- Created: 29 April 2020 29 April 2020
Much debate surrounds the patient safety of spinal manipulative therapy (SMT) in children. This controversy is of particular interest for policy-makers who regulate the safety of health care interventions.
A group of Canadian researchers conducted a rapid review of the safety of SMT in children (< 10 years). They 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.
They systematically searched MEDLINE, CINAHL, and Index to Chiropractic Literature. Eligible studies (case reports/series, cohort studies and randomized controlled trials) were critically appraised and studies of high and acceptable methodological quality were included.
25 articles qualified for inclusion in the synthesis. Of those, 22 were case reports or case series, two were randomized clinical trials and one was a cohort study. The review suggests that 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.
The Canadian researchers conclude that 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. Further research is needed to determine the incidence of adverse events associated with SMT in children.
Melissa Corso, Carol Cancelliere, Silvano Mior, Anne Taylor-Vaisey & Pierre Côté: The safety of spinal manipulative therapy in children under 10 years: a rapid review. Chiropractic & Manual Therapies 2020 https://chiromt.biomedcentral.com/articles/10.1186/s12998-020-0299-y