Chiropractic Care for non-musculoskeletal conditions Study title: Chiropractic care for non-musculoskeletal conditions: A systematic review with implications for whole systems research Author: Hawk C et al. Publication information: The Journal of Alternative and Complementary Medicine 2007; 13(5): 491-512. Summary: Below I Dr.Shawn Thistle is the founder and president of Research Review Service Inc., an online, subscription- based service designed to help busy practitioners to integrate current, relevant scientific evidence into their practice. Shawn graduated from CMCC and holds an Hon- ours Degree in Kinesiology from McMaster University. He also holds a certificate in Contemporary Medi- cal Acupuncture from McMaster University, and is a Certified Active Release Techniques (ART®) Pro- vider. For more information about the Research Review Service, visit www.researchreviewservice.com. n response to the growing demand for evidence-based information, and in order to better inform clinical decision making, the Council on Chiropractic Guide- lines and Practice Parameters (CCGPP) established expert teams to evaluate and critique the evidence for the treatment of various conditions. This paper summarizes the evidence regarding chiropractic care for non-musculoskeletal (NMSK) condi- tions. For this review, NMSK conditions were defi ned as those in which the primary symptoms are not related to the spine or musculature. (For operational purposes, the review specifi cally excluded “headaches”, as they are included in the CCGPP cervical spine project.) THE SPECIFIC AIMS OF THIS REVIEW WERE TO: 1) evaluate the effi cacy of chiropractic “care,” not meaning only spinal manipula- tion, on NMSK conditions and, 2) identify specific defi ciencies in the literature in order to develop a whole sys- tems approach to researching this topic. A comprehensive literature search (PubMed, Ovid, Mantis, ICL, CINAHL) iden- tifi ed studies evaluating spinal manipulation/mobilization – both chiropractic and osteopathic – or general chiropractic management of NMSK conditions. Papers were excluded if they: 1) did not present or analyze original data, 2) did not evaluate treatment outcomes, 3) did not involve a specifi c condition, or 4) did not utilize at least one manual intervention. Fourteen randomized controlled trials, investigating 10 different conditions, met these criteria and were formally reviewed and evaluated for quality using the following: 1) Scottish Intercollegiate Guidelines Network (SIGN) checklist 2) Jadad scale 3) modified CONSORT checklist 4) whole systems research considerations An additional 165 papers were included in the review – case series, single group studies, case reports etc. – for a total of 179 citations. Each condition will be summarized individually: ASTHMA (15 CITATIONS TOTAL): • three RCTs reported no adverse effects from spinal manipulative therapy (SMT) • although physiological measures did not improve in any study, medication use generally declined, and symptoms were generally reported to improve HYPERTENSION (12 CITATIONS TOTAL): • two RCTs reported no adverse effects with SMT (directed at the thoracic and cervical spines) 12 • CANADIAN CHIROPRACTOR | MAY 2008 www.canadianchiropractor.ca Shawn Thistle, BKin (Hons), DC, CSCS
Chiropractic + Naturopathic Doctor May 08: Page 12
