Background
Methods
Search strategy
Chiropractic | AND | pediatric* |
Chiropractic | AND | child* |
Chiropractic | AND | adolescent* |
Manipulation, chiropractic (MeSH heading) | AND | (pediatric*, child*, adolescent*) |
Manipulation, orthopedic (MeSH heading) | AND | (pediatric*, child*, adolescent*) |
Manipulation, osteopathic (MeSH heading) | AND | (pediatric*, child*, adolescent*) |
Osteopath* | AND | (pediatric*, child*, adolescent*) |
Orthopedic manipulation | AND | (pediatric*, child*, adolescent*) |
Orthoped* | AND | (pediatric*, child*, adolescent*) |
Pediatric manual therapy | AND | (pediatric*, child*, adolescent*) |
Ped MT | AND | (pediatric*, child*, adolescent*) |
Spinal manipulative therapy | AND | (pediatric*, child*, adolescent*) |
SMT | AND | (pediatric*, child*, adolescent*) |
Eligibility criteria
SMT (Spinal Manipulative Therapy) | A procedure involving an high velocity, low amplitude (HVLA) thrust beyond the passive range of motion into the para-physiological space, but within the limits of anatomic integrity [71]p10, [72]p142–143, [73]. It is a bimanual motor skill involving various levels of interlimb coordination and postural control combined with a timely weight transfer and is characterized by a HVLA thrust that typically results in joint cavitation [74]. SMT is highly adaptive and context-dependent, meaning the amount of force delivered to the patient must take into account clinically relevant pathologies as well as anthropomorphic differences between the doctor and patient [73].The safe delivery of SMT requires consideration with respect to preload, speed of force production, peak amplitude of force delivered, duration of impulse/thrust delivered, doctor position, patient positioning, and line of drive (direction of thrust) [71, 74]. |
Mobilization | |
OMT (Osteopathic Manipulative Therapy) | Involves physical manipulation of various tissues and parts of the body that includes soft tissue massage and stretch, strain-counter-strain, articulation, high velocity thrust, gentle low amplitude mobilizations and neuromuscular techniques [49]p1–2. In some instances OMT is better classified as a mobilization [71]p18 . |
CST (Cranial-Sacral Therapy) | A group of manual procedures directed to the sutures of the skull designed to enhance the functioning of the membranes, tissues, fluids, and bones surrounding or associated with the brain and spinal cord. It is postulated that low-force pressure can influence the vitality of the Cranial Rhythmic Impulse created by the flow of cerebrospinal fluid as it moves from the ventricles of the skull to the sacrum within the spinal cord [71]p123–136. |
CMT (Chiropractic Manipulative Therapy) | Synonymous with SMT, but performed by a doctor of chiropractic. |
VOMT (Visceral Osteopathic Manipulation) | A manual therapy directed to various organs of the body to aid in smooth muscle function, influence somatic biomechanics and body fluid mechanics [49]p251–252. |
Instrument-assisted manipulation | The use of any number of different types of hand held instruments used to provide a manipulation-type force. |
MT (Manual Therapy) | Any of the above. |
Study selection, data extraction, & summary assessment
Quality assessment-individual studies
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adequate sequence generation,
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allocation concealment,
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patient blinding,
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assessor blinding,
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addressing of incomplete data,
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selective outcome reporting, and
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other sources of bias.
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inclusion/exclusion criteria variances across groups (cohort studies only),
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recruitment strategies for groups (cohort studies only),
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appropriate, selection of comparison groups (cohort studies only),
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blinding outcome assessor to intervention,
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use of valid and reliable outcome tools,
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length of follow-up variances across study groups,
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missing important primary outcomes,
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missing harms or adverse events, and
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account of any confounding variables.
Quality assessment-overall conditions
High quality evidence
Moderate quality evidence
Low quality (inconclusive) evidence
Results
Search results
Clinical condition | UK update (1) summary | Studies in current review | Intervention | Citations | Quality | Sample size | Results of study | Current study overall summary |
---|---|---|---|---|---|---|---|---|
Gastrointestinal Conditions | ||||||||
Constipation | Not evaluated | 1 OBS | OMT | Tarsuslu, 2009 [18] | Medium | 13 | No difference | Inconclusive (unclear) |
Infantile Colic | Inconclusive/ favorable | 3 RCT 1 OBS | CMT | Miller, 2012 [19] Wiberg, 2010 [20] Browning, 2008 [21] Olafsdottir, 2001 [22] | High Low High High | 104 749 43 86 | Improvement No improvement No difference No difference | Inconclusive (unclear) |
Infantile Colic | Inconclusive/ favorable | 1 RCT | OMT/CST | Hayden, 2006 [23] | Medium | 28 | Improvement | Inconclusive (favorable) |
Pediatric dysfunctional voiding | Inconclusive/ favorable | 1 RCT | OMT | Nemett, 2008 [24] | Medium | 21 | Improvement | Inconclusive (favorable) |
Pediatric nocturnal enuresis | Inconclusive/ favorable | 1 OBS | CMT | van Poecke, 2009 [25] | Medium | 33 | Improvement | Inconclusive (unclear) |
Suboptimal infant breastfeeding | Not evaluated | 2 OBS | CMT/CST | Miller, 2009 [26] Vallone, 2004 [27] | Medium Low | 114 25 | Improvement Improvement | Inconclusive (favorable) |
Musculoskeletal Conditions | ||||||||
Clubfoot | Not evaluated | 1 RCT | MT | Nilgun, 2011 [28] | Low | 29 | Improvement | Inconclusive (favorable) |
Cuboid Syndrome | Not evaluated | 1 OBS | MT | Jennings, 2005 [29] | Medium | 2 | Improvement | Inconclusive (unclear) |
Headache | Not evaluated for pediatrics | 1 OBS | OMT | Przekop, 2016 [30] | Medium | 83 | Improvement | Inconclusive (unclear) |
Headache | Not evaluated for pediatrics | 1 RCT | MT | Borusiak, 2010 [31] | Medium | 52 | No difference | Inconclusive (unclear) |
Headache | Not evaluated for pediatrics | 1 OBS | CMT | Marchand, 2009 [32] | Low | 13 | Improvement | Inconclusive (unclear) |
Low Back Pain | Not evaluated | 1 RCT 1 OBS | CMT | Evans, 2018 [33] Hayden J, 2003 [36] | High Medium | 185 54 | Improvement Improvement | Moderate (favorable) |
Low back pain | Not evaluated | 1 OBS 1 RCT | MT | Walston, 2016 [34] Selhorst, 2015 [35] | Medium Medium | 3 35 | Improvement No difference | Inconclusive (unclear) |
Pulled (Nursemaid’s) Elbow | Not evaluated | 2 RCT | MT | Garcia-Mata, 2014 [37] Bek, 2009 [38] | Medium Medium | 115 66 | Improvement Improvement | Moderate (favorable) |
Temporomandibular Joint Dysfunction | Not evaluated for pediatrics | 1 RCT | OMT | Monaco, 2008 [39] | Low | 28 | Improvement | Inconclusive (favorable) |
Respiratory Conditions | ||||||||
Asthma | Not evaluated for pediatrics | 1 RCT | OMT | Guiney, 2005 [40] | Medium | 140 | Improvement | Inconclusive (favorable) |
Asthma | Not evaluated for pediatrics | 1 RCT | CMT | Bronfort, 2001 [41] | High | 34 | No improvement | Inconclusive (unclear) |
