The use of spinal manipulative therapy for pediatric health conditions: a systematic review of the literature

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J Can Chiropr Assoc. 2012 Jun; 56(2): 128–141.

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Table 2

Summary Chart of all 16 Clinical Trials Reviewed

Reference	Objective	Trial Design	/50	Patients/Conditions	Interventions	Main Outcome Measures	Follow-Up Period	Main Results/Conclusions
Bronfort, JMPT 2001	To determine if SMT in addition to optimal medical management resulted in asthma-related outcomes in children. To assess the feasibility of conducting a full-scale, RCT in terms of recruitment, evaluation, treatment and ability to deliver sham SMT.	Prospective clinical case series with observer blinded, pilot randomized and 1 year follow-up	48	36 patients 6–17 years old with mild to moderate asthma	20 chiropractic treatments over the course of 3 months (active or sham SMT)	Pulmonary function test, parental diary, parental Q of L form, severity, am/pm peak expiration flow.	12 months post-treatment follow up	After 3 months in combination with SMT and optimal medical management the children’s Q of L increased significantly and were maintained at 1 year follow up. No change in lung function or hyper-responsiveness. Improvements unlikely to be from SMT alone. Further research is required as to which aspect of the encounter is responsible for improvement.
Balon, NEJM 1998	To compare the effect of true SMT to sham SMT on asthmatic children.	RCT	45	80 children aged 7–16 years with mild to moderate asthma	Treatment group received SMT and STT. Control group received STT and pressure to spine. No changes to pretrial medication.	Change from baseline of peak expiratory out-flow plus several other more qualitative outcomes.	Immediate (journals) and 2 and 4 months.	Small improvements in peak expiratory outflow as well as other indicators; no significant differences.
Rowe, Chiro Osteo 2006	To conduct a pilot study and explore issues of safety, patient recruitment and compliance relevant to planning a RCT.	Pilot RCT	42	6 subjects over 6 months with idiopathic scoliosis.	Standard medical care, standard medical care and chiropractic manipulation, standard care and sham manipulation.	Cobb angle and scoliosis QLI.		There were not enough subjects to compare outcomes between treatment groups, however the study was successful in providing researchers with information needed to plan a full-scale study.
Browning, Clin Chiro 2008	To compare 2 interventions for infantile colic (SMT and OSD).	Single-blinded, randomized comparison trial	41	43 infants less than 8 weeks old who cried >3 hr/day 4 out of the previous 7 days.	SMT and OSD	Change in daily hours crying.	4 weeks	Both SMT and OSD had significant benefits in reducing infant colic. Both groups cried less and slept more after 2 weeks of treatment.
Olafsdottir, Arch Dis 2001	To investigate the efficacy of chiropractic SMT in the management of infantile colic.	Randomized, blinded, placebo controlled clinical trial	37	86 infants	SMT and control	Parent diaries of hours crying.	8–14 days	Chiropractic SMT is no more effective than placebo in the treatment of colic.
Wiberg & Nordsreen, JMPT 1999	To determine if there is a short-term effect of SMT in the management of infantile colic.	RCT	37	41 infants aged 2–10 weeks	SMT and dimethicone	Parent diaries of hours crying.	Immediate or none	During days 4–7 crying decreased 1 hour in dimethicone group and 2.4 hours in SMT group. During days 8–11 crying decreased 1 hour in dimethicone group and 2.7 hours in SMT group.
Sawyer, JMPT 1999	A pilot study assessing the feasibility of conducting a full scale RCT investigating the efficacy of SMT for children with chronic otitis media with effusion.	Prospective, parallel-group, observer-blinded, randomized feasibility study	36	22 patients age 6 months to 6 years.	SMT or sham SMT	Parent diaries, presence or absence of effusion.	4 weeks	Recruitment is feasible. Parents are compliant with daily diaries and willing to participate in active and sham SMT. Objective outcomes involving tympanometry and otoscopy are extremely challenging and should be performed by validated examiners in future studies.
Sandell, JCM 2007	To investigate the effect of chiropractic treatment on hip joint extension ability and running velocity.	Prospective, randomized, controlled experimental pilot study	34	17 male middle distance runners age 17–20.	SMT and control	Hip extension and running velocity	Immediate or none	Treatment group showed significantly greater hip extension ability after chiropractic treatment than controls. Treatment group did not show a significant decrease in time for running 30 m after treatment.
