In: van der Velde , G , Côté , P , Bayoumi , A M , Cassidy , J D , Boyle , E , Shearer , H M , Stupar , M , Jacobs , C , Ammendolia , C , Carette , S & van Tulder , M 2011 , ' Protocol for an economic evaluation alongside the University Health Network Whiplash Intervention Trial: cost-effectiveness of education and activation, a rehabilitation program, and the legislated standard of care for acute whiplash injury in Ontario ' , B M C Public Health , vol. 11 , pp. 594 . https://doi.org/10.1186/1471-2458-11-594
Whiplash injury affects 83% of persons in a traffic collision and leads to whiplash-associated disorders (WAD). A major challenge facing health care decision makers is identifying cost-effective interventions due to lack of economic evidence. Our objective is to compare the cost-effectiveness of: 1) physician-based education and activation, 2) a rehabilitation program developed by Aviva Canada (a group of property and casualty insurance providers), and 3) the legislated standard of care in the Canadian province of Ontario: the Pre-approved Framework Guideline for Whiplash developed by the Financial Services Commission of Ontario.
In: Côté , P , Boyle , E , Shearer , H M , Stupar , M , Jacobs , C , Cassidy , J D , Carette , S , van der Velde , G , Wong , J J , Hogg-Johnson , S , Ammendolia , C , Hayden , J A , van Tulder , M & Frank , J W 2019 , ' Is a government-regulated rehabilitation guideline more effective than general practitioner education or preferred-provider rehabilitation in promoting recovery from acute whiplash-associated disorders? A pragmatic randomised controlled trial ' , BMJ Open , vol. 9 , no. 1 , e021283 . https://doi.org/10.1136/bmjopen-2017-021283
OBJECTIVE: To evaluate the effectiveness of a government-regulated rehabilitation guideline compared with education and activation by general practitioners, and to a preferred-provider insurance-based rehabilitation programme on self-reported global recovery from acute whiplash-associated disorders (WAD) grade I-II. DESIGN: Pragmatic randomised clinical trial with blinded outcome assessment. SETTING: Multidisciplinary rehabilitation clinics and general practitioners in Ontario, Canada. PARTICIPANTS: 340 participants with acute WAD grade I and II. Potential participants were sampled from a large automobile insurer when reporting a traffic injury. INTERVENTIONS: Participants were randomised to receive one of three protocols: government-regulated rehabilitation guideline, education and activation by general practitioners or a preferred-provider insurance-based rehabilitation. PRIMARY AND SECONDARY OUTCOME MEASURES: Our primary outcome was time to self-reported global recovery. Secondary outcomes included time on insurance benefits, neck pain intensity, whiplash-related disability, health-related quality of life and depressive symptomatology at 6 weeks and 3, 6, 9 and 12 months postinjury. RESULTS: The median time to self-reported global recovery was 59 days (95% CI 55 to 68) for the government-regulated guideline group, 105 days (95% CI 61 to 126) for the preferred-provider group and 108 days (95% CI 93 to 206) for the general practitioner group; the difference was not statistically significant (Χ2=3.96; 2 df: p=0.138). We found no clinically important differences between groups in secondary outcomes. Post hoc analysis suggests that the general practitioner (hazard rate ratio (HRR)=0.51, 95% CI 0.34 to 0.77) and preferred-provider groups (HRR=0.67, 95% CI 0.46 to 0.96) had slower recovery than the government-regulated guideline group during the first 80 days postinjury. No major adverse events were reported. CONCLUSIONS: Time-to-recovery did not significantly differ across intervention groups. We found no differences between groups with regard to neck-specific outcomes, depression and health-related quality of life. TRIAL REGISTRATION NUMBER: NCT00546806.
