. 2021 Feb 17;29(1):8.

doi: 10.1186/s12998-021-00362-9.

The global summit on the efficacy and effectiveness of spinal manipulative therapy for the prevention and treatment of non-musculoskeletal disorders: a systematic review of the literature

Pierre Côté^{1

2

3

4}, Jan Hartvigsen^{5

6}, Iben Axén^{7

8}, Charlotte Leboeuf-Yde⁹, Melissa Corso^{10

11}, Heather Shearer^{11

12}, Jessica Wong^{10

11

13}, Andrée-Anne Marchand¹⁴, J David Cassidy¹³, Simon French¹⁵, Gregory N Kawchuk¹⁶, Silvano Mior^{11

17}, Erik Poulsen⁵, John Srbely¹⁸, Carlo Ammendolia^{12

19}, Marc-André Blanchette¹⁴, Jason W Busse²⁰, André Bussières^{14

21}, Carolina Cancelliere^{10

11}, Henrik Wulff Christensen⁶, Diana De Carvalho²², Katie De Luca¹⁵, Alister Du Rose²³, Andreas Eklund⁷, Roger Engel¹⁵, Guillaume Goncalves²⁴, Jeffrey Hebert²⁵, Cesar A Hincapié²⁶, Maria Hondras²⁷, Amanda Kimpton²⁸, Henrik Hein Lauridsen⁵, Stanley Innes²⁹, Anne-Laure Meyer²⁴, David Newell³⁰, Søren O'Neill^{9

31}, Isabelle Pagé¹⁴, Steven Passmore³², Stephen M Perle³³, Jeffrey Quon³⁴, Mana Rezai¹¹, Maja Stupar¹⁷, Michael Swain¹⁵, Andrew Vitiello³⁵, Kenneth Weber³⁶, Kenneth J Young³⁷, Hainan Yu^{10

11}

Affiliations

¹ Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada. pierre.cote@uoit.ca.
² Centre for Disability Prevention and Rehabilitation at Ontario Tech University and CMCC, Oshawa, Canada. pierre.cote@uoit.ca.
³ Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. pierre.cote@uoit.ca.
⁴ IHPME, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. pierre.cote@uoit.ca.
⁵ Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
⁶ Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark.
⁷ Intervention & Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
⁸ ELIB - et liv i bevegelse, Oslo, Norway.
⁹ Department for Regional Health Research, University of Southern Denmark, Odense, Denmark.
¹⁰ Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada.
¹¹ Centre for Disability Prevention and Rehabilitation at Ontario Tech University and CMCC, Oshawa, Canada.
¹² IHPME, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
¹³ Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
¹⁴ Department de Chiropractique, Université du Québec à Trois-Rivières, Trois-Rivières, Canada.
¹⁵ Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia.
¹⁶ Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.
¹⁷ Canadian Memorial Chiropractic College, Toronto, Canada.
¹⁸ Department of Human Health & Nutritional Sciences, University of Guelph, Guelph, Canada.
¹⁹ Rebecca MacDonald Centre, Mount Sinai Hospital, Toronto, Canada.
²⁰ Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
²¹ School of Physical & Occupational Therapy, McGill University, Montreal, Canada.
²² Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada.
²³ Faculty of Life Sciences and Education University of South Wales, Cardiff, UK.
²⁴ Institut Franco-Européen de Chiropraxie, Ivry-Sur-Seine, France.
²⁵ Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada.
²⁶ Department of Chiropractic Medicine, Faculty of Medicine, University of Zurich & Balgrist University Hospital, Zurich, Switzerland.
²⁷ Department of Anesthesiology, University of Kansas Medical Center, Kansas City, USA.
²⁸ RMIT University, Melbourne, Australia.
²⁹ College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Australia.
³⁰ AECC University College, Bournemouth, UK.
³¹ Spine Center of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark.
³² Faculty of Kinesiology & Recreation Management University of Manitoba, Winnipeg, Canada.
³³ School of Chiropractic, University of Bridgeport, Bridgeport, USA.
³⁴ School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
³⁵ School of Health, Medical and Applied Sciences, CQ University, Sydney, Australia.
³⁶ Stanford University School of Medicine, Stanford University, Stanford, USA.
³⁷ School of Sport and Health Sciences, University of Central Lancashire, Preston, England.

PMID: 33596925
PMCID: PMC7890602
DOI: 10.1186/s12998-021-00362-9

The global summit on the efficacy and effectiveness of spinal manipulative therapy for the prevention and treatment of non-musculoskeletal disorders: a systematic review of the literature

Pierre Côté et al. Chiropr Man Therap. 2021.

. 2021 Feb 17;29(1):8.

doi: 10.1186/s12998-021-00362-9.