Obstructive apnea | Not evaluated | 1 RCT | OMT | Vandenplas, 2008 [42] | Medium | 34 | Improvement | Inconclusive (favorable) |
Otitis Media | Inconclusive/ unclear | 3 RCT 1 OBS | OMT | Steele, 2014 [43] Wahl, 2008 [44] Degenhardt, 2006 [45] Mills, 2003 [47] | Medium High Medium High | 34 90 8 57 | Improvement No difference Improvement Improvement | Inconclusive (favorable) |
Otitis Media | Not evaluated | 1 OBS | CMT | Zhang, 2004 [46] | Medium | 22 | Improvement | Inconclusive (unclear) |
Special Needs | ||||||||
ADHD | Inconclusive/ unclear | 1 RCT | OMT | Accorsi, 2014 [48] | High | 28 | Improvement | Inconclusive (favorable) |
Autism | Not evaluated | 1 OBS | VOMT | Bramati-Castellarian, 2016 [49] | Medium | 49 | Improvement | Inconclusive (unclear) |
Not evaluated | 1 RCT | CMT | Khorshid, 2006 [50] | Low | 14 | Improvement | Inconclusive (favorable) | |
Cerebral Palsy | Inconclusive/ unclear | 3 RCT | OMT | Wyatt, 2011 [51] Duncan, 2008 [53] Duncan, 2004 [52] | High High Low | 142 55 50 | No improvement Improvement Improvement | Inconclusive (unclear) |
Preterm infants | Inconclusive/ unclear | 4 RCT | OMT/CST | Raith, 2015 [54] Cerretelli, 2015 [55] Pizzolorusso, 2014 [56] Cerretelli, 2013 [57] | High High High High | 30 695 110 110 | No difference Improvement Improvement Improvement | Inconclusive/unclear for general movement Moderate (favorable) length of stay and hospital costs |
Structural Conditions | ||||||||
Cranial asymmetry | Not evaluated | 1 RCT | MT/CST | Cabrera-Martos, 2016 [58] | High | 46 | Improvement | Inconclusive (favorable) |
Not evaluated | 1 OBS | OMT | Lessard, 2011 [59] | Medium | 12 | Improvement | Inconclusive (unclear) | |
Postural Asymmetry | Not evaluated | 1 RCT | OMT/CST | Phillippi, 2006 [60] | High | 32 | Improvement | Inconclusive (favorable) |
Scoliosis | Not evaluated | 1 RCT 3 OBS | CMT | Byun, 2016 [61] Rowe, 2006 [62] Morningstar, 2004 [63] Lantz, 2001 [64] | Medium High Low Medium | 5 6 6 42 | Improvement No difference Improvement No improvement | Inconclusive (unclear) |
Scoliosis | Not evaluated | 1 RCT | OMT | Hasler, 2010 [65] | High | 20 | No improvement | Inconclusive (unfavorable) |
Torticollis | Not evaluated | 1 RCT | MT | Haugen, 2011 [66] | Medium | 32 | No difference | Inconclusive (unfavorable) |
Upper cervical dysfunction | Not evaluated | 1 OBS | MT | Saedt, 2017 [67] | High | 307 | Improvement | Inconclusive (unclear) |
Author/year | Condition sample size (n) | Results summary | Intervention | Selection bias: random | Selection bias: allocation | Performance bias: blinding of personnel and participants | Detection bias: blinding of outcome assessment | Attrition bias: incomplete outcome data | Reporting bias: selective reporting | Other bias: anything else, ideally pre-specified | Overall quality rating |
---|---|---|---|---|---|---|---|---|---|---|---|
Gastrointestinal/Urinary | |||||||||||
Miller J, et al. 2012 [19] | Infantile Colic (n = 104) | Improvement | CMT | L computer generated permutated blocks | L sealed in sequentially numbered opaque envelopes | L envelopes revealed to treating provider before treatment, 1 of 3 groups parents knew infants were being treated | U-PY two of three groups of parents blinded to treatment, data extractor blinded to teratment | H per protocol analysis conducted | L all outcomes reported | U-PN “parent diagnosis”, selective nature of diary | High |
Browning M & Miller J, 2008 [21] | Infantile Colic (n = 43) | No difference | CMT | L computer generated | H not stated | L blinding of both parents and patients | L independent observer binded to treatment | L all outcomes reported | L all outcomes reported | H strict inclusion criteria, small study size, inexperienced iterns | High |
Hayden C & Mullinger B, 2006 [23] | Infantile Colic (n = 28) | Improvement | OMT/CST | L random number table | U-PY random table number utilized but not discussed | H patients and providers not blinded | H outcome assessors unblinded | H 2 withdrew and not included in analysis | L all outcomes reported | U-PN small study size, lack of standardized treatment | Medium |
Olafsdottir E, et al. 2001 [22] | Infantile Colic (n = 86) | No difference | CMT | H “randomized” not described | U-PY “sealed” envelopes | L parents and providers blinded | L outcome assessor blinded | L intention to treat analysis | L all outcomes reported | U-PY small sample size | High |
Musculoskeletal | |||||||||||
Nemett D, et al. 2008 [24] | Pediatric Dysfunctional Voiding (n = 21) | Improvement | OMT | U-PY stated “randomized assigned” with no further description | H nothing stated | H nothing stated | H only primary outcome assessor blinded | H per protocol analysis conducted | L all expected outcomes reported, secondary outcome not initially evaluated in control group per protocol | L study appears free of other sources of bias | Medium |
Nilgun B, et al. 2011 [28] | Idiopathic Clubfoot (n = 29) | Improvement | MT | H randomized by travel and physical abilities | H not concealed | H parents, patients, therapists not blinded | H outcome assessor not blinded | L all outcomes reported | L all outcomes reported | H pilot study only | Low |
Borusiak P, et al. 2010 [31] | Cervicogenic HA (n = 52) | No difference | MT | L computer generated | L sequentially numbered identical opaque envelopes | L parents, patients and pediatrician blinded | U-PY pre-established analysis plan not described | H per protocol analysis conducted | L all outcomes reported | H small sample size, clinical effect of sham, observational bias | Medium |
Evans R, et al. 2018 [33] | Subacute and Chronic LBP (n = 185) | Improvement | CMT | L computerized dynamic allocation (rank-order minization) system | L sealed in sequentially numbered opaque envelopes | H patients and providers not blinded | L outcome assessor blinded | L all outcomes reported | L all outcomes reported | L study appears free of other sources of bias | High |
Selhorst M & Selhorst B, 2015 [35] | Mechanical LBP (n = 35) | No difference | MT | H not described | H not described | U-PY blinding of patients, exercise therapist, no blinding of manual therapist | L all outcomes patient self-report blinded | H per protocol anaylsis conducted | L all outcomes reported | L study appear to be free of other sources of bias | Medium |
Garcia-Mata S & Hidalgo-Ovejero A, 2014 [37] | Pulled Elbow (n = 115) | Improvement | MT | H not described | H not described | H parents, patients, therapists not blinded | H outcome assessors not blinded | L all expected outcomes reported | L all outcomes reported | L study appear to be free of other sources o bias | Medium |
Bek B, et al. 2009 [38] | Pulled Elbow (n = 66) | Improvement | MT | H not described | H not described | H no blinding | H outcome assessors not blinded | L intention to treat analysis | L all outcomes reported | L study appears free of other source of bias | Medium |
Monaco A, et al. 2008 [39] | Non-Specific Temporomandibular Disorder (n = 28) | Improvement | OMT | H not described | H not described | H patients and providers not blinded | H outcome assessor not blinded | H follow up of participants were not discussed | U-PN sample response for each outcome not provided | U-PN small study size | Low |
Respiratory | |||||||||||
Guiney P, et al. 2005 [40] | Asthma (n = 140) | Improvement | OMT | U-PY not well described “randomization based on a 2:1 ratio” | H not described | H provider not blinded | H outcome assessor not blinded | L all patients accounted for | L all outcomes reported | L study appears free of other sources of bias | Medium |
Bronfort G et al. 2001 [41] | Asthma (n = 34) | No improvement | CMT | L computer generated | L sealed in opaque envelopes | L blinding of both parents and patients | L outcome assessor blinded | L all patients accounted for | L all outcomes reported | L study appears free of other sources of bias | High |
Vandenplas YDE, et al. 2008 [42] | Obstructive Apnea (n = 34) | Improvement | OMT | H not described | H not described | L patients blinded | L outcome assessors blinded | H per protocol analysis, 6 participants dropped out and not included in analysis | L all outcomes reported | U-PN small study size, imbalance in sizes of control to study | Medium |
Steele D, et al. 2014 [43] | Otitis Media (n = 34) | Improvement | OMT | L study used “Research Randomizer” | U-PY randomized tables generated with unique number assignment | H providers not blinded, parents blinded but in treatment room | L outcome assessors blinded | L all patients accounted for | L all outcomes reported | H small sample size, pilot study | Medium |
Wahl R, et al. 2008 [44] | Otitis Media (n = 90) | No difference | OMT | L randomization in blockes of 8 using random number table | L 2 by2 factorial design | L patients, parents, providers blinded | L outcome assessor blinded | L all patients accounted for | L all outcomes reported | U-PN unequal distribution of risk factors in treatment group | High |
Mills M, et al. 2003 [47] | Acute Otitis Media (n = 57) | Improvement | OMT | L computer generated | L independent nurse monitored and disclosed by phone | H parents and provider not blinded | L outcome assessor blinded | H per protocol analysis, 19 dropped out and not included in analysis | L all outcomes reported | L study appears free of other sources of bias | High |
Special Needs | |||||||||||
Accorsi A, et al. 2014 [48] | Attention-Deficit/Hyperactivity Disorder (n = 28) | Improvement | OMT | L permuted-block ratio 1:1 using R statistical program | U- PN allocation was concealed but not described | U -PY patients/parents/providers not blinded but were blinded as to outcomes | L outcome assessors blinded | L all patients accounted for | U -PN adverse events were being collected but not reported | U-PN sample size not justified | High |
Khorshid KA, et al. 2006 [50] | Autism (n = 14) | Improvement | CMT | H not described | H not described | H patients and providers not blinded | H outcome assessors not blinded | U-PN enrollment number not discussed | L all outcomes reported | U-PN sample size not justified | Low |
Wyatt K, et al. 2011 [51] | Cerebral Palsy (n = 142) | No improvement | OMT | L telephone based randomization by independent statistician at remote site | L allocation provided by independent statistician at remote site | H parents and patients not blinded | L outcome assessors blinded | L all patients accounted for | L all outcomes reported | U-PN sample size not justified | High |
Duncan B, et al. 2008 [53] | Cerebral Palsy (n = 55) | Improvement | OMT | L draw technique using stratification | L blinding of concealment | H parents, patients, providers not blinded | L outcome assessor blinded | H per protocol analysis conducted | L all outcomes reported | L study appears free of other sources of bias | High |
Duncan B, et al. 2004 [52] | Cerebral Palsy (n = 50) | Improvement | OMT | H not described | H not described | H not described | H outcome assessors not discussed | H per protocol analysis conducted | L all outcomes reported | L study appears free of other sources of bias | Low |
Raith W, et al. 2016 [54] | Prematurity (n = 30) | No difference | OMT/CST | L randomized using block design with block size 6 | L sequentially sealed opaque envelopes | L parents and providers blinded | L outcome assessors blinded | L all patients accounted for | L all outcomes reported | L study appears free of other sources of bias | HIgh |
Cerritelli F, et al. 2015 [55] | Prematurity (n = 695) | Improvement | OMT/CST | L randomized using block design with block size 10 | L performed in coordinating center | U-PN providers not blinded | L NICU staff blinded | H per protocol analysis performed | L all outcomes reported | L study appears free of other sources of bias | High |
Pizzolorusso G, et al. 2014 [56] | Prematurity (n = 110) | Improvement | OMT/CST | L computer generated permuted block | L randomized by IT consultant | U-PN providers not blinded | L outcome assessors blinded | L all patients accounted for | L all outcomes reported | L study appears free of other sources of bias | High |
Cerritelli F, et al. 2013 [57] | Prematurity (n = 110) | Improvement | OMT/CST | L computer generated permuted block | L random allocation by independent consultant | H parents, patients, providers not blinded | L outcome assessor blinded | H per protocol analysis conducted | L all outcomes reported | L study appears free of other sources of bias | High |
Structural | |||||||||||
Cabrera-Martos I, et al. 2016 [58] | Cranial Asymmetry (nonsynostotic plagiocephaly) (n = 46) | Improvement | MT/CST | L randomized number generator in blocks of 4 | L sealed envelope | H patients and providers not blinded | L outcome assessors blinded | L all outcomes accounted for | L all outcomes reported | L study appears free of other sources of bias | High |
Philippi H, et al. 2006 [60] | Postural Asymmetry (n = 32) | Improvement | OMT/CST | L block randomization | L sealed in sequentially numbered envelopes | L parents, patients, provider blinded | L outcome assessor blinded | L all outcomes accounted for | L all outcomes reported | L study appears free of other sources of bias | High |
Hasler C, et al. 2010 [65] | Scoliosis (n = 20) | No improvement | OMT | L block randomization | U-PY consealed envelopes | H patients and provider not blinded | L outcome assessor blinded | L all outcomes accounted for | L all outcomes reported | U-PN small sample size | High |
Rowe DE, et al. 2006 [62] | Scoliosis (n = 6) | No difference | CMT | L computer generated | L independent personnel provided allocation assignent via e-mail | L patients and provider blinded | L outcome assessors blinded | L all outcomes accounted for | L all outcomes reported | U-PN small sample size | High |
Haugen E, et al. 2011 [66] | Torticollis (n = 32) | No difference | MT | H not described | U-PY selaed envelope | U-PN patients blinded, providers not blinded | L outcome assessor blinded | U-PN patient description and enrollment not discussed | H not all outcomes reported | U-PN sample size not justified | Medium |
Author/year | Study design type | Condition sample size (n) | Result summary | Intervention | Include/exclude | Recruitment strategy | Comparison selection | Blinded outcome assessor(s) | Valid, reliable measures | Length of follow-up | Missing outcomes | Missing harms/ adverse events | Missing confounding variables | Overall quality rating |
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Gastrointestinal/Urinary | ||||||||||||||
Tarsuslu T, et al. 2009 [18] | Interrupted time series (with comparison group) | Constipation and Cerebral Palsy (n = 13) | No difference | OMT | L does not vary | H not described | H not described | H not blinded | U-PN property measurements not fully evaluated for children | L consistent | L all outcomes discussed | H adverse events not reported | U-PN dietary | Medium |
Wiberg K & Wiberg J, 2010 [20] | Interrupted time series (without a comparison group) | Infantile colic (n = 749) | No improvement | CMT | NA | NA | NA | H not blinded | U-PN property measurements not fully evaluated for children | H not discussed | L all outcomes discussed | H adverse events not reported | U- PN co-interventions missing | Low |
