Assessing the evidence for the use of chiropractic manipulation in paediatric health conditions: A systematic review.
OBJECTIVE
To review the biomedical literature up to and including 2003, and determine the extent of the evidence related to the therapeutic application of chiropractic manipulation for paediatric health conditions. No critical appraisal of the evidence is undertaken.


METHODS
The indexed manual therapy sector including medical, chiropractic, physiotherapy, naturopathic and osteopathic literature was searched. This included PubMed; the Manual, Alternative, and Natural Therapy Index System; the Cumulative Index to Nursing and Allied Health Literature; the Index to Chiropractic Literature; the Paediatric Economic Database Evaluation Project; the Cochrane Library; the Canadian Coordinating Office for Health Technology Assessment database; and the Agency for Healthcare Research and Quality database. Other resources included research conference and symposium proceedings, and the references of identified studies.


RESULTS
The search identified 1731 articles, of which 166 met the eligibility criteria. Two reviewers determined by consensus each citation's appropriate level on the strength of evidence scale. There was one systematic review, nine randomized controlled trials, one observational study, 141 descriptive case studies and 14 conference abstracts.


CONCLUSIONS
Health claims made by practitioners regarding the application of chiropractic manipulation as a health care intervention for paediatric health conditions are, for the most part, supported by low levels of scientific evidence. Chiropractors, in particular, employ manipulation for the treatment of a wide variety of paediatric health conditions. The evidence rests primarily with clinical experience, descriptive case studies and a few randomized controlled trials. There is a need for more rigorous scientific inquiry to examine the value of manipulative therapy in the treatment of paediatric conditions. To advance the health interests of paediatric patients, health care decisions made on the basis of expert opinion or clinical experience must integrate the best research evidence available from high-quality, scientific studies.
Gotlib
Allan
A
Canadian Chiropractic Association, Toronto, Ontario.
Rupert
Ron
R
Paediatr Child Health. 2002 May;7(5):319-22
20046310
J Manipulative Physiol Ther. 1991 Feb;14(2):110-5
2019820
J Manipulative Physiol Ther. 1999 Oct;22(8):517-22
10543581
J Manipulative Physiol Ther. 2001 Jul-Aug;24(6):369-77
11514813
J Manipulative Physiol Ther. 2001 Mar-Apr;24(3):199-205
11313616
N Engl J Med. 1998 Oct 8;339(15):1013-20
9761802
J Manipulative Physiol Ther. 2001 Mar-Apr;24(3):191-8
11313615
J Manipulative Physiol Ther. 1994 Nov-Dec;17(9):596-600
7884329
Arch Dis Child. 2001 Feb;84(2):138-41
11159288
Arch Pediatr Adolesc Med. 2002 May;156(5):474-9
11980553
J Manipulative Physiol Ther. 1999 Jun;22(5):292-8
10395431
Paediatr Child Health. 2002 May;7(5):323-4
20046312
Med Care. 2003 Oct;41(10):1142-52
14515110
J Manipulative Physiol Ther. 1994 Sep;17(7):465-73
7989880
Pediatrics. 1998 Jul;102(1):e10
9651462