Authors

Affiliations

¹ Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada. pierre.cote@uoit.ca.
² Centre for Disability Prevention and Rehabilitation at Ontario Tech University and CMCC, Oshawa, Canada. pierre.cote@uoit.ca.
³ Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. pierre.cote@uoit.ca.
⁴ IHPME, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. pierre.cote@uoit.ca.
⁵ Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
⁶ Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark.
⁷ Intervention & Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
⁸ ELIB - et liv i bevegelse, Oslo, Norway.
⁹ Department for Regional Health Research, University of Southern Denmark, Odense, Denmark.
¹⁰ Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada.
¹¹ Centre for Disability Prevention and Rehabilitation at Ontario Tech University and CMCC, Oshawa, Canada.
¹² IHPME, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
¹³ Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
¹⁴ Department de Chiropractique, Université du Québec à Trois-Rivières, Trois-Rivières, Canada.
¹⁵ Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia.
¹⁶ Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.
¹⁷ Canadian Memorial Chiropractic College, Toronto, Canada.
¹⁸ Department of Human Health & Nutritional Sciences, University of Guelph, Guelph, Canada.
¹⁹ Rebecca MacDonald Centre, Mount Sinai Hospital, Toronto, Canada.
²⁰ Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
²¹ School of Physical & Occupational Therapy, McGill University, Montreal, Canada.
²² Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada.
²³ Faculty of Life Sciences and Education University of South Wales, Cardiff, UK.
²⁴ Institut Franco-Européen de Chiropraxie, Ivry-Sur-Seine, France.
²⁵ Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada.
²⁶ Department of Chiropractic Medicine, Faculty of Medicine, University of Zurich & Balgrist University Hospital, Zurich, Switzerland.
²⁷ Department of Anesthesiology, University of Kansas Medical Center, Kansas City, USA.
²⁸ RMIT University, Melbourne, Australia.
²⁹ College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Australia.
³⁰ AECC University College, Bournemouth, UK.
³¹ Spine Center of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark.
³² Faculty of Kinesiology & Recreation Management University of Manitoba, Winnipeg, Canada.
³³ School of Chiropractic, University of Bridgeport, Bridgeport, USA.
³⁴ School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
³⁵ School of Health, Medical and Applied Sciences, CQ University, Sydney, Australia.
³⁶ Stanford University School of Medicine, Stanford University, Stanford, USA.
³⁷ School of Sport and Health Sciences, University of Central Lancashire, Preston, England.

PMID: 33596925
PMCID: PMC7890602
DOI: 10.1186/s12998-021-00362-9

Erratum in

Correction to: The global summit on the efficacy and effectiveness of spinal manipulative therapy for the prevention and treatment of non-musculoskeletal disorders: a systematic review of the literature.
Côté P, Hartvigsen J, Axén I, Leboeuf-Yde C, Corso M, Shearer H, Wong J, Marchand AA, Cassidy JD, French S, Kawchuk GN, Mior S, Poulsen E, Srbely J, Ammendolia C, Blanchette MA, Busse JW, Bussières A, Cancelliere C, Christensen HW, De Carvalho D, De Luca K, Du Rose A, Eklund A, Engel R, Goncalves G, Hebert J, Hincapié CA, Hondras M, Kimpton A, Lauridsen HH, Innes S, Meyer AL, Newell D, O'Neill S, Pagé I, Passmore S, Perle SM, Quon J, Rezai M, Stupar M, Swain M, Vitiello A, Weber K, Young KJ, Yu H. Côté P, et al. Chiropr Man Therap. 2021 Mar 8;29(1):11. doi: 10.1186/s12998-021-00368-3. Chiropr Man Therap. 2021. PMID: 33685457 Free PMC article. No abstract available.

Abstract

Background: A small proportion of chiropractors, osteopaths, and other manual medicine providers use spinal manipulative therapy (SMT) to manage non-musculoskeletal disorders. However, the efficacy and effectiveness of these interventions to prevent or treat non-musculoskeletal disorders remain controversial.

Objectives: We convened a Global Summit of international scientists to conduct a systematic review of the literature to determine the efficacy and effectiveness of SMT for the primary, secondary and tertiary prevention of non-musculoskeletal disorders.

Global summit: The Global Summit took place on September 14-15, 2019 in Toronto, Canada. It was attended by 50 researchers from 8 countries and 28 observers from 18 chiropractic organizations. At the summit, participants critically appraised the literature and synthesized the evidence.

