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Review
. 2020 Feb 25;28(1):12.
doi: 10.1186/s12998-020-0299-y.

The safety of spinal manipulative therapy in children under 10 years: a rapid review

Melissa Corso  1 , Carol Cancelliere  1 , Silvano Mior  1   2 , Anne Taylor-Vaisey  1   2 , Pierre Côté  3
Affiliations
Review

The safety of spinal manipulative therapy in children under 10 years: a rapid review

Melissa Corso et al. Chiropr Man Therap. .

Abstract

Introduction: The safety of spinal manipulative therapy (SMT) in children is controversial. We were mandated by the College of Chiropractors of British Columbia to review the evidence on this issue.

Objectives: We conducted a rapid review of the safety of SMT in children (< 10 years). We aimed to: 1) describe adverse events; 2) report the incidence of adverse events; and 3) determine whether SMT increases the risk of adverse events compared to other interventions.

Evidence review: We searched MEDLINE, CINAHL, and Index to Chiropractic Literature from January 1, 1990 to August 1, 2019. We used rapid review methodology recommended by the World Health Organization. Eligible studies (case reports/series, cohort studies and randomized controlled trials) were critically appraised. Studies of high and acceptable methodological quality were included. The lead author extracted data. Data extraction was independently validated by a second reviewer. We conducted a qualitative synthesis of the evidence.

Findings: Most adverse events are mild (e.g., increased crying, soreness). One case report describes a severe adverse event (rib fracture in a 21-day-old) and another an indirect harm in a 4-month-old. The incidence of mild adverse events ranges from 0.3% (95% CI: 0.06, 1.82) to 22.22% (95% CI: 6.32, 54.74). Whether SMT increases the risk of adverse events in children is unknown.

Conclusion: The risk of moderate and severe adverse events is unknown in children treated with SMT. It is unclear whether SMT increases the risk of adverse events in children < 10 years.

Keywords: Adverse event; Child; Pediatric; Safety; Spinal manipulation; Spinal mobilization.

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Conflict of interest statement

Pierre Côté reports research grants unrelated to this work from Aviva Canada, Canadian Institutes of Health Research—Canada Research Chair Program, French Chiropractic Association, Ontario Ministry of Finance, Ontario Trillium Foundation; travel expenditures unrelated to this work from Griffith University - Whiplash Symposium 2017, Southern Denmark University, Institut Franco-Europeen de Chiropraxie, Karolinska Institutet, North American Spine Society, University of Quebec-Trois-Rivieres, University of Zurich, World Federation of Chiropractic; fees medical-legal expertise from the Canadian Chiropractic Protective Association. Carol Cancelliere reports a research grant unrelated to this work from the Canadian Chiropractic Research Foundation – Research Chair in Knowledge Translation in the Faculty of Health Sciences, Ontario Tech University, Canada. Silvano Mior reports research grants unrelated to this work from the Canadian Chiropractic Association, Ontario Chiropractic Association and Ontario Ministry to Seniors Affairs; travel expenditures unrelated to this work from Institut Franco-Europeen de Chiropraxie, World Federation of Chiropractic and University of Norway.

Figures

Fig. 1
Fig. 1
Flow diagram of study selection
See this image and copyright information in PMC

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