Guideline for Reporting Interventions on Spinal Manipulative Therapy: Consensus on Interventions Reporting Criteria List for Spinal Manipulative Therapy (CIRCLe SMT)

Groeneweg, Ruud; Rubinstein, Sidney M.; Oostendorp, R.A.B.; Ostelo, Raymond; Tulder, Maurits W. van

doi:10.1016/j.jmpt.2016.10.013

Cited by 25 publications

(17 citation statements)

References 37 publications

(40 reference statements)

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“…The chiropractors were told to perform necessary treatment to fit each patient individually. This can be considered to be a limitation to our study, and is diverging from the Guideline for Reporting Interventions on Spinal Manipulative Therapy [ 21 ]. However, the design of our intervention is equivalent to the treatment a woman would receive, consulting a random chiropractor for PGP during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Chiropractic management of dominating one-sided pelvic girdle pain in pregnant women; a randomized controlled trial

Gausel

Kjærmann

Malmqvist

et al. 2017

BMC Pregnancy Childbirth

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BackgroundThe aim of this study was to investigate the outcome of chiropractic management for a subgroup of pregnant women with dominating one-sided pelvic girdle pain (PGP).MethodsThe study population was recruited from a prospective longitudinal cohort study of pregnant women. Women reporting pelvic pain (PP), and who were diagnosed with dominating one-sided PGP after a clinical examination, were invited to participate in the intervention study. Recruitment took place either at 18 weeks, or after an SMS-tracking up to week 29. The women were randomized into a treatment group or a control group. The treatment group received chiropractic treatment individualized to each woman with regards to treatment modality and number of treatments. The control group was asked to return to conventional primary health care. The primary outcome measure was new occurrence of full time and/or graded sick leave due to PP and/or low back pain. Secondary outcome measures were self-reported PP, physical disability and general health status. Proportion of women reporting new occurrence of sick leave were compared using Chi squared tests. Differences in secondary outcome measures were estimated using linear regression analyses.ResultsFifty-Six women were recruited, and 28 of them were randomized into the treatment group, and 28 into the control group. There was no statistically significant difference in sick leave, PP, disability or general health status between the two groups during pregnancy or after delivery.ConclusionThe study did not demonstrate superiority of chiropractic management over conventional care for dominating one-sided PGP during pregnancy. However, the analyses revealed wide confidence intervals containing both positive and negative clinically relevant effects. Trial registrationThe study was registered in ClinicalTrials.gov (NCT01098136; 22/03/2010).

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Section: Discussionmentioning

confidence: 99%

Chiropractic management of dominating one-sided pelvic girdle pain in pregnant women; a randomized controlled trial

Gausel

Kjærmann

Malmqvist

et al. 2017

BMC Pregnancy Childbirth

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“…They were instructed not to discuss the project with the participants in order to avoid influencing their assessment of treatment outcomes. No further training was completed before initiating the trial 33 .…”

Section: Blinding From Baseline Lab Data the Assessor (Cgn) Identifmentioning

confidence: 99%

The effect on clinical outcomes when targeting spinal manipulation at stiffness or pain sensitivity: a randomized trial

Nim

Kawchuk

Schiøttz‐Christensen

et al. 2020

Sci Rep

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The mechanisms underlying pain relief following spinal manipulative therapy (SMT) are not understood fully although biomechanical and neurophysiological processes have been proposed. As such, we designed this randomized trial to elucidate the contributions of biomechanical and neurophysiological processes. A total of 132 participants with low back pain were randomly assigned to receive SMT at either the lumbar segment measured as the stiffest or the segment measured as having the lowest pain threshold. The primary outcome was patient reported low back pain intensity following treatment. Secondary outcomes were biomechanical stiffness and neurophysiological pressure pain threshold. All outcomes were measured at baseline, after the fourth and final session and at 2-weeks follow-up. Data were analyzed using linear mixed models, and demonstrated that the SMT application site did not influence patient reported low back pain intensity or stiffness. However, a large and significant difference in pressure pain threshold was observed between groups. This study provides support that SMT impacts neurophysiological parameters through a segment-dependent neurological reflex pathway, although this do not seem to be a proxy for improvement. This study was limited by the assumption that the applied treatment was sufficient to impact the primary outcome. Treatment of low back pain. Low back pain (LBP) is now the number one cause for years lived disability worldwide 1. In most cases, a specific pathoanatomical cause of LBP cannot be identified 2. Without a specific therapeutic target, a predictably large and diverse spectrum of interventions are available to clinicians that range from joint mobilization to spinal fusion surgery 3. Given these almost endless possibilities, clinical guidelines rate education and exercise as first line therapy for low back pain often in combination with manual therapy 3. Although, these guideline recommendations are generally clear and unambiguous, it is challenging for clinicians to implement them in practice (e.g. which exercises to recommend, how often, and which patients to offer manual therapy etc.). Spinal manipulative therapy. Spinal manipulative therapy (SMT) is a manual therapy recommended as a second line intervention for LBP in most clinical guidelines 4. However, like other conservative treatments, there is little evidence or consensus regarding the specifics of SMT application such as which patients are likely to respond, which type of SMT should be used, and which dose/frequency of SMT is optimal. While the specific SMT technique does not seem to be important 5-7 , there are at least two theoretical rationales for where to apply SMT: at the site of greatest biomechanical dysfunction or the site of greatest pain sensitivity. As the goal of SMT is to restore normal function to segments with biomechanical dysfunctions 8 , it may be surprising to some that the evidence for identifying such dysfunction is sparse. A narrative review reported that clinicians use a variety of different ways to ...

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“…Future studies should clearly report the SMT techniques in detail. The CIRCLe SMT study presented criteria for reporting SMT techniques [35]. Lastly, studies in which various SMT techniques are embedded within different treatment protocols are warranted.…”

Section: Discussionmentioning

confidence: 99%

Physicians using spinal manipulative treatment in The Netherlands: a description of their characteristics and their patients

Schuller

Ostelo

Rohrich

et al. 2017

BMC Musculoskelet Disord

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BackgroundVarious health care professionals apply Spinal Manipulative Treatment (SMT) in daily practice. While the characteristics of chiropractors and manual therapists and the characteristics of their patient populations are well described, there is little research about physicians who use SMT techniques. A distinct group of physicians in The Netherlands has been trained in musculoskeletal (MSK) medicine, which includes the use of SMT. Our objective was to describe the characteristics of these physicians and their patient population.MethodsAll registered MSK physicians were approached with questionnaires and telephone interviews to collect data about their characteristics. Data about patient characteristics were extracted from a web-based register. In this register physicians recorded basic patient data (age, gender, the type and duration of the main complaint, concomitant complaints and the type of referral) at the first consultation. Patients were invited to fill in web-based questionnaires to provide baseline data about previous treatments and the severity of their main complaint. Functional impairment was measured with Patient Reported Outcome Measures (PROMs).ResultsQuestionnaires were sent to 138 physicians of whom 90 responded (65%). Most physicians were trained in MSK medicine after a career in other medical specialities. They reported to combine their SMT treatment with a variety of diagnostic and treatment options part of which were only permissible for physicians, such as prescription medication and injections. The majority of patients presented with complaints of long duration (62.1% > 1 year), most frequently low back pain (48.1%) or neck pain (16.9%), with mean scores of 6.0 and 6.2, respectively, on a 0 to10 numerical rating scale (NRS) for pain intensity. Mean scores on all PROMs showed moderate impairment. Patients most frequently reported previous treatment by physical therapists (68.1%), manual therapists (37.7%) