy Specialists, Anchorage, USA
| | - Annalie Basson
- grid.11951.3d0000 0004 1937 1135University of Witwatersrand, Johannesburg, South Africa
| | - Anita R. Gross
- grid.25073.330000 0004 1936 8227McMaster University, Hamilton, Canada
| |
Collapse
|
8
|
Cordeiro Santos ML, da Silva Júnior RT, de Brito BB, França da Silva FA, Santos Marques H, Lima de Souza Gonçalves V, Costa dos Santos T, Ladeia Cirne C, Silva NOE, Oliveira MV, de Melo FF. Non-pharmacological management of pediatric functional abdominal pain disorders: Current evidence and future perspectives. World J Clin Pediatr 2022; 11:105-119. [PMID: 35433299 PMCID: PMC8985495 DOI: 10.5409/wjcp.v11.i2.105] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/19/2021] [Accepted: 02/13/2022] [Indexed: 02/06/2023] Open
Abstract
Functional abdominal pain disorders (FAPDs) are an important and prevalent cause of functional gastrointestinal disorders among children, encompassing the diagnoses of functional dyspepsia, irritable bowel syndrome, abdominal migraine, and the one not previously present in Rome III, functional abdominal pain not otherwise specified. In the absence of sufficiently effective and safe pharmacological treatments for this public problem, non-pharmacological therapies emerge as a viable means of treating these patients, avoiding not only possible side effects, but also unnecessary prescription, since many of the pharmacological treatments prescribed do not have good efficacy when compared to placebo. Thus, the present study provides a review of current and relevant evidence on non-pharmacological management of FAPDs, covering the most commonly indicated treatments, from cognitive behavioral therapy to meditation, acupuncture, yoga, massage, spinal manipulation, moxibustion, and physical activities. In addition, this article also analyzes the quality of publications in the area, assessing whether it is possible to state if non-pharmacological therapies are viable, safe, and sufficiently well-based for an appropriate and effective prescription of these treatments. Finally, it is possible to observe an increase not only in the number of publications on the non-pharmacological treatments for FAPDs in recent years, but also an increase in the quality of these publications. Finally, the sample selection of satisfactory age groups in these studies enables the formulation of specific guidelines for this age group, thus avoiding the need for adaptation of prescriptions initially made for adults, but for children use.
Collapse
Affiliation(s)
- Maria Luísa Cordeiro Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - Breno Bittencourt de Brito
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - Hanna Santos Marques
- Campus Vitória da Conquista, Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista 45083-900, Bahia, Brazil
| | | | - Talita Costa dos Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Carolina Ladeia Cirne
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Natália Oliveira e Silva
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Márcio Vasconcelos Oliveira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| |
Collapse
|
9
|
Pohlman KA, Carroll L, Tsuyuki RT, Hartling L, Vohra S. Comparison of active versus passive surveillance adverse event reporting in a paediatric ambulatory chiropractic care setting: a cluster randomised controlled trial. BMJ Open Qual 2020; 9:bmjoq-2020-000972. [PMID: 33203708 PMCID: PMC7674099 DOI: 10.1136/bmjoq-2020-000972] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 10/01/2020] [Accepted: 10/18/2020] [Indexed: 01/22/2023] Open
Abstract
Objectives This pragmatic, cluster, stratified randomised controlled trial (RCT) compared the quantity and quality of adverse event (AE) reports after chiropractic manual therapy in children less than 14 years of age, using active versus passive surveillance reporting systems. Method Data were collected between November 2014 and July 2017 from 60 consecutive paediatric patient visits to participating chiropractors. Those allocated to active surveillance collected AE information with three paper-based questionnaires (two from patients, one from chiropractors) to identify any new or worsening symptoms after treatment. Passive surveillance involved AE information reported by chiropractors on a web-based system. To assess quality of reporting, AE reports greater than mild were reviewed by content experts. The primary outcome was the cumulative incidence of AE reports in active versus passive surveillance. Results Ninety-six chiropractors agreed to participate and enrolled in the study: 34 chiropractors in active surveillance with 1894 patient visits from 1179 unique patients and 35 chiropractors in passive surveillance with 1992 patient visits from 1363 unique patients. In the active arm, AEs were reported in 8.8% (n=140, 95% CI 6.72% to 11.18%) of patients/caregivers, compared with 0.1% (n=2, 95% CI 0.02% to 0.53%) in the passive arm (p<0.001). The quality of AE reports was not evaluated because the five AE reports reviewed by the content experts were determined to be of mild severity. Conclusion We found that active surveillance resulted in significantly more AE reports than passive surveillance. Further prospective active surveillance research studies should be conducted with children receiving chiropractic manual therapy to understand mechanisms and risk factors for moderate and severe AEs, and to further explore how and when to solicit patient safety information.
