The risk associated with spinal manipulation: an overview of reviews

Research output: Contribution to journalReviewResearchpeer-review

Standard

The risk associated with spinal manipulation : an overview of reviews. / Nielsen, Sabrina Mai; Tarp, Simon; Christensen, Robin; Bliddal, Henning; Klokker, Louise; Henriksen, Marius.

In: Systematic Reviews, Vol. 6, No. 1, 64, 24.03.2017.

Research output: Contribution to journalReviewResearchpeer-review

Harvard

Nielsen, SM, Tarp, S, Christensen, R, Bliddal, H, Klokker, L & Henriksen, M 2017, 'The risk associated with spinal manipulation: an overview of reviews', Systematic Reviews, vol. 6, no. 1, 64. https://doi.org/10.1186/s13643-017-0458-y

APA

Nielsen, S. M., Tarp, S., Christensen, R., Bliddal, H., Klokker, L., & Henriksen, M. (2017). The risk associated with spinal manipulation: an overview of reviews. Systematic Reviews, 6(1), [64]. https://doi.org/10.1186/s13643-017-0458-y

Vancouver

Nielsen SM, Tarp S, Christensen R, Bliddal H, Klokker L, Henriksen M. The risk associated with spinal manipulation: an overview of reviews. Systematic Reviews. 2017 Mar 24;6(1). 64. https://doi.org/10.1186/s13643-017-0458-y

Author

Nielsen, Sabrina Mai ; Tarp, Simon ; Christensen, Robin ; Bliddal, Henning ; Klokker, Louise ; Henriksen, Marius. / The risk associated with spinal manipulation : an overview of reviews. In: Systematic Reviews. 2017 ; Vol. 6, No. 1.

Bibtex

@article{18571ff7aad041db908ae34ddb00ce9e,
title = "The risk associated with spinal manipulation: an overview of reviews",
abstract = "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 .",
keywords = "Journal Article",
author = "Nielsen, {Sabrina Mai} and Simon Tarp and Robin Christensen and Henning Bliddal and Louise Klokker and Marius Henriksen",
year = "2017",
month = "3",
day = "24",
doi = "10.1186/s13643-017-0458-y",
language = "English",
volume = "6",
journal = "Systematic Reviews",
issn = "2046-4053",
publisher = "BioMed Central",
number = "1",

}

RIS

TY - JOUR

T1 - The risk associated with spinal manipulation

T2 - an overview of reviews

AU - Nielsen, Sabrina Mai

AU - Tarp, Simon

AU - Christensen, Robin

AU - Bliddal, Henning

AU - Klokker, Louise

AU - Henriksen, Marius

PY - 2017/3/24

Y1 - 2017/3/24

N2 - 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 .

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 .

KW - Journal Article

U2 - 10.1186/s13643-017-0458-y

DO - 10.1186/s13643-017-0458-y

M3 - Review

C2 - 28340595

VL - 6

JO - Systematic Reviews

JF - Systematic Reviews

SN - 2046-4053

IS - 1

M1 - 64

ER -

ID: 186778341