In: Côté , P , Boyle , E , Shearer , H M , Stupar , M , Jacobs , C , Cassidy , J D , Carette , S , Van Der Velde , G , Wong , J J , Hogg-Johnson , S , Ammendolia , C , Hayden , J A , Van Tulder , M & Frank , J W 2019 , ' Is a government-regulated rehabilitation guideline more effective than general practitioner education or preferred-provider rehabilitation in promoting recovery from acute whiplash-associated disorders? A pragmatic randomised controlled trial ' , BMJ Open , vol. 9 , no. 1 , e021283 . https://doi.org/10.1136/bmjopen-2017-021283
Objective To evaluate the effectiveness of a government-regulated rehabilitation guideline compared with education and activation by general practitioners, and to a preferred-provider insurance-based rehabilitation programme on self-reported global recovery from acute whiplash-associated disorders (WAD) grade I-II. Design Pragmatic randomised clinical trial with blinded outcome assessment. Setting Multidisciplinary rehabilitation clinics and general practitioners in Ontario, Canada. Participants 340 participants with acute WAD grade I and II. Potential participants were sampled from a large automobile insurer when reporting a traffic injury. Interventions Participants were randomised to receive one of three protocols: Government-regulated rehabilitation guideline, education and activation by general practitioners or a preferred-provider insurance-based rehabilitation. Primary and secondary outcome measures Our primary outcome was time to self-reported global recovery. Secondary outcomes included time on insurance benefits, neck pain intensity, whiplash-related disability, health-related quality of life and depressive symptomatology at 6 weeks and 3, 6, 9 and 12 months postinjury. Results The median time to self-reported global recovery was 59 days (95% CI 55 to 68) for the government-regulated guideline group, 105 days (95% CI 61 to 126) for the preferred-provider group and 108 days (95% CI 93 to 206) for the general practitioner group; the difference was not statistically significant (X 2 =3.96; 2 df: P=0.138). We found no clinically important differences between groups in secondary outcomes. Post hoc analysis suggests that the general practitioner (hazard rate ratio (HRR)=0.51, 95% CI 0.34 to 0.77) and preferred-provider groups (HRR=0.67, 95% CI 0.46 to 0.96) had slower recovery than the government-regulated guideline group during the first 80 days postinjury. No major adverse events were reported. Conclusions Time-to-recovery did not significantly differ across intervention groups. We found no differences between groups with regard to neck-specific outcomes, depression and health-related quality of life.
In: Côté , P , Hartvigsen , J , Leboeuf-Yde , C , Corso , M , Shearer , H , Wong , J , Marchand , A-A , French , S , Kawchuk , G N , Mior , S , Poulsen , E , Srbely , J , Ammendolia , C , Blanchette , M-A , Busse , J W , Bussières , A , Cancelliere , C , Christensen , H W , De Carvalho , D , De Luca , K , Du Rose , A , Eklund , A , Engel , R , Goncalves , G , Hebert , J , Hincapié , C A , Kimpton , A , Lauridsen , H H , Innes , S , Meyer , A-L , Newell , D , O'Neill , S , Pagé , I , Passmore , S , Perle , S M , Quon , J , Rezai , M , Stupar , M , Swain , M , Vitello , A , Weber , K , Young , K J & Yu , H 2021 , ' The global summit on the efficacy and effectiveness of spinal manipulative therapy for the prevention and treatment of non-musculoskeletal disorders: a systematic review of the literature ' , Chiropractic & Manual Therapies , vol. 29 , 8 . https://doi.org/10.1186/s12998-021-00362-9
Background: A small proportion of chiropractors, osteopaths, and other manual medicine providers use spinal manipulative therapy (SMT) to manage non-musculoskeletal disorders. However, the efficacy and effectiveness of these interventions to prevent or treat non-musculoskeletal disorders remain controversial. Objectives: We convened a Global Summit of international scientists to conduct a systematic review of the literature to determine the efficacy and effectiveness of SMT for the primary, secondary and tertiary prevention of non-musculoskeletal disorders. Global summit: The Global Summit took place on September 14–15, 2019 in Toronto, Canada. It was attended by 50 researchers from 8 countries and 28 observers from 18 chiropractic organizations. At the summit, participants critically appraised the literature and synthesized the evidence. Systematic review of the literature: We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health, and the Index to Chiropractic Literature from inception to May 15, 2019 using subject headings specific to each database and free text words relevant to manipulation/manual therapy, effectiveness, prevention, treatment, and non-musculoskeletal disorders. Eligible for review were randomized controlled trials published in English. The methodological quality of eligible studies was assessed independently by reviewers using the Scottish Intercollegiate Guidelines Network (SIGN) criteria for randomized controlled trials. We synthesized the evidence from articles with high or acceptable methodological quality according to the Synthesis without Meta-Analysis (SWiM) Guideline. The final risk of bias and evidence tables were