• however, in one study, six sub- jects had to withdraw due to unaccept- able increases in blood pressure (note: medication had been withdrawn prior to treatment) • some results suggest decreased medication use and blood pressure, but the overall conclusion at this point is that: “…chiropractic care is not of great clinical utility to a broad population of hypertensive patients.” (Goertz CH et al., 2002) VERTIGO (12 CITATIONS TOTAL): • one RCT reported no adverse ef- fects with SMT • most studies reported dizziness accompanied by neck pain • in general, patients with dizziness and neck pain/cervical spine dysfunc- tion appeared to benefi t from SMT and manual therapy (note: the controlled studies were underpowered to reach statistical significance) DYSMENORRHEA AND PREMENSTRUAL SYNDROME (10 CITATIONS TOTAL): • one RCT reported minor low back soreness in both treatment and sham treatment groups • across studies, any group receiving an intervention involving any amount of biomechanical force, even when mi- nor, showed some improvement • a Cochrane review has concluded that active treatment is no more effi- cacious than sham treatment, but is more effective than no treatment • for premenstrual syndrome, re- sults were inconsistent across four papers, each intervening over at least three menstrual cycles INFANTILE COLIC (NINE CITATIONS TOTAL): • one RCT reported no adverse effects from SMT • a variety of manipulative tech- niques were utilized in the other eight citations (including localized and full- spine approaches) • generally, results indicated improve- ment with SMT • one systematic review reported insuffi cient evidence, while another indicated that although not superior to sham/no treatment, SMT seemed to improve parent-reported outcomes 14 • CANADIAN CHIROPRACTOR | MAY 2008 OTITIS MEDIA (EIGHT CITATIONS TOTAL): • two RCTs reported no adverse ef- fects, and even some patient-reported positive effects (relaxation and im- proved sleep) • again, a variety of manual tech- niques were utilized • in one RCT, significantly fewer surgical procedures were needed in the osteopathic mobilization group com- pared to usual medical care (Mills MV et al., 2003) • in the other citations, natural history of the condition could not be differentiated from the treatment effects NOCTURNAL ENURESIS (FIVE CITATIONS TOTAL): • one RCT reported only transient pain (headache and low back) that resolved with further treatment in the treatment group • generally, the trend is in the direc- tion of no treatment effect PNEUMONIA (TWO CITATIONS TOTAL): • both studies included patients over 60 years of age who were hospital- ized • one RCT reported withdrawal of two patients due to transient muscle/ joint soreness after osteopathic manip- ulative therapy (OMT) • generally, hospital stays and courses of intravenous antibiotics were shorter in those receiving OMT, mobi- lization, myofascial release, and other soft tissue treatment versus those re- ceiving only light touch JET LAG AND PHOBIA (TWO CITATIONS TOTAL): tion) • two RCTs (one for each condi- • the study on jet lag showed no signifi cant treatment effects (but, this study had only 15 subjects divided into three groups, and, so was under- powered) • the study on phobia did report signifi cant improvement in emotional response, but not pulse rate reduc- tion, with SMT (however, no statisti- cal data was provided to support this “signifi cant” change – a vital fl aw in the study) CONCLUSIONS AND PRACTICAL APPLICATION: Several limitations of this project should be kept in mind when interpret- ing the results: • there is limited literature on this topic on which conclusions can be based • the literature selection was limited only to English • potential bias when evaluating studies (authors attempted to reduce this by using accepted checklists). PRACTICE IMPLICATIONS: 1) adverse effects noted with SMT are rare, non-severe, and transient 2) evidence is adequate to indicate that chiropractic (including SMT and “other” factors) can provide benefit for those with asthma, cervicogenic ver- tigo, or infantile colic 3) promising evidence exists for the potential benefi t of manual therapy for children with otitis media and hospital- ized elderly patients with pneumonia – more research is required, however. 4) the evidence does not support chiropractic care for hypertension; however, a subset of hypertensive pa- tients may exist that could benefit – more research is required. 5) evidence is equivocal for chi- ropractic care for dysmenorrhea and premenstrual syndrome 6) there is insuffi cient evidence to conclude whether chiropractic care can benefit other NMSK conditions. • Additional References: Goertz CH et al. Treatment of Hyper- tension with Alternative Therapies (THAT) Study: A randomized clinical trial. J Hyper- tension 2002; 20: 2063-2068. Mills MV et al. The use of osteopathic manipulative treatment as adjuvant ther- apy in children with recurrent acute otitis media. Arch Pediatr Adolesc Med 2003; 157: 861-866. www.canadianchiropractor.ca
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