van Poecke A & Cunliffe C, 2009 [25] | Before-after | Nocturnal Enuresis (n = 33) | Improvement | CMT | NA | NA | NA | H not blinded | U-PN property measurements not fully evaluated for children | L consistent | L all outcomes discussed | H adverse events not reported | U- PN dietary | Medium |
Miller J, et al. 2009 [26] | Before-after | Suboptimal Infant Breastfeeding (n = 114) | Improvement | CMT | NA | NA | NA | H not blinded | U-PN property measurements not fully evaluated for children | H not discussed | L all outcomes discussed | L adverse events reported | L confounding variables accounted for | Medium |
Vallone S, 2004 [27] | Before-after | Suboptimal Infant Breastfeeding (n = 25) | Improvement | CMT/CST | NA | NA | NA | H not blinded | U-PN property measurements not fully evaluated for children | H not discussed | U-PN different outcomes for participants | H adverse events not reported | H no confounding variables included | Low |
Musculoskeletal | ||||||||||||||
Jennings J & Davies G, 2005 [29] | Interrupted time series (without comparison group) | Cuboid Syndrome (n = 2) | Improvement | MT | NA | NA | NA | H not blinded | U-PN property measurements not fully evaluated for children | U-PY not different but not specified | L all outcomes discussed | H adverse events not reported | U-PN variables that may influence outcome discussed but no adjustment to outcome taken into account | Medium |
Przekop P, et al. 2016 [30] | Before-after | Chronic tension-type headache (n = 83) | Improvement | OMT | NA | NA | NA | H not blinded | U-PN property measurements not fully evaluated for children | L consistent | L all outcomes discussed | H adverse events not reported | L confounding variables accounted for | Medium |
Marchand A, et al. 2009 [32] | Before-after | Benign infant headache (n = 13) | Improvement | CMT | NA | NA | NA | H not blinded | U-PN property measurements not fully evaluated for children | H not discussed | L all outcomes discussed | H adverse events not reported | H medication not accounted for | Low |
Walston Z & Yake D, 2016 [34] | Interrupted time series (without comparison) | Mechanical Low Back Pain (n = 3) | Improvement | MT | NA | NA | NA | H not blinded | U-PN property measurements not fully evaluated for children | H not consistent | L all outcomes discussed | L adverse events reported | U-PN information not consistently collected | Medium |
Hayden J, et al. 2003 [36] | Before-after | Mechanical Low Back Pain (n = 54) | Improvement | CMT | NA | NA | NA | H not blinded | U-PN property measurements not fully evaluated for children | L consistent | U-PN not all cases collected | H adverse events not reported | U-PY retrospective data, information not consistently collected | Medium |
Respiratory | ||||||||||||||
Degenhardt B & Kuchera M, 2006 [45] | Before-after | Otitis media (n = 8) | Improvement | OMT/CST | NA | NA | NA | H not blinded | U-PN property measurements not fully evaluated for children | L consistent | L all outcomes discussed | H adverse events not reported | U-PN natural course of OM diagnosis, differences in AOM and OM, dietary considerations | Medium |
Zhang JQ & Snyder BJ, 2004 [46] | Before-after | Otitis media (n = 22) | Improvement | CMT | NA | NA | NA | H not blinded | U-PN property measurements not fully evaluated for children | H not discussed | L all outcomes discussed | L adverse events reported | H several confounding varaibles missing | Medium |
Special Needs | ||||||||||||||
Bramati-Castellarin I, et al. 2016 [49] | Interrupted time series (without comparison) | Autism (n = 49) | Improvement | VOMT | NA | NA | NA | H not blinded | U-PN property measurements not fully evaluated for children | L follow up consistent | L all outcomes discussed | H adverse events not reported | U-PY not all confounding variables known | Medium |
Structural | ||||||||||||||
Lessard S, et al. 2011 [59] | Before-after | Cranial asymmetry (nonsynostotic plagiocephaly) (n = 12) | Improvement | OMT | NA | NA | NA | L blinded | U-PN property measurements not fully evaluated for children | L follow-up consistent | L all outcomes discussed | H adverse events not reported | U-PN natural course | Medium |
Byun S & Han D, 2016 [61] | Before-after | Scoliosis (n = 5) | Improvement | CMT | NA | NA | NA | H not blinded | L Cobb angle | L follow-up consistent | L all outcomes discussed | H adverse events not discussed | H confounding variables not accounted for, no mention of natural course | Medium |
Morningstar M, et al. 2004 [63] | Before-after | Scoliosis (n = 6) | Improvement | CMT | NA | NA | NA | H not blinded | L Cobb angle | H length of follow-up similar but some patients had received prior treatment | L all outcomes discussed | H adverse events not reported | H confounding variables not accounted for, no mention of natural course | Low |
Lantz C & Chen J, 2001 [64] | Before-after | Scoliosis (n = 42) | No improvement | CMT | NA | NA | NA | L blinded | L Cobb angle | H follow-up not consistent | L all outcomes discussed | H adverse events not reported | H confounding variables missing, no mention of natural course | Medium |
Saedt E, et al. 2018 [67] | Before-after | Upper cervical dysfunction (n = 307) | Improvement | MT | NA | NA | NA | L blinded | U-PN property measurements not fully evaluated for children | L follow-up consistent | L all outcomes discussed | L adverse events discussed | U-PY not all confounding variables known | High |
Pediatric clinical conditions
Condition | Author/year | Study objective | Study design Sample size Intervention | Patient description/condition | Primary/ main outcome(s) | Main results/ conclusions | Adverse events |
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Constipation | Tarsuslu T, et al. 2009 [18] | Investigate potential effects of osteopathic treatment on constipation in children with cerebral palsy. | Interrupted Time Series (with comparison group) n = 13 OMT | Children with CP, ages 2–16, with constipation | Defecation frequency, gross motor function classification system, Modified Ashworth scale, functional independence measure for children, constipation assessment scale, visual analog scale | Both groups showed significant changes from all baseline measures at 3 mos. | There was no mention of adverse events made in this study. |
Infantile Colic | Miller JE, et al. 2012 [19] | Two-fold: 1. Determine efficacy of chiropractic manipulation therapy for infants with colic; and 2. Parental reporting bias. | RCT n = 104 CMT | Infants < 8 weeks, diagnosed with colic | Decreased crying (as assessed by parent questionnaire and 24 h crying diary) | 1. Greater decrease in crying in colicky infants treated with CMT compared to infants who were not treated. 2. Unlikely that observed treatment effect is due to bias on part of reporting parent. | One patient in the control group noted increased crying. |
Wiberg K & Wiberg J, 2010 [20] | Investigate if the outcome of excessively crying infants treated with chiropractic manipulation is associated with age. | Interrupted Time Series (without comparison group) n = 749 CMT | Healthy, thriving infants, ages 0–3 months, who fit diagnostic criteria of infantile colic | Parent report of crying: classified as “improved”, “uncertain recovery”, “non recovered” | No apparent link between clinical effect of chiropractic treatment and a natural crying pattern was found, Slightly older age was found to be linked to crying infants with clinical improvement | There was no mention of adverse events made in this study. | |
