title: Adverse events and manual therapy: a systematic review.
abstract: OBJECTIVE
  To explore the incidence and risk of adverse events with manual therapies.
  
  
  METHODS
  The main health electronic databases, plus those specific to allied medicine and manual therapy, were searched. Our inclusion criteria were: manual therapies only; administered by regulated therapists; a clearly described intervention; adverse events reported. We performed a meta-analysis using incident estimates of proportions and random effects models.
  
  
  RESULTS
  Eight prospective cohort studies and 31 manual therapy RCTs were accepted. The incidence estimate of proportions for minor or moderate transient adverse events after manual therapy was approximately 41% (CI 95% 17-68%) in the cohort studies and 22% (CI 95% 11.1-36.2%) in the RCTs; for major adverse events approximately 0.13%. The pooled relative risk (RR) for experiencing adverse events with exercise, or with sham/passive/control interventions compared to manual therapy was similar, but for drug therapies greater (RR 0.05, CI 95% 0.01-0.20) and less with usual care (RR 1.91, CI 95% 1.39-2.64).
  
  
  CONCLUSIONS
  The risk of major adverse events with manual therapy is low, but around half manual therapy patients may experience minor to moderate adverse events after treatment. The relative risk of adverse events appears greater with drug therapy but less with usual care.
authors.affiliation: Barts and The London School of Medicine and Dentistry, Centre for Health Sciences, 2 Newark St, London E1 2AT, UK. d.carnes@qmul.ac.uk
authors.forename: Dawn
authors.initials: D
authors.lastname: Carnes
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Mars
authors.forename: Brenda
authors.initials: B
authors.lastname: Mullinger
authors.forename: Robert
authors.initials: R
authors.lastname: Froud
authors.forename: Martin
authors.initials: M
authors.lastname: Underwood
mesh_terms: D006801:Humans; D015994:Incidence; D008349:Manipulation, Orthopedic / Q000009:adverse effects*; D026201:Musculoskeletal Manipulations / Q000009:adverse effects*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors