More effective reporting needed on spinal manipulation in children

Few serious harmful events stemming from spinal manipulation in children have been reported compared to the number of manipulations delivered, says new University of Alberta research. The results, which are to be presented at The North American Research Conference on Complementary and Integrative Medicine held in Edmonton, Alberta, Canada, May 24th-27th, 2006, show the need to develop a more effective reporting system among health professions.

"What we have to take into consideration is how many millions of children have received spinal manipulation in the same time period," said study co-author Dr. Sunita Vohra, associate professor of pediatrics at the University of Alberta and director of the Complementary and Alternative Research Education Program (CARE) at the Stollery Children's Hospital. "The question we pose is, 'are these events truly rare, or are they under-reported?'"

The study, which will be presented by Bradley Johnston, a research fellow in the Department of Pediatrics at the University of Alberta analyzed available data on adverse events associated with pediatric spinal manipulation.

The research team identified 14 cases of direct adverse events involving neurological or musculoskeletal events. Nine cases involved serious adverse events such as hemorrhage or paraplegia, two cases reported moderate adverse events requiring medical attention such as severe headache and three involved minor adverse events such as mid-back soreness.

The research team is now collaborating with professionals that use spinal manipulation--chiropractors, physiotherapists, massage therapists--as well as physicians to see if a more effective reporting system can be developed. Only then will they be able to answer the study question, says the research team.

Until then, parents should continue to treat health-care procedures, conventional or complementary, with all due caution, says Vohra. "They should make sure they are informed consumers and ask about the individual's training and experience with regards to children," said Vohra. "They should ask about potential and known risks and benefits."

Part of the obligation should lie with those providing the procedure to help systematically collect data on the outcome, including harms. Some of the providers may not be regulated and even those who are, such as chiropractors, have no formal reporting mechanism for collecting adverse events.

"Evidence, not emotion, should guide what we tell families about potential harm," said Vohra.

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Abstract 360
Adverse events associated with pediatric spinal manipulation: A systematic review
Johnston, Bradley C. Cramer, Kristie, Humphreys, Kim, Vohra, Sunita.


Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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