Browning M & Miller J, 2008 [21] | To compare chiropractic manual therapy and occipital-sacral decompression in the treatment of infant colic. | RCT n = 43 CMT | Infants < 8 weeks, who cried more than 3 h a day for at least 4 of the previous 7 days | Change in group mean daily hours of crying (recorded in crying diary) | Mean hours of crying were significantly reduced in both groups. Both treatments appear to offer benefits to infants with colic. There was no difference between two treatment approaches. | There was no mention of adverse events made in this study. | |
Olafsdottir E, et al. 2001 [22] | To evaluate chiropractic spinal manipulation management on infantile colic. | RCT n = 86 CMT | Infants ages 3–9 weeks, diagnosed with infantile colic | 24 h diary of infant’s crying (crying diary) completed by parent; Parent report of effect after last visit (8–14 days later) | No difference between groups with either outcome. | There was no mention of adverse events made in this study. | |
Hayden C & Mullinger B, 2006 [23] | To determine the impact of cranial osteopathy on infantile colic. | RCT n = 28 OMT/CST | Infants 1–12 weeks, with signs of infantile colic that included; 90 min/24 h. of inconsolable crying on 5 out of 7 days and additional clinical signs such as borborygmi, knees drawn up to chest, fists clenched, backward bending of head or trunk | Parents record of time spent crying and sleeping in a 24-h diary | No between group comparisons done. While both groups, demonstrated decreases, only the OMT/CST group had significant reduction for time spent crying and sleeping. | There was no mention of adverse events made in this study. | |
Pediatric dysfunctional voiding | Nemett D, et al. 2008 [24] | To determine whether manual physical therapy-osteopathic approach added to standard treatment improves dysfunctional voiding more effectively than standard treatment alone. | RCT n = 21 OMT | Children ages 4–11, diagnosed with dysfunctional voiding and symptoms of daytime incontinence and or vesicoureteral reflux | Improved dysfunctional voiding symptoms; 1. improved or resolved vesicoureteral reflux 2. elimination of post-void urine residuals | Results suggest that manual physical therapy-osteopathic approach treatment can improve short-term outcomes in children with dysfunctional voiding, beyond improvements observed with standard treatments. | There was no mention of adverse events made in this study. |
Nocturnal Enuresis | van Poecke A & Cunliffe C, 2009 [25] | To evaluate the effect of chiropractic treatment on the wet night frequency of patients with nocturnal enuresis. | Before-After n = 33 CMT | Children ages 3–18, diagnosis of nocturnal enuresis | Diary of wet night frequency, diurnal urinary output | 66.6% resolution rate within 1 year, indication for possible effectiveness of chiropractic treatment (Neuroimpulse instrument) in patients with primary nocturnal enuresis. | There was no mention of adverse events made in this study. |
Suboptimal infant breastfeeding | Miller J, et al. 2009 [26] | To determine the effect of chiropractic manipulative therapy on infants who had difficulty breastfeeding. | Before-After n = 114 CMT | Infants ages 2 days - 12 weeks diagnosed by medical provider with feeding difficulties | Mother’s report of exclusivity of breastfeeding, rating of improving and infant weight gain | Exclusively of breastfeeding was accomplished in 78%. | No negative side effects were reported. |
Vallone S, 2004 [27] | To investigate problems interfering with successful breastfeeding and to see if proper lactation management can increase the bonding experience. | Before-After n = 25 CMT/CST | Infants ages 5 days - 12 weeks, referred by other healthcare providers as having difficulty breastfeeding | Improvement in ability to latch and ability to breastfeed | > 80% of infants experienced improvement in latch and ability to breastfeed. | There was no mention of adverse events made in this study. |
Condition | Author/ year | Study objective | Study design sample size intervention | Patient description/condition | Primary/main outcome(s) | Main results/conclusions | Adverse events |
---|---|---|---|---|---|---|---|
Clubfoot | Nilgun B, et al. 2011 [28] | To determine efficacy of physical therapy, including manual mobilization, as adjunct to Ponseti technique in idiopathic clubfoot. | RCT n = 29 MT | Children ages 3 and under, Dimeglio Score of 17 or under with idiopathic clubfoot | Improvements in passive ranges of motion for plantar flexion, inversion, eversion, rear foot varus angle and forefoot adduction angle and decrease in Dimeglio Score | Treatment procured a statistically significant improvements in ranges of motion, Dimeglio Score and decrease of rear foot varus angle in the study group. | There is no mention of adverse events made in this study. |
Cuboid Syndrome | Jennings J & Davies D, 2005 [29] | Describe the examination and treatment of the cuboid syndrome following lateral ankle sprain. | Interrupted Time Series (with comparison group) n = 2 MT | 7 patients age range 15–36 (2 pediatric patients can be isolated), with cuboid syndrome | Visual Analog Scale: Pre- and post-treatment | All patients had substantial resolution of symptoms following cuboid manipulation. | There is no mention of adverse events made in this study. |
Headache | Przekop P, et al. 2016 [30] | Evaluate and compare a multimodal with pharmacologic treatment for the prevention of chronic tension type headaches (CTTH) in adolescents. | Before-After n = 83 OMT | Children ages 13–18, diagnosed with CTTH | 5 main effects: headache frequency, pain intensity, general health, pain restriction and number of tender points | Both approaches showed significant improvements across all 5 main effects outcomes, but multimodal treatments produced more favorable results in headache frequency, general health, and number of tender points. | There is no mention of adverse events made in this study. |
Borusiak P, et al. 2010 [31] | To investigate the efficacy of spinal manipulative therapy in adolescents with recurrent headache. | RCT n = 52 MT | Adolescents ages 7–15, with cervicogenic headache | Assessment of; percentage of days with headache, total duration of headache, days with school absence due to headache, consumption of analgesics, and intensity of headache | No difference in any outcome measure between placebo and cervical spine manipulation. | No serious or moderate adverse events were noted. Minor adverse events occurred in both groups that included; hot skin in 15 patients (treatment group 6, placebo 9), dizziness in 11 patients (treatment group 7, placebo 4). There was reported transitory increase in headache intensity and frequency being reported for up to 4 days (treatment group 8, placebo 6). | |
Marchand A, et al. 2009 [32] | To conduct a retrospective file search of infants presenting with probable benign infantile headache at a chiropractic teaching clinic. | Before-After n = 13 CMT | Children ages 2 days - 8.5 months, with benign infant headache | Reduction in behavioral findings recorded verbatim by parents such as; grabbing holding face, ineffective latching, grimacing and positional discomfort, rapping head against floor, photophobia, and anorexia. | All 13 consecutive cases had favorable results based on parent report of outcomes. | There is no mention of adverse events made in this study. | |
Low Back Pain | Evans R, et al. 2018 [33] | To compare 12 weeks of chiropractic manipulative therapy combined with exercise therapy to exercise therapy alone in the treatment of chronic lower back pain in children. | RCT n = 185 CMT | Children ages 12–18, with chronic lower back pain | Primary outcome - self-reported level of low back pain (11 box numerical rating scale), Secondary outcomes - patient-rated disability (18 item Roland-Morris Disability questionnaire), quality of life (23 item PedsQL), improvement (9-point scale), frequency of medication use for low back pain (days/week), patient satisfaction with care (7-point scale) | Chiropractic manipulative therapy plus exercise resulted in larger reduction in primary outcome of pain severity over the course of 1 year. | Side effects were similar in both groups, mild and self-limiting and occurred at a frequency comparable to adult population. |
Walston Z & Yake D, 2016 [34] | To illustrate the feasibility and safety of lumbar manipulation as an adjunct to exercise for treatment of adolescent population with mechanical low back pain. | Interrupted Time Series (without comparison group) n = 3 MT | Adolescents ages 13–15, with mechanical low back pain | Pain measured on numerical pain rating scale and disability (Oswestry) for each patient | All outcome showed improvements (0/10 on numeric scale and 0% in the Oswestry disability index) for each patient. | No adverse reactions were reported or observed with any episode of manipulation. | |
Selhorst M & Selhorst B, 2015 [35] | To assess efficacy of lumbar manipulation in addition to a 4-week physical therapy exercise program. | RCT n = 35 MT | Adolescents ages 13–17, with mechanical low back pain of < 90 days | Patient Specific Functional Scale, pain (11-point Numerical Pain Rating Scale), and Global Rating of Chance scales | No difference between groups for Patient Specific Functional Scale, pain, or Global Rating of Chance scales. All patients improved. | Two patients in both the sham and manipulation group had an adverse reaction at 1 week. No patients in either groups reported adverse reactions at either 4 weeks or 6 months. They concluded that no additional risk of having an adverse reaction were noted in this study. | |
Hayden J, et al. 2003 [36] | To describe chiropractic management, outcomes, and factors associated with outcomes for low back pain in childhood. | Before-After n = 54 CMT | Children ages 4–18, with acute mechanical low back pain | Subjective assessment of improvement on a 5-point rating scale (Pediatric Visual Analog Scale) | Over a course of 4–6 weeks of chiropractic management, 55–62% of patients had improvement that met the study’s stringent criteria and 82–87% had much improvement. | Complications from chiropractic patient management were collected with none noted throughout the study data collection period. | |
Pulled Elbow | García-Mata S & Hidalgo-Ovejero A, 2014 [37] | To determine the relative efficacy of two pulled elbow reduction maneuvers, hyper pronation and supination-flexion. | RCT n = 115 MT | Children ages 1–5, with pulled elbow | Reduction of pulled elbow verified by observing active flexion and extension | Both maneuvers were effective with a higher first-attempt success rate with hyper pronation. | There is no mention of adverse events collected in this study. |
Bek D, et al. 2009 [38] | To compare the reduction efficiency of hyper pronation to supination-flexion maneuvers for a pulled elbow. | RCT n = 66 MT | Children ages 1–5, with pulled elbow | Reduction of pulled elbow indicated by child using the arm | Final reduction rates similar. Hyper pronation maneuver was more successful on the first attempt. | There is no mention of adverse events collected in this study. | |
Temporomandibular Disorder | Monaco A et al. 2008 [39] | To evaluate the effects of osteopathic manipulative therapy on mandibular kinematics in patients with temporomandibular dysfunction. | RCT n = 28 OMT | Children average age 12, diagnosed with TMD | Objective measures pre- and post-treatment using kinesiographic tracings to assess mandibular movement | Osteopathic manipulation made significant improvements in maximal mouth opening and in maximal mouth opening velocity. | There is no mention of adverse events made in this study. |
Condition | Author/year | Study objective | Study design sample size intervention | Patient description/ condition | Primary/main outcome(s) | Main results/conclusions | Adverse events |
---|---|---|---|---|---|---|---|
Asthma | Guiney P, et al. 2005 [40] | To demonstrate the therapeutic relevance of osteopathic manipulation in the pediatric asthma population. | RCT n = 140 OMT | Children ages 5–17, diagnosed with asthma by guidelines from NIH | Peak Expiratory Flow Rates | There was statistically significant improvement of 7 L per minute to 9 L per minute for peak expiratory flow rates in the treatment group. | There was no mention of adverse events made in this study. |
Bronfort G, et al. 2001 [41] | To determine if chiropractic manipulative therapy in addition to optimal medical management resulted in clinically important changes in asthma-related outcomes. | RCT n = 34 CMT | Children ages 6–17, with persistent asthma | Pulmonary function tests, diary recording peak expiratory flow and inhaler use, questionnaires assessing quality of life, asthma severity and improvement | Little to no change in pulmonary function tests at 12 weeks and no change in patient, parent/guardian or pulmonologist rated improvement | There was no mention of adverse events made in this study. | |
Obstructive Apnea | Vandenplas Y, et al. 2008 [42] | To evaluate if osteopathy can influence the incidence of obstructive apnea during sleep in infants. | RCT n = 34 OMT | Infants aged 1.5–4 months, with obstructive apnea as determined by a polysomnographic test | Decrease in the number of obstructive apneas as measured by polysomnography. | Infants aged 1.5–4 months, with obstructive apnea as determined by polysomnographic | There was no mention of adverse events made in this study. |
Otitis Media | Steele D, et al.2014 [43] | To evaluate the efficacy of an osteopathic manipulative treatment protocol on middle ear effusion resolution following acute otitis media. | RCT n = 52 OMT | Infant ages 6–24 months, with acute otitis media and abnormal tomogram | Tympanometer and acoustic reflectometer | Both tympanometer data and acoustic reflectometer analysis demonstrated significantly significant improvement in middle ear effusion at visit 3 in the standard care plus osteopathic treatment group. | There were no serious adverse events reported during the study. |
Wahl R, et al. 2008 [44] | To assess the efficacy of Echinacea and osteopathic manipulative treatment for preventing acute otitis media. | RCT n = 90 OMT | Children aged 12–60 months, with recurrent otitis media | Reduction in future episodes of OM | No interaction was found between Echinacea and osteopathic manipulation. Echinacea was associated with a borderline increased risk of having at least one episode of acute otitis media during 6-month follow-up compared to placebo. Osteopathic manipulation did not significantly affect risk compared to sham. | “One subject withdrew from the study following an adverse effect (vomiting after taking the Echinacea placebo). One additional subject reported adverse effects (vomiting and non-urticarial rash 2 days after starting Echinacea for a viral upper respiratory illness) but did not withdraw. Neither adverse effect was considered to have been caused by the study medication. | |
Degenhardt B & Kuchera M, 2006 [45] | Does osteopathic manipulation decrease the recurrence of otitis media? | Before-After n = 8 OMT/CST | Infants ages 7–35 months, with recurrent otitis media | Decreased incidence of acute otitis media | 5 participants had no recurrence after 1 year follow-up. 1 participant had 1 recurrence. 2 participants had a short-term of no recurrence only. | There is no mention of adverse events made in this study. | |
