Chiropractic manipulation in Adolescent Idiopathic Scoliosis: a pilot study

Abstract

BackgroundAdolescent idiopathic scoliosis (AIS) remains the most common deforming orthopedic condition in children. Increasingly, both adults and children are seeking complementary and alternative therapy, including chiropractic treatment, for a wide variety of health concerns. The scientific evidence supporting the use chiropractic intervention is inadequate. The purpose of this study was to conduct a pilot study and explore issues of safety, patient recruitment and compliance, treatment standardization, sham treatment refinement, inter-professional cooperation, quality assurance, and outcome measure selection.MethodsSix patients participated in this 6-month study, 5 of whom were female. One female was braced. The mean age of these patients was 14 years, and the mean Cobb angle was 22.2 degrees. The study design was a randomized controlled clinical trial with two independent and blinded observers. Three patients were treated by standard medical care (observation or brace treatment), two were treated with standard medical care plus chiropractic manipulation, and one was treated with standard medical care plus sham manipulation. The primary outcome measure was Cobb, and the psychosocial measure was Scoliosis Quality of Life Index.ResultsOrthopedic surgeons and chiropractors were easily recruited and worked cooperatively throughout the trial. Patient recruitment and compliance was good. Chiropractic treatments were safely employed, and research protocols were successful.ConclusionOverall, our pilot study showed the viability for a larger randomized trial. This pilot confirms the strength of existing protocols with amendments for use in a full randomized controlled trial.Trial registrationThis trial has been assigned an international standard randomized controlled trial number by Current Controlled Trials, Ltd. . The number is ISRCTN41221647.

Manual therapy for the pediatric population: a systematic review

“…Motor behaviour was normal in all the infants after treatment.Study reported no adverse effects were seen during the treatment period.Lessard S, et al 2011 [59]Does osteopathic manipulation alter cranial asymmetry in infants.Before-After n = 12OMTInfants ages < 6.5 months, diagnosed with nonsynostotic plagiocephalyAnthropometric changesOsteopathic treatment led to improvements in cranial asymmetry.There is no mention of adverse events made in this study.Postural AsymmetryPhilippi H, et al 2006 [60]To assess the therapeutic efficacy of osteopathic manipulation in infants with postural asymmetry.RCT n = 32OMT/CSTInfant ages 6–12 weeks, with postural asymmetryVideo-based measurementsSignificant improvement in postural asymmetry (mean 5.9 points) observed with osteopathic manipulation.“At least two of the seven vegetative symptoms aggravated for 2 days after the interventions in six patients of the control group and in four patients of the treatment group. Otherwise no adverse effects were seen.”ScoliosisByun S & Han D, 2016 [61]Examine whether chiropractic techniques would reduce the curvature of idiopathic scoliosis.Before-After n = 5CMTChildren ages 10–13, with Cobb angles > 10 degreesReduction in Cobb angleNo significant difference in Cobb angle was noted after the 4th week of chiropractic manipulation.There is no mention of adverse events made in this study.Hasler C, et al 2010 [65]Test to see if osteopathy alters trunk morphology, to unload the concave side of the scoliosis to halt curve progression.RCT n = 20OMTPost-pubertal females ages 12–18, with Cobb angles 20–40Trunk morphology, spine flexibility and scoliometer measurementsRepeat measurements revealed no therapeutic effect on rib hump, lumbar prominence, plumb line, sagittal profile and global flexibility.“No intervention-related side effects or complications were noted”Rowe D, et al 2006 [62]To conduct a pilot (feasibility) study and explore issues of patient safety, patient recruitment and compliance, treatment standardization, sham treatment refinement, interprofessional cooperation, quality assurance, and outcome measure selection.RCT n = 6CMTChildren ages 10–16, with Cobb angles 20–40 degreesReduction in Cobb angleFeasible to recruit AIS patients for a randomized clinical trial to compare chiropractic care and standard medical treatment.CMT delivered on 52 visits resulted in two benign reactions one with moderate pain lasting 24 h; the other produced mild pain lasting 6 h.Morningstar M, et al 2004 [63]Evaluate of scoliosis treatment using a combination of manipulative and rehabilitative therapy.Before-After n = 19 (6 pediatrics)CMTScoliotic patients aged 15–65 (6 patients 18 and under- identified in Table …”

Questions asked and answered in pilot and feasibility randomized controlled trials

“…The one paper that presented tabulated/graphical results relating to outcome assessment portrayed values elicited with category rating scales mapped onto a visual analogue scale format [20]. We rated the average costs per randomization presented in one paper [49] as detailed results relating to randomization procedures, the two papers with brief results on this topic commented on a failure in the randomization service [12] and gave numbers and reasons why potential participants missed being randomized [38]. Although our sample included 19 multi-centre trials only one presented numerical results evaluating procedures involved (ratings of cooperation between different centres [49]).…”

Evidence-Based of Nonoperative Treatment in Adolescent Idiopathic Scoliosis

“…The results returned from MEDLINE database query demonstrated that only 3 articles were met criteria among total of 73 relevant articles including the review by Romano and Negrini [ 17 ]. In addition, there is one paper required further study due to a small sample size [ 17 ] and the other reported that manipulation therapy was ineffective [ 18 ]. Lastly the other article written by Morningstar et al [ 19 ] in year 2004 revealed an interesting outcome that manipulation therapy can reduce 17 degrees in Cobb's angle when prescribed for 4 to 6 weeks [ 15 ].…”