Collapse
Affiliation(s)
| | - Linda Carroll
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Ross T Tsuyuki
- Department of Pharmacology, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa Hartling
- Department of Paediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Sunita Vohra
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
10
|
Corso M, Cancelliere C, Mior S, Kumar V, Smith A, Côté P. The clinical utility of routine spinal radiographs by chiropractors: a rapid review of the literature. Chiropr Man Therap 2020; 28:33. [PMID: 32641135 PMCID: PMC7346665 DOI: 10.1186/s12998-020-00323-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/24/2020] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION When indicated by signs or symptoms of potentially serious underlying pathology (red flags), chiropractors can use radiographs to inform their diagnosis. In the absence of red flags, the clinical utility of routine or repeat radiographs to assess the structure and function of the spine is controversial. OBJECTIVES To determine the diagnostic and therapeutic utility of routine or repeat radiographs (in the absence of red flags) of the cervical, thoracic or lumbar spine for the functional or structural evaluation of the spine. Investigate whether functional or structural findings on repeat radiographs are valid markers of clinically meaningful outcomes. The research objectives required that we determine the validity, diagnostic accuracy and reliability of radiographs for the structural and functional evaluation of the spine. EVIDENCE REVIEW We searched MEDLINE, CINAHL, and Index to Chiropractic Literature from inception to November 25, 2019. We used rapid review methodology recommended by the World Health Organization. Eligible studies (cross-sectional, case-control, cohort, randomized controlled trials, diagnostic and reliability) were critically appraised. Studies of acceptable quality were included in our synthesis. The lead author extracted data and a second reviewer independently validated the data extraction. We conducted a qualitative synthesis of the evidence. FINDINGS We identified 959 citations, screened 176 full text articles and critically appraised 23. No relevant studies assessed the clinical utility of routine or repeat radiographs (in the absence of red flags) of the cervical, thoracic or lumbar spine for the functional or structural evaluation of the spine. No studies investigated whether functional or structural findings on repeat radiographs are valid markers of clinically meaningful outcomes. Nine low risk of bias studies investigated the validity (n = 2) and reliability (n = 8) of routine or repeat radiographs. These studies provide no evidence of clinical utility. CONCLUSION We found no evidence that the use of routine or repeat radiographs to assess the function or structure of the spine, in the absence of red flags, improves clinical outcomes and benefits patients. Given the inherent risks of ionizing radiation, we recommend that chiropractors do not use radiographs for the routine and repeat evaluation of the structure and function of the spine.
Collapse
Affiliation(s)
- Melissa Corso
- Faculty of Health Sciences, Ontario Tech University and Centre for Disability Prevention and Rehabilitation, 2000 Simcoe St N, Oshawa, ON, L1G 0C5, Canada
| | - Carol Cancelliere
- Faculty of Health Sciences, Ontario Tech University and Centre for Disability Prevention and Rehabilitation, 2000 Simcoe St N, Oshawa, ON, L1G 0C5, Canada
| | - Silvano Mior
- Faculty of Health Sciences, Ontario Tech University and Centre for Disability Prevention and Rehabilitation, 2000 Simcoe St N, Oshawa, ON, L1G 0C5, Canada
- Canadian Memorial Chiropractic College, North York, Ontario, Canada
| | - Varsha Kumar
- Canadian Memorial Chiropractic College, North York, Ontario, Canada
| | - Ali Smith
- Canadian Memorial Chiropractic College, North York, Ontario, Canada
| | - Pierre Côté
- Faculty of Health Sciences, Ontario Tech University and Centre for Disability Prevention and Rehabilitation, 2000 Simcoe St N, Oshawa, ON, L1G 0C5, Canada.
| |
Collapse
|