title: Review conclusions by Ernst and Canter regarding spinal manipulation refuted.
abstract: In the April 2006 issue of the Journal of Royal Society of Medicine, Ernst and Canter authored a review of the most recent systematic reviews on the effectiveness of spinal manipulation for any condition. The authors concluded that, except for back pain, spinal manipulation is not an effective intervention for any condition and, because of potential side effects, cannot be recommended for use at all in clinical practice. Based on a critical appraisal of their review, the authors of this commentary seriously challenge the conclusions by Ernst and Canter, who did not adhere to standard systematic review methodology, thus threatening the validity of their conclusions. There was no systematic assessment of the literature pertaining to the hazards of manipulation, including comparison to other therapies. Hence, their claim that the risks of manipulation outweigh the benefits, and thus spinal manipulation cannot be recommended as treatment for any condition, was not supported by the data analyzed. Their conclusions are misleading and not based on evidence that allow discrediting of a large body of professionals using spinal manipulation.
authors.forename: Gert
authors.initials: G
authors.lastname: Bronfort
authors.forename: Mitchell
authors.initials: M
authors.lastname: Haas
authors.forename: David
authors.initials: D
authors.lastname: Moher
authors.forename: Lex
authors.initials: L
authors.lastname: Bouter
authors.forename: Maurits
authors.initials: M
authors.lastname: van Tulder
authors.forename: John
authors.initials: J
authors.lastname: Triano
authors.forename: Willem J J
authors.initials: WJ
authors.lastname: Assendelft
authors.forename: Roni
authors.initials: R
authors.lastname: Evans
authors.forename: Simon
authors.initials: S
authors.lastname: Dagenais
authors.forename: Anthony
authors.initials: A
authors.lastname: Rosner