Systematic review of the literature: We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health, and the Index to Chiropractic Literature from inception to May 15, 2019 using subject headings specific to each database and free text words relevant to manipulation/manual therapy, effectiveness, prevention, treatment, and non-musculoskeletal disorders. Eligible for review were randomized controlled trials published in English. The methodological quality of eligible studies was assessed independently by reviewers using the Scottish Intercollegiate Guidelines Network (SIGN) criteria for randomized controlled trials. We synthesized the evidence from articles with high or acceptable methodological quality according to the Synthesis without Meta-Analysis (SWiM) Guideline. The final risk of bias and evidence tables were reviewed by researchers who attended the Global Summit and 75% (38/50) had to approve the content to reach consensus.

Results: We retrieved 4997 citations, removed 1123 duplicates and screened 3874 citations. Of those, the eligibility of 32 articles was evaluated at the Global Summit and 16 articles were included in our systematic review. Our synthesis included six randomized controlled trials with acceptable or high methodological quality (reported in seven articles). These trials investigated the efficacy or effectiveness of SMT for the management of infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. None of the trials evaluated the effectiveness of SMT in preventing the occurrence of non-musculoskeletal disorders. Consensus was reached on the content of all risk of bias and evidence tables. All randomized controlled trials with high or acceptable quality found that SMT was not superior to sham interventions for the treatment of these non-musculoskeletal disorders. Six of 50 participants (12%) in the Global Summit did not approve the final report.

Conclusion: Our systematic review included six randomized clinical trials (534 participants) of acceptable or high quality investigating the efficacy or effectiveness of SMT for the treatment of non-musculoskeletal disorders. We found no evidence of an effect of SMT for the management of non-musculoskeletal disorders including infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. This finding challenges the validity of the theory that treating spinal dysfunctions with SMT has a physiological effect on organs and their function. Governments, payers, regulators, educators, and clinicians should consider this evidence when developing policies about the use and reimbursement of SMT for non-musculoskeletal disorders.

Keywords: Chiropractic; Effectiveness; Efficacy; Mobilization; Non-musculoskeletal; Spinal manipulation; Systematic review.

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Conflict of interest statement

The following individuals had nothing to declare: CA, IA, JB, DDC, JDC, AE, RE, GG, CAH, MH, SI, AK, AAM, ALM, DN, ADR, HS, MS, AV, JJW.

MA Blanchette reports research grants unrelated to this work from University of Quebec-Trois-Rivieres; fees medical-legal expertise from the Canadian Chiropractic Protective Association and Intact Assurance. A Bussières is an Editorial Board member of Chiropractic & Manual Therapies but had no part in the editorial or peer-review process. He reports receiving grants unrelated to this work from the Canadian Chiropractic Research Foundation. C Cancelliere is funded by the Canadian Chiropractic Research Foundation. HW Christensen has received grants unrelated to this work from The Danish Chiropractic Research Fund and my institution has paid for accommodation and travel expenses. P Côté reports research grants unrelated to this work from Aviva Canada, Canadian Institutes of Health Research-Canada Research Chair Program, Canadian Chiropractic Association, Canadian Chiropractic Research Foundation, College of Chiropractors of British Columbia, Et liv i bevegelse” (ELIB), French Chiropractic Association, Financial Services Commission of Ontario, Ontario Ministry of Finance, Ontario Trillium Foundation; travel expenditures unrelated to this work from Griffith University - Whiplash Symposium 2017, Eurospine, 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 for medical-legal expertise from the Canadian Chiropractic Protective Association. K Deluca reports she has multiple research grants from Australian funding agencies, unrelated to this work. She has received coverage of travel expenditures associated with the Global Summit. SD French is a Deputy Editor-in-Chief of Chiropractic & Manual Therapies but had no part in the editorial or peer-review process of this manuscript. He has received research grants unrelated to this work from Australian and international funding agencies and from chiropractic professional associations. J Hartvigsen reports that he holds multiple research grants from Danish and international funding agencies and charities. He has received coverage of travel expenditures from multiple sources internationally in connection with speaking engagements. Within the past year he has received speaking fees from Parker Seminars and Novartis. J Hébert receives salary support from the Canadian Chiropractic Research Foundation and the New Brunswick Health Research Foundation. He is also an Associate Editor of Chiropractic and Manual Therapies but played no part in the review of this submission and was blinded to the process. G Kawchuk reports active research grants unrelated to this work from The Natural Sciences and Engineering Research, The National Institutes of Health, The Alberta Spine Foundation, The American Orthotic and Prosthetic Association, The New Frontiers in Research Fund and the Canadian Chiropractic Research Foundation. Travel expenditures unrelated to this work in the past year include Kiropraktik i Sverige Live, Et liv i bevegelse” (ELIB), the Nordic Institute of Chiropractic and Clinical Biomechanics, The American Chiropractic Association, The National Institutes of Health, The British Columbia Chiropractic Association, and The World Federation of Chiropractic. Fees for medical-legal expertise unrelated to this work from the Canadian Chiropractic Protective Association. HH Lauridsen holds multiple research grants from funding agencies and charities of which the main contributor is the Danish Foundation for Chiropractic Research and Postgraduate Education. HHL is presently employed as associate professor and head of chiropractic studies at University of Southern Denmark. No funding has been received for the present project. C Leboeuf-Yde reports no competing interests as she obtains no funding from the chiropractic profession. S Mior reports receiving grants unrelated to this work from the Canadian Chiropractic Association, Ontario Chiropractic Association, and Canadian Chiropractic Research Foundation. S O’Neill reports funding by local, regional health authorities and by the Danish chiropractic foundation for research and postgraduate education, but not in relation specifically to this project I Pagé has received grants unrelated to this work. S Perle is an Associate Editor of Chiropractic & Manual Therapies but had no part in the editorial or peer-review process. He has received grants unrelated to this work from the West Hartford Group, Inc. and NCMIC Foundation, Inc. E Poulsen reports research grants from the Danish Foundation for Chiropractic Research and Postgraduate Education, which is funded by the Danish chiropractors, and the Danish Regions. No funding has been received for the present project. J Quon has funding unrelated to this work from the Canadian Chiropractic Guideline Initiative and The Vancouver Foundation. He is a member of the editorial board of Chiropractic & Manual Therapies but had no part in the editorial or peer-review process for this manuscript. M Rezai is a member of the World Federation of Chiropractic Research Disability and Rehabilitation Committee. JS is am active licensed member of Ontario and Canadian Chiropractic Associations. He is currently receiving research support from the Ontario Chiropractic Association. Previously received research support from Canadian Chiropractic Research Foundation and Ontario Chiropractic Association. M Swain holds research grants unrelated to this work. He received the Chiropractic Australia Research Foundation Travel Grant 2019 to cover travel expenses associated with the Global Summit. Within the past year he has received consultation fees unrelated to this work. He is a non-executive director of Chiropractic Australia. He is a governor of the Sydney College of Chiropractic. K Weber was supported by grants from the National Institute of Neurological Disorders and Stroke (K23NS104211 and L30NS108301) of the National Institutes of Health (Bethesda, Maryland, USA). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. K J Young received a Personal PhD Grant (2018) from the Royal College of Chiropractors (UK - £1600) that partially funded two papers unrelated to this work.

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Comment in

Letter to the editor: the global summit on the efficacy and effectiveness of spinal manipulative therapy for the prevention and treatment of non-musculoskeletal disorders: a systematic review of the literature.
Lawrence DJ. Lawrence DJ. Chiropr Man Therap. 2021 Jul 20;29(1):25. doi: 10.1186/s12998-021-00378-1. Chiropr Man Therap. 2021. PMID: 34284790 Free PMC article. No abstract available.
Response to Lawrence DJ: the global summit on the efficacy and effectiveness of spinal manipulative therapy for the prevention and treatment of non-musculoskeletal disorders: a systematic review of the literature.
Côté P, Hartvigsen J, Axén I, Leboeuf-Yde C, Corso M, Shearer H, Wong J, Marchand AA, Cassidy JD, French S, Kawchuk GN, Mior S, Poulsen E, Srbely J, Ammendolia C, Blanchette MA, Busse JW, Bussières A, Cancelliere C, Christensen HW, De Carvalho D, De Luca K, Rose AD, Eklund A, Engel R, Goncalves G, Hebert J, Hincapié CA, Hondras M, Kimpton A, Lauridsen HH, Innes S, Meyer AL, Newell D, O'Neill S, Pagé I, Passmore S, Perle SM, Quon J, Rezai M, Stupar M, Swain M, Vitiello A, Weber K, Young KJ, Yu H. Côté P, et al. Chiropr Man Therap. 2021 Jul 20;29(1):26. doi: 10.1186/s12998-021-00380-7. Chiropr Man Therap. 2021. PMID: 34284791 Free PMC article. No abstract available.

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Chiropractic pediatric patient management and interdisciplinary collaboration: a descriptive cross-sectional study of chiropractors in Quebec.
Doucet C, Dubuc É, Imbeau C, Pohlman KA, Blanchette MA. Doucet C, et al. Chiropr Man Therap. 2022 Dec 13;30(1):54. doi: 10.1186/s12998-022-00464-y. Chiropr Man Therap. 2022. PMID: 36514117 Free PMC article.
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The global summit on the efficacy and effectiveness of spinal manipulative therapy for the prevention and treatment of non-musculoskeletal disorders: a systematic review of the literature

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The global summit on the efficacy and effectiveness of spinal manipulative therapy for the prevention and treatment of non-musculoskeletal disorders: a systematic review of the literature

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