PMID- 28340595
OWN - NLM
STAT- MEDLINE
DCOM- 20180314
LR  - 20220410
IS  - 2046-4053 (Electronic)
IS  - 2046-4053 (Linking)
VI  - 6
IP  - 1
DP  - 2017 Mar 24
TI  - The risk associated with spinal manipulation: an overview of reviews.
PG  - 64
LID - 10.1186/s13643-017-0458-y [doi]
LID - 64
AB  - BACKGROUND: Spinal manipulative therapy (SMT) is a widely used manual treatment, 
      but many reviews exist with conflicting conclusions about the safety of SMT. We 
      performed an overview of reviews to elucidate and quantify the risk of serious 
      adverse events (SAEs) associated with SMT. METHODS: We searched five electronic 
      databases from inception to December 8, 2015. We included reviews on any type of 
      studies, patients, and SMT technique. Our primary outcome was SAEs. Quality of 
      the included reviews was assessed using a measurement tool to assess systematic 
      reviews (AMSTAR). Since there were insufficient data for calculating incidence 
      rates of SAEs, we used an alternative approach; the conclusions regarding safety 
      of SMT were extracted for each review, and the communicated opinion were judged 
      by two reviewers independently as safe, harmful, or neutral/unclear. Risk ratios 
      (RRs) of a review communicating that SMT is safe and meeting the requirements for 
      each AMSTAR item, were calculated. RESULTS: We identified 283 eligible reviews, 
      but only 118 provided data for synthesis. The most frequently described adverse 
      events (AEs) were stroke, headache, and vertebral artery dissection. Fifty-four 
      reviews (46%) expressed that SMT is safe, 15 (13%) expressed that SMT is harmful, 
      and 49 reviews (42%) were neutral or unclear. Thirteen reviews reported incidence 
      estimates for SAEs, roughly ranging from 1 in 20,000 to 1 in 250,000,000 
      manipulations. Low methodological quality was present, with a median of 4 of 11 
      AMSTAR items met (interquartile range, 3 to 6). Reviews meeting the requirements 
      for each of the AMSTAR items (i.e. good internal validity) had a higher chance of 
      expressing that SMT is safe. CONCLUSIONS: It is currently not possible to provide 
      an overall conclusion about the safety of SMT; however, the types of SAEs 
      reported can indeed be significant, sustaining that some risk is present. High 
      quality research and consistent reporting of AEs and SAEs are needed. SYSTEMATIC 
      REVIEW REGISTRATION: PROSPERO CRD42015030068 .
FAU - Nielsen, Sabrina Mai
AU  - Nielsen SM
AD  - The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, 
      Frederiksberg, 2000, Denmark.
FAU - Tarp, Simon
AU  - Tarp S
AD  - The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, 
      Frederiksberg, 2000, Denmark.
FAU - Christensen, Robin
AU  - Christensen R
AD  - The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, 
      Frederiksberg, 2000, Denmark.
FAU - Bliddal, Henning
AU  - Bliddal H
AD  - Clinical Research Unit, The Parker Institute, Copenhagen University Hospital, 
      Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark.
FAU - Klokker, Louise
AU  - Klokker L
AD  - The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, 
      Frederiksberg, 2000, Denmark.
FAU - Henriksen, Marius
AU  - Henriksen M
AD  - Physiotherapy and Biomechanics Research Unit, The Parker Institute, Copenhagen 
      University Hospital, Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark. 
      marius.Henriksen@regionh.dk.
LA  - eng
PT  - Journal Article
PT  - Review
PT  - Systematic Review
DEP - 20170324
PL  - England
TA  - Syst Rev
JT  - Systematic reviews
JID - 101580575
SB  - IM
MH  - Humans
MH  - Manipulation, Spinal/*adverse effects
MH  - Risk
PMC - PMC5366149
EDAT- 2017/03/28 06:00
MHDA- 2018/03/15 06:00
PMCR- 2017/03/24
CRDT- 2017/03/26 06:00
PHST- 2016/11/21 00:00 [received]
PHST- 2017/03/15 00:00 [accepted]
PHST- 2017/03/26 06:00 [entrez]
PHST- 2017/03/28 06:00 [pubmed]
PHST- 2018/03/15 06:00 [medline]
PHST- 2017/03/24 00:00 [pmc-release]
AID - 10.1186/s13643-017-0458-y [pii]
AID - 458 [pii]
AID - 10.1186/s13643-017-0458-y [doi]
PST - epublish
SO  - Syst Rev. 2017 Mar 24;6(1):64. doi: 10.1186/s13643-017-0458-y.