The aim of this overview was to critically evaluate the evidence of effectiveness for spinal manipulation in any paediatric condition. Four electronic databases were searched from their inception to July 2011 to identify all relevant systematic reviews of spinal manipulation for any paediatric condition. Reviews were defined as systematic if they included explicit and repeatable inclusion and exclusion criteria. Five systematic reviews were included, which covered the following conditions: infant colic (n=2), kinetic imbalance due to suboccipital strain (n=1), nocturnal enuresis (n=1) and otitis media (n=1). None of the systematic reviews generated conclusive evidence to suggest that spinal manipulation is an effective treatment for any paediatric condition. Collectively these data failed to demonstrate that spinal manipulation is a useful therapy for paediatric complaints. The safety of spinal manipulation in paediatrics is also less than clear.
OBJECTIVES: The aim of this update is to critically evaluate the evidence for or against the effectiveness of spinal manipulation in patients with any type of clinical condition.
DESIGN: Four electronic databases were searched to identify all relevant systematic reviews of the effectiveness of spinal manipulation in any condition published between 2005 and January 2011. Reviews were defined as systematic, if they included an explicit and repeatable inclusion and exclusion criteria for studies.
RESULTS: Forty-five systematic reviews were included relating to the following conditions: low back pain (n=7), headache (n=6), neck pain (n=4), asthma (n=4), musculoskeletal conditions (n=3), any non-musculoskeletal conditions (n=2), fibromyalgia (n=2), infant colic (n=2), any medical problem (n=1), any paediatric conditions (n=1), carpal tunnel syndrome (n=1), cervicogenic dizziness (n=1), dysmenorrhoea (n=1), gastrointestinal problems (n=1), hypertension (n=1), idiopathic scoliosis (n=1), lateral epicondylitis (n=1), lower extremity conditions (n=1), pregnancy and related conditions (n=1), psychological outcome (n=1), shoulder pain (n=1), upper extremity conditions (n=1) and whiplash injury (n=1). Positive or, for multiple SR, unanimously positive conclusions were drawn for psychological outcomes (n=1) and whiplash (n=1).
CONCLUSION: Collectively these data fail to demonstrate convincingly that spinal manipulation is an effective intervention for any condition.
Background The use of complementary and alternative medicine (CAM) in paediatric populations is common yet, to date, there has been no synthesis of the evidence of its effectiveness in that population. This overview of systematic review evaluates the evidence for or against the effectiveness of CAM for any childhood condition. Methods Medline, AMED and Cochrane were searched from inception until September 2009. Reference lists of retrieved articles were hand-searched. Experts in the field of CAM were contacted. No language restrictions were applied. Results 17 systematic reviews were included in this overview, covering acupuncture, chiropractic, herbal medicine, homeopathy, hypnotherapy, massage and yoga. Results were unconvincing for most conditions although there is some evidence to suggest that acupuncture may be effective for postoperative nausea and vomiting, and that hypnotherapy may be effective in reducing procedure-related pain. Most of the reviews failed to mention the incidence of adverse effects of CAMs. Conclusions Although there is some encouraging evidence for hypnosis, herbal medicine and acupuncture, there is insufficient evidence to suggest that other CAMs are effective for the treatment of childhood conditions. Many of the systematic reviews included in this overview were of low quality, as were the randomised clinical trials within those reviews, further reducing the weight of that evidence. Future research in CAM for children should conform to the reporting standards outlined in the CONSORT and PRISMA guidelines.
The aim of this overview was to critically evaluate the evidence of effectiveness for spinal manipulation in any paediatric condition. Four electronic databases were searched from their inception to July 2011 to identify all relevant systematic reviews of spinal manipulation for any paediatric condition. Reviews were defined as systematic if they included explicit and repeatable inclusion and exclusion criteria. Five systematic reviews were included, which covered the following conditions: infant colic (n=2), kinetic imbalance due to suboccipital strain (n=1), nocturnal enuresis (n=1) and otitis media (n=1). None of the systematic reviews generated conclusive evidence to suggest that spinal manipulation is an effective treatment for any paediatric condition. Collectively these data failed to demonstrate that spinal manipulation is a useful therapy for paediatric complaints. The safety of spinal manipulation in paediatrics is also less than clear.
