The author declares that he has no competing interests.
Pediatric manual therapy is controversial within the medical community particularly with respect to adverse events. Pediatric manual therapy (Ped MT) is commonly used by a number of professions such as chiropractors, osteopaths and naturopaths for a variety of treatments in children. Ped MT interventions range from advice, light touch, massage, through to mobilisation and high velocity spinal manipulation. However, current evidence related to adverse events associated with Ped MT is not well understood.
To update the clinical research literature from the 2007 report by Vohra, Johnston, Cramer and Humphreys on possible adverse events in children treated by spinal manipulation.
A review of the clinical research literature from June 2004 until January 2010 as reported in MEDLINE, PubMed and PubMed Central for adverse events specifically related to the treatment of pediatric cases by manual therapy.
Only three new clinical studies, one systematic review with meta-analysis and one evidence report were identified. Two clinical studies reported on chiropractic care and one on osteopathic spinal manipulation in children. The systematic review investigated all studies of adverse events and manual therapy and was not specific for pediatric patients. The evidence review focused on effectiveness of spinal manipulation in a variety of musculoskeletal conditions. No serious or catastrophic adverse events were reported in the clinical studies or systematic review. However for adults, it has been estimated that between 0.003% and 0.13% of manual therapy treatments may result in a serious adverse event. Although mild to moderate adverse events are common in adults, an accurate estimate from high quality pediatric studies is currently not available.
There is currently insufficient research evidence related to adverse events and manual therapy. However, clinical studies and systematic reviews from adult patients undergoing manual therapy, particularly spinal manipulation report that mild to moderate adverse events are common and self limiting. However serious adverse events are rare and much less than for medication commonly prescribed for these problems. More high quality research specifically addressing adverse events and pediatric manual therapy is needed.
Canadian Pediatric Society: Chiropractic care for children: Controversies and Issues. Position Statement (CP 2002-01). Paediatr Child Health. 2002, 7 (2): 85-89.
Barnes PM, Powell-Griner E, McFann K, Nahin RL: Complementary and alternative medicine use among adults: United States, 2002. Adv Data. 2004, 343: 1-19. PubMed
Spigelblatt L, Liane-Ammara G, Pless B, Guyver A: The use of alternative medicine by children. Pediatrics. 1994, 94: 811-814. PubMed
Gotlib A, Rupert R: Assessing the evidence for the use of chiropractic manipulation in pediatric health conditions - a systematic review. Pediatr Child Health. 2005, 10 (3): 157-161.
Brontfort G, Haas M, Evans R, Leiniger B, Triano J: Effectiveness of Manual Therapies: the UK evidence report. Chiropractic and Osteopathy. 2010, 18: 3-10.1186/1746-1340-18-3. CrossRef
Hawk C, Khorsan R, Lisi A, Ferrance R, Evans M: Chiropractic care for nonmusculoskeletal conditions: a systematic review with implications for whole systems research. J Alt Comp Med. 2007, 13 (5): 491-512. 10.1089/acm.2007.7088. CrossRef
Ernst E: Serious adverse effects of unconventional therapies for children and adolescents: a systematic review of recent evidence. Eur J Pediatr. 2003, 162: 72-80. PubMed
Walach H: The campaign against CAM and the notion of "evidence-based". J Altern Complement Med. 2009, 15 (10): 1055-56. 10.1089/acm.2009.0423. CrossRef
Carnes D, Mars TS, Mullinger B, Froud R, Underwood M: Adverse events and manual therapy: A systematic review. Manual Therapy. 2010,
Leboeuf C, Broen P, Herman A, Leembruggen K, Walton D, Crisp TC: Chiropractic care of children with nocturnal enuresis: a prospective outcome study. J Manipulative Physiol Ther. 1991, 14: 110-115. PubMed
Smith RL: At Your Own Risk: The Case Against Chiropractic. 1969, New York, NY: Simon & Schuster
Rageot E: Complications and accidents in vertebral manipulation [in French]. Cah Coll Med Hop Paris. 1968, 9: 1149-1154. PubMed
Jocobi G, Riepert TH, Kieslich M, Bohl J: Case of death during physical therapy according to Vojta [in German]. Z Physiother. 2001, 53: 573-576.
Klougart N, Leboeuf-Yde C, Rasmussen LR: Safety in chiropractic practice. Part II: treatment to the upper neck and the rate of cerebrovascular incidents. J Manipulative Physiol Ther. 1996, 19: 563-569. PubMed
Ziv I, Rang M, Hoffman HJ: Paraplegia in osteogenesis imperfecta. J Bone Joint Surg Br. 1983, 65: 184-185. PubMed
Held JP: Dangers of cervical manipulation in neurology [in French]. Ann Med Phys (Lille). 1966, 251-259.
L'Ecuyer JL: Congenital occipitalization of the atlas with chiropractic manipulation: a case report. Nebr State Med J. 1959, 44: 546-549. PubMed
Hayes NM, Bezilla TA: Incidence of iatrogenesis associated with osteopathic manipulative treatment of pediatric patients. J Am Osteopath Assoc. 2006, 106: 605-608. PubMed
Rubinstein SM, Leboeuf-Yde C, Knol DL, de Koekkoek TE, Pfeifle CE, van Tulder MW: The benefits outweigh the risks for patients undergoing chiropractic care for neck pain: A prospective, multicenter, cohort study. J Manipulative Physiol Ther. 2007, 30: 408-418. 10.1016/j.jmpt.2007.04.013. CrossRefPubMed
Pistolese RA: Risk assessment of neurological and/or vertebrobasilar complications in the pediatric chiropractic patient. J Vertebral Subluxation Res. 1998, 2: 77-85.
- Possible adverse events in children treated by manual therapy: a review
B Kim Humphreys
- BioMed Central
Neu im Fachgebiet Orthopädie und Unfallchirurgie
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