reviewed by researchers who attended the Global Summit and 75% (38/50) had to approve the content to reach consensus. Results: We retrieved 4997 citations, removed 1123 duplicates and screened 3874 citations. Of those, the eligibility of 32 articles was evaluated at the Global Summit and 16 articles were included in our systematic review. Our synthesis included six randomized controlled trials with acceptable or high methodological quality (reported in seven articles). These trials investigated the efficacy or effectiveness of SMT for the management of infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. None of the trials evaluated the effectiveness of SMT in preventing the occurrence of non-musculoskeletal disorders. Consensus was reached on the content of all risk of bias and evidence tables. All randomized controlled trials with high or acceptable quality found that SMT was not superior to sham interventions for the treatment of these non-musculoskeletal disorders. Six of 50 participants (12%) in the Global Summit did not approve the final report. Conclusion: Our systematic review included six randomized clinical trials (534 participants) of acceptable or high quality investigating the efficacy or effectiveness of SMT for the treatment of non-musculoskeletal disorders. We found no evidence of an effect of SMT for the management of non-musculoskeletal disorders including infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. This finding challenges the validity of the theory that treating spinal dysfunctions with SMT has a physiological effect on organs and their function. Governments, payers, regulators, educators, and clinicians should consider this evidence when developing policies about the use and reimbursement of SMT for non-musculoskeletal disorders.
Abstract Background A small proportion of chiropractors, osteopaths, and other manual medicine providers use spinal manipulative therapy (SMT) to manage non-musculoskeletal disorders. However, the efficacy and effectiveness of these interventions to prevent or treat non-musculoskeletal disorders remain controversial. Objectives We convened a Global Summit of international scientists to conduct a systematic review of the literature to determine the efficacy and effectiveness of SMT for the primary, secondary and tertiary prevention of non-musculoskeletal disorders. Global summit The Global Summit took place on September 14–15, 2019 in Toronto, Canada. It was attended by 50 researchers from 8 countries and 28 observers from 18 chiropractic organizations. At the summit, participants critically appraised the literature and synthesized the evidence. Systematic review of the literature We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health, and the Index to Chiropractic Literature from inception to May 15, 2019 using subject headings specific to each database and free text words relevant to manipulation/manual therapy, effectiveness, prevention, treatment, and non-musculoskeletal disorders. Eligible for review were randomized controlled trials published in English. The methodological quality of eligible studies was assessed independently by reviewers using the Scottish Intercollegiate Guidelines Network (SIGN) criteria for randomized controlled trials. We synthesized the evidence from articles with high or acceptable methodological quality according to the Synthesis without Meta-Analysis (SWiM) Guideline. The final risk of bias and evidence tables were reviewed by researchers who attended the Global Summit and 75% (38/50) had to approve the content to reach consensus. Results We retrieved 4997 citations, removed 1123 duplicates and screened 3874 citations. Of those, the eligibility of 32 articles was evaluated at the Global Summit and 16 articles were included in our systematic review. Our synthesis included six randomized controlled trials with acceptable or high methodological quality (reported in seven articles). These trials investigated the efficacy or effectiveness of SMT for the management of infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. None of the trials evaluated the effectiveness of SMT in preventing the occurrence of non-musculoskeletal disorders. Consensus was reached on the content of all risk of bias and evidence tables. All randomized controlled trials with high or acceptable quality found that SMT was not superior to sham interventions for the treatment of these non-musculoskeletal disorders. Six of 50 participants (12%) in the Global Summit did not approve the final report. Conclusion Our systematic review included six randomized clinical trials (534 participants) of acceptable or high quality investigating the efficacy or effectiveness of SMT for the treatment of non-musculoskeletal disorders. We found no evidence of an effect of SMT for the management of non-musculoskeletal disorders including infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. This finding challenges the validity of the theory that treating spinal dysfunctions with SMT has a physiological effect on organs and their function. Governments, payers, regulators, educators, and clinicians should consider this evidence when developing policies about the use and reimbursement of SMT for non-musculoskeletal disorders.
In: Côté , P , Bussières , A , Cassidy , J D , Hartvigsen , J , Kawchuk , G N , Leboeuf-Yde , C , Mior , S , Schneider , M , Aillet , L , Ammendolia , C , Arnbak , B , Axen , I , Baechler , M , Barbier-Cazorla , F , Barbier , G , Bergstrøm , C , Beynon , A , Blanchette , M A , Bolton , P S , Breen , A , Brinch , J , Bronfort , G , Brown , B , Bruno , P , Konner , M B , Burrell , C , Busse , J W , Byfield , D , Campello , M , Cancelliere , C , Carroll , L , Cedraschi , C , Chéron , C , Chow , N , Christensen , H W , Claussen , S , Corso , M , Davis , M A , Demortier , M , De Carvalho , D , De Luca , K , De Zoete , A , Doktor , K , Downie , A , Du Rose , A , Eklund , A , Engel , R , Erwin , M , Eubanks , J E , Evans , R , Evans , W , Fernandez , M , Field , J , Fournier , G , French , S , Fuglkjaer , S , Gagey , O , Giuriato , R , Gliedt , J A , Goertz , C , Goncalves , G , Grondin , D , Gurden , M , Haas , M , Haldeman , S , Harsted , S , Hartvigsen , L , Hayden , J , Hincapié , C , Hébert , J J , Hesby , B , Hestbæk , L , Hogg-Johnson , S , Hondras , M A , Honoré , M , Howarth , S , Injeyan , H S , Innes , S , Irgens , P M , Jacobs , C , Jenkins , H , Jenks , A , Jensen , T S , Johhansson , M , Kongsted , A , Kopansky-Giles , D , Kryger , R , Lardon , A , Lauridsen , H H , Leininger , B , Lemeunier , N , Le Scanff , C , Lewis , E A , Linaker , K , Lothe , L , Marchand , A A , McNaughton , D , Meyer , A L , Miller , P , Mølgaard , A , Moore , C , Murphy , D R , Myburgh , C , Myhrvold , B , Newell , D , Newton , G , Nim , C , Nordin , M , Nyiro , L , O'Neill , S , Øverås , C , Pagé , I , Pasquier , M , Penza , C W , Perle , S M , Picchiottino , M , Piché , M , Poulsen , E , Quon , J , Raven , T , Rezai , M , Roseen , E J , Rubinstein , S , Salmi , L R , Schweinhardt , P , Shearer , H M , Sirucek , L , Sorondo , D , Stern , P J , Stevans , J , Stochkendahl , M J , Stuber , K , Stupar , M , Srbely , J , Swain , M , Teodorczyk-Injeyan , J , Théroux , J , Thiel , H , Uhrenholt , L , Verbeek , A , Verville , L , Vincent , K , Dan Wang , A L , Weber , K A , Whedon , J M , Wong , J , Wuytack , F , Young , J , Yu , H & Ziegler , D 2020 , ' A united statement of the global chiropractic research community against the pseudoscientific claim that chiropractic care boosts immunity ' , Chiropractic and Manual Therapies , vol. 28 , no. 1 , 21 . https://doi.org/10.1186/s12998-020-00312-x
Background: In the midst of the coronavirus pandemic, the International Chiropractors Association (ICA) posted reports claiming that chiropractic care can impact the immune system. These claims clash with recommendations from the World Health Organization and World Federation of Chiropractic. We discuss the scientific validity of the claims made in these ICA reports. Main body: We reviewed the two reports posted by the ICA on their website on March 20 and March 28, 2020. We explored the method used to develop the claim that chiropractic adjustments impact the immune system and discuss the scientific merit of that claim. We provide a response to the ICA reports and explain why this claim lacks scientific credibility and is dangerous to the public. More than 150 researchers from 11 countries reviewed and endorsed our response. Conclusion: In their reports, the ICA provided no valid clinical scientific evidence that chiropractic care can impact the immune system. We call on regulatory authorities and professional leaders to take robust political and regulatory action against those claiming that chiropractic adjustments have a clinical impact on the immune system.