Zhang J & Snyder B, 2004 [46] | To study the effect of Toftness chiropractic adjustment for acute otitis media. | Before-After n = 22 CMT | Children ages 9 months −9 years, with acute otitis media | Tympanic Membrane visualization via otoscopic exam and oral temperature | After Toftness chiropractic adjustment, red and bulging tympanic membrane returned to normal in 95% of children. A decrease in average oral temperature was noted. | “During the study protocol, no side effects or deterioration of clinical presentations were found among 21 children with otitis media.” | |
Mills M, et al. 2003 [47] | To evaluate the effect of usual care and osteopathic manipulation for children with acute otitis media. | RCT n = 57 OMT | Children ages 6 months - 6 years, with recurrent otitis media | Decreased frequency of acute otitis media, antibiotic us, surgical interventions, and improved tympanometric and audiometric performance | Intervention group had fewer episodes of acute otitis media, fewer surgical procedures and an increased frequency of more normal tympanogram readings. | There were no adverse events reported during the study. |
Condition | Author/year | Study objective | Study design sample size intervention | Patient description/condition | Primary/main outcome(s) | Main results/conclusions | Adverse events |
---|---|---|---|---|---|---|---|
ADHD | Accorsi A, et al. 2014 [48] | To evaluate efficacy of osteopathic manipulative treatment of children with ADHD. | RCT n = 28 OMT | Children ages 5–15, with primary diagnosis of ADHD | Biancardi-Stroppa Modified Bell Cancellation Test, accuracy and rapidity scores | Osteopathic manipulative treatment was positively associated with changes in the Biancardi-Stroppa Test accuracy and rapidity scores. | There was no mention of adverse events made in this study. |
Autism | Bramati-Castellarin I, et al. 2016 [49] | Investigate the influence of visceral osteopathic technique on the behaviour and GI symptoms of children with autism. | Interrupted Time Series (without control group) n = 49 VOMT | Autistic children ages 3 1/2–8, with GI symptoms, impaired social interactions and communication | Parental completion of the Modified Autism Research Institute outcomes survey form (9 S.O.S. questionnaires) and secretin assessment used to assess GI signs and symptoms | Significant improvements reported in “social behavior and communication” and “digestive signs” subscale of the questionnaire and in vomiting and poor appetite comparing before and after VOMT. | “There was no mention of adverse events made in this study.” |
Khorshid K, et al. 2006 [50] | Identify the differences in efficacy between upper cervical and full spine adjustment in autistic children | RCT n = 14 CMT | Children diagnosed with autism | ATEC average scores and parental observations | Clinical improvements observed through parental observations and through a decrease in the ATEC scores in both groups. Upper cervical group had improved ATEC average scores of 32%. Full spine group had improved ATEC scores of 19%. | Clinical deterioration was shown in one of the children of the full spine group, but only marginal in one child of the upper cervical group. | |
Cerebral Palsy | Wyatt K, et al. 2011 [51] | Evaluate the general health and wellbeing effect of cranial osteopathy on cerebral palsy children. | RCT n = 142 Cranial Osteopathy | Children with CP, ages 5–12 | Gross Motor Function Measure - (GMFMM-66) Quality of life Child Health Questionnaire-(CHQ) PF50 | No statistical change in GMFM-66 or CHQ. PF50 Parents (unblinded) reported better global health. | No serious adverse events were reported. |
Duncan B, et al. 2004 [52] | Evaluate effectiveness of osteopathic manipulation or acupuncture as a supplemental therapies for children with spastic cerebral palsy. | RCT n = 50 OMT | Children with spastic CP, ages 20 months - 12 years | Parent reporting of changes observed (open-ended questions) | 96% reported improvements. Most frequent seen in use of arms and legs (61 and 68%) and more restful sleep (39 and 68%) in osteopathic and acupuncture respectively. Additional improvements also noted in mood and bowel functions. | There was no mention of adverse events made in this study. | |
Duncan B, et al. 2008 [53] | Evaluate effectiveness of osteopathic manipulation (cranial field, myofascial release or both) vs. acupuncture in spastic cerebral palsy patients. | RCT n = 55 OMT/Acupuncture | Children with CP, ages 20 months - 12 years | 11 outcomes used: Primary-GMFCS, GMFM total percent, PEDI mobility, PEDI self-care, WeeFIM mobility, WeeFIM self-care; Secondary- DO rating of spasticity, MAS biceps, MAS hamstring, parent/guardian rating of arched back, parent/guardian rating of startle reflex | Osteopathic manipulation was associated with improvements in 2 of 11 outcomes; GMFM total percent and WeeFIM Mobility. Acupuncture was not associated with improvements in any of the outcomes variables. | There was no mention of adverse events made in this study. | |
Prematurity | Raith W, et al. 2016 [54] | Investigate neurological short term effects of craniosacral therapy on general movements in preterm infants. | RCT n = 30 OMT/CST | Preterm infants ages 25–33 weeks, free from medical complications in NICU | Primary outcome: General movement assessment tool. Secondary outcomes: General movement optimality score | No difference in the general movement could be observed between the groups. No change in general movement optimality score was noted. | There was no mention of adverse events made in this study. |
Cerretelli F, et al. 2015 [55] | Investigate whether osteopathic manipulation reduces the length of hospital stay, costs, and weight gain for preterms. | RCT n = 695 OMT/CST | Preterm infants ages 29–37 weeks, without congenital complications in NICU | 1. Reducing length of hospital stay 2. Weight gain and hospital savings | Osteopathic treatment reduced days hospital (3.9 days) and reduced costs by 1250.65€ per newborn per length of stay. No change in weight gain was noted. | There were no complications associated to the intervention. | |
Pizzolorusso G, et al. 2014 [56] | Investigate whether osteopathic manipulation reduces length of hospital stay, what effect the timing of introduction of osteopathic treatment may have on the outcome and hospital costs in preterm infants. | RCT n = 110 OMT/CST | Preterm infants ages 32–37 weeks, free from medical complications in NICU | 1. Reducing length of hospital stay and impact on length of stay of timing of introduction of osteopathic manipulation 2. Reducing hospital cost | Sooner osteopathic manipulation introduced, shorter length of stay. There is a positive association of osteopathic manipulation with overall reduction in cost of care. | There were no complications associated to the intervention. | |
Cerretelli F, et al. 2013 [57] | Determine effectiveness of osteopathic manipulative therapy in reducing the length of hospital stay, hospital costs and weight gain in preterm infants. | RCT n = 110 OMT/CST | Preterm infants ages >28 and <38 weeks, free from medical complications in NICU | 1. Decreased length of hospital stay 2. Improved weight gain and reduced NICU costs | Osteopathic manipulation reduced length of stay and hospital costs but not effect weight gain. | No serious adverse events were reported. |
Condition | Author/year | Study objective | Study design sample size intervention | Patient description/ condition | Primary/main outcome(s) | Main results/conclusions | Adverse events |
---|---|---|---|---|---|---|---|
