title: The Use of Spinal Manipulative Therapy in the Management of Chronic Obstructive Pulmonary Disease: A Systematic Review.
abstract: OBJECTIVE
  To evaluate the methodologic quality of the evidence for the use of spinal manipulative therapy (SMT) with and without other therapies in the management of chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  A systematic review of the literature.
  
  
  METHODS
  Any participant of a primary research study that investigated the effect of SMT on COPD. Only studies with participants older than age 18 years with an existing diagnosis of COPD were included.
  
  
  METHODS
  Interventions included any form of high-velocity, low-amplitude spinal manipulation with or without other forms of manual therapy, exercise, and/or pharmacologic intervention.
  
  
  METHODS
  Six-minute walking test, forced expiratory volume in 1 second, forced vital capacity, residual volume, total lung capacity, Chronic Respiratory Questionnaire, St George's Respiratory Questionnaire, and the Hospital Anxiety and Depression Scale.
  
  
  RESULTS
  Six articles met all of the inclusion criteria and were included in the review: three randomized controlled trials (RCTs), one pre-post observational study, one case series, and one single case study. Sample sizes varied from 1 to 33 participants ranging in age from 55 to 85 years. Risk of bias was low for the three RCTs and high for the other studies. All three RCTs used SMT in conjunction with exercise from a pulmonary rehabilitation program. Five of the six studies reported improvements in lung function and exercise performance following SMT intervention.
  
  
  CONCLUSIONS
  This review provides a methodologic evaluation of the evidence for using SMT with and without other therapies in the management of COPD. While the quality of the evidence provided by three RCTs was high, they were all conducted on small sample sizes. These results highlight the need for further research into the use of SMT in conjunction with exercise on people with COPD.
authors.affiliation: 1 Department of Chiropractic, Macquarie University , Sydney, Australia .
authors.forename: Jaxson
authors.initials: J
authors.lastname: Wearing
authors.affiliation: 2 Private practice, Sydney, Australia .
authors.forename: Sheridan
authors.initials: S
authors.lastname: Beaumont
authors.affiliation: 1 Department of Chiropractic, Macquarie University , Sydney, Australia .
authors.forename: Danielle
authors.initials: D
authors.lastname: Forbes
authors.affiliation: 1 Department of Chiropractic, Macquarie University , Sydney, Australia .
authors.forename: Benjamin
authors.initials: B
authors.lastname: Brown
authors.affiliation: 1 Department of Chiropractic, Macquarie University , Sydney, Australia .
authors.forename: Roger
authors.initials: R
authors.lastname: Engel
mesh_terms: D015444:Exercise; D006801:Humans; D008168:Lung; D020393:Manipulation, Spinal; D017063:Outcome Assessment, Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012107:Research Design / Q000592:standards*