Reed, JMPT 1994	To evaluate chiropractic management of primary nocturnal enuresis in children.	Controlled clinical trial for 10 weeks plus 2 weeks post of non-treatment	33	46 children (31 in treatment group and 15 in control group).	High velocity short lever SMT or sham SMT	Frequency of “wet” nights	2 weeks	Baseline treatment group had 9.1 nights/2 weeks wet. Post treatment group had 7.6 nights/2 weeks wet. Baseline control had 11.1 nights/2 weeks wet. Post treatment group had no change.
Straub, JMPT 2001	To determine the effect of chiropractic care on jet lag in athletes travelling from Finland to the USA and returning to Finland.	Randomized (blinded in the sham and active groups) in 3 groups	26	15 Finnish junior elite athletes, ranged 6–21 years (mean age 18.3 years).	Sham SMT, active SMT, control group (toggle/recoil procedure)	Psychological assessment POMS, heart rate, sleep disturbances, jet lag evaluation.	5 day follow up after returning to Finland.	Chiropractic care does not reduce the effects of jet lag.
Lebouef, JMPT 1991	To observe the effect of SMT on nocturnal enuresis.	Prospective study	25	171 children aged 4–15 years (mean age 8.3).	SMT; 94% received upper cervical	Parental diaries, clinician assessment (hours crying, intensity, feeding, stools).	None but checked in at 1, 2 and 4 weeks.	85% better or stopped at 1 week. 95% better or stopped at 2 weeks. 97% better or stopped at 4 weeks.
Khorshid, JVSR 2006	To identify the difference in efficacy between upper cervical and full spine adjustment in autistic children.	Randomized clinical trial	23	14 autistic children	Atlas Orthogonal upper cervical adjustment or full spine adjustment.	Autism Treatment Evaluation Checklist (ATEC), leg length analysis & x-rays.	Immediate or non	Improvement of ATEC scores was seen in 6/7 children under upper cervical adjustment and in 5/7 children under full spine adjustment.
Miller & Miller JMPT 2009	To describe the circumstances, clinical features, role, and results of chiropractic management of infants who were referred to a chiropractic clinic for failure to adequately feel at the breast.	Clinicial case series	22	114 infants (12 weeks or younger) cases of hospital-diagnosed or lactation consultant diagnosed feeding problems that were treated with chiropractic therapy in addition to routine care and followed to short-term result.	Treatment aimed at releasing the area of tension, imbalance or pain producing tissue through routine low force chiropractic manual therapy.	Outcome after treatment was based on mother’s rating of improvement in their infant’s symptoms. This was a form of a 10-point numerical rating scale as well as discussion with the parents	Short term	Treatment was chiropractic therapy in addition to any support given elsewhere. All children showed some improvement with 78% being able to exclusively breastfeed after 2 to 5 treatments within a 2-week time period. Cooperative multidisciplinary care to support breastfeeding was demonstrated in this population. Chiropractic treatment may be a useful adjunct to routine care given by other professionals in cases of diagnosed breastfeeding problems with a biomechanical component.
Klougart, JMPT 1989	To observe the effect of regular PSMT on colicky infants.	Prospective uncontrolled study	21	316 infants age 2–52 weeks.	SMT at the discretion of the 73 Chiropractors involved	Parental diaries and clinician assessments performed after 1, 2 and 4 weeks post treatment.	A similar evaluation performed at the 14-day mark was performed at 4 weeks to estimate relapses.	SMT of the vertebral column in infants with colic constitutes effective treatment. Results show a satisfactory effect of the treatment in 94% of cases within 14 days from the start of treatment. Further studies must be designed in such a way that the number of sources of bias affecting the interpretation of results is reduced. This will more closely estimate a placebo effect.
Wiberg, JMPT 2010	To investigate if the outcomes of excessively crying infants treated with chiropractic care was associated with age and/or can be partially explained by age.	Retrospective evaluation	19	276 infants who fit the inclusion criteria.	Chiropractic manipulation as decided by the treating Chiropractor.	Parental reports were noted as improved un-certain, or non-recovered.	None or immediate follow up	Data matched the clinical experience of good treatment effect independent of the infant’s age. Slightly older age and longer duration of treatment were found to explain co-variables linked to crying infant’s improvement.
Miller, JMPT 2008	To identify adverse effects of PSMT on children under the age of three years to evaluate risk of complications.	3 year retrospective study	18	697 children under the age of three years with colic and/or irritability due to biomechanical disorders likely resulting from birth trauma.	77% received full spine PSMT; others received cervical spine decompression, segmental SMT etc.	Parental perception of improvement, no change or worsening of symptoms.	Immediate or none	85% improved. 15% showed no change. ~1% had an adverse reaction (n = 7) and 3 of 7 were perceived to be regular side effects of PSMT.