Cranial Asymmetry | Cabrera-Martos I, et al. 2016 [58] | Evaluate the effects of manual therapy as an adjuvant option on treatment duration and motor development in infants with severe nonsynostotic plagiocephaly. | RCT n = 46 MT/CST | Infants ages 4–8 months, with severe nonsynostotic plagiocephaly | Treatment duration and motor development assessed with Alberta Infant Motor Scale | Treatment duration was significantly reduced in manual therapy group (109.84 +/− 14.45) compared to the control group (148.65 +/− 11.53) days. Asymmetry after the treatment was minimal Type 0 or Type 1. Motor behaviour was normal in all the infants after treatment. | Study reported no adverse effects were seen during the treatment period. |
Lessard S, et al. 2011 [59] | Does osteopathic manipulation alter cranial asymmetry in infants. | Before-After n = 12 OMT | Infants ages < 6.5 months, diagnosed with nonsynostotic plagiocephaly | Anthropometric changes | Osteopathic treatment led to improvements in cranial asymmetry. | There is no mention of adverse events made in this study. | |
Postural Asymmetry | Philippi H, et al. 2006 [60] | To assess the therapeutic efficacy of osteopathic manipulation in infants with postural asymmetry. | RCT n = 32 OMT/CST | Infant ages 6–12 weeks, with postural asymmetry | Video-based measurements | Significant improvement in postural asymmetry (mean 5.9 points) observed with osteopathic manipulation. | “At least two of the seven vegetative symptoms aggravated for 2 days after the interventions in six patients of the control group and in four patients of the treatment group. Otherwise no adverse effects were seen.” |
Scoliosis | Byun S & Han D, 2016 [61] | Examine whether chiropractic techniques would reduce the curvature of idiopathic scoliosis. | Before-After n = 5 CMT | Children ages 10–13, with Cobb angles > 10 degrees | Reduction in Cobb angle | No significant difference in Cobb angle was noted after the 4th week of chiropractic manipulation. | There is no mention of adverse events made in this study. |
Hasler C, et al. 2010 [65] | Test to see if osteopathy alters trunk morphology, to unload the concave side of the scoliosis to halt curve progression. | RCT n = 20 OMT | Post-pubertal females ages 12–18, with Cobb angles 20–40 | Trunk morphology, spine flexibility and scoliometer measurements | Repeat measurements revealed no therapeutic effect on rib hump, lumbar prominence, plumb line, sagittal profile and global flexibility. | “No intervention-related side effects or complications were noted” | |
Rowe D, et al. 2006 [62] | To conduct a pilot (feasibility) study and explore issues of patient safety, patient recruitment and compliance, treatment standardization, sham treatment refinement, interprofessional cooperation, quality assurance, and outcome measure selection. | RCT n = 6 CMT | Children ages 10–16, with Cobb angles 20–40 degrees | Reduction in Cobb angle | Feasible to recruit AIS patients for a randomized clinical trial to compare chiropractic care and standard medical treatment. | CMT delivered on 52 visits resulted in two benign reactions one with moderate pain lasting 24 h; the other produced mild pain lasting 6 h. | |
Morningstar M, et al. 2004 [63] | Evaluate of scoliosis treatment using a combination of manipulative and rehabilitative therapy. | Before-After n = 19 (6 pediatrics) CMT | Scoliotic patients aged 15–65 (6 patients 18 and under- identified in Table 3 of study) | Reduction in Cobb angle | Reduction in Cobb angles in all patients. | There is no mention of adverse events made in this study. | |
Lantz C & Chen J, 2001 [64] | Effect of chiropractic manipulation on small scoliotic curves in younger subjects. | Before-After n = 42 CMT | Children aged 6–17, with Cobb angles 6–25 | Reduction in Cobb angle | No overall reduction in Cobb angle after 6.5–28.5 months of care. | There is no mention of adverse events made in this study. | |
Torticollis | Haugen E, 2011 [66] | Evaluate measurement methods and examine short-time effect of manual therapy in addition to physiotherapy in infants with torticollis. | RCT n = 32 MT | Infant aged 3–6 months, diagnosed with torticollis | Primary outcome: Videoclip recordings, Secondary outcomes: 12 parameters of body function, activity, participation | No significant difference in primary outcome. Found non-significant tendency to greater improvement in lateral flexion and head righting in intervention group. | There is no mention of adverse events made in this study. |
Upper Cervical Dysfunction | Saedt E, et al. 2018 [67] | To gain insight into the patient characteristics and reasons for seeking care in infants with indications of upper cervical dysfunction referred for manual therapy. | Before-After n = 295 MT | Infants aged < 27 weeks, with positional preference, restlessness, abnormal head position, excessive crying | Improved flexion-rotation test and lateral flexion tests Parental perception of treatment effects Pre- and post treatment self-reported questionnaires | Flexion- rotation test decreased from 78.8 to 6.8%. Lateral flexion test decreased from 91.5% tp 6.2%. All parents perceived positive treatment effects. | No serious adverse events were reported during this study. |
Discussion
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Low Back Pain (using CMT);
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Pulled (or Nurse’s) Elbow (using MT); and
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Preterm Infants (using OMT/CST to reduce days and costs in hospital).
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ADHD (using OMT);
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Autism (using CMT);
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Asthma (using OMT);
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Clubfoot (using MT);
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Cranial Asymmetry (using MT/CST);
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Dysfunctional Voiding (using OMT);
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Infantile Colic (using OMT/CST);
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Obstructive Apnea (using OMT);
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Otitis Media (using OMT);
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Postural Asymmetry (using OMT/CST);
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Suboptimal Infant Breastfeeding (using CMT/CST); and
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Temporomandibular Joint Dysfunction (using OMT).
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Asthma (using CMT);
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Autism (using VOMT);
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Cerebral Palsy (using OMT);
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Constipation (using OMT);
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Cranial Asymmetry (using OMT);
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Cuboid Syndrome (using MT);
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Headache (using CMT, OMT, and MT);
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Infantile Colic (using CMT);
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Low Back Pain (using MT);
-
Otitis Media (using CMT);
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Nocturnal Enuresis (using CMT);
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Preterm Infants (using OMT/CST for general movement);
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Scoliosis (using CMT); and
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Upper Cervical Dysfunction (using MT).
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Scoliosis (using OMT) and
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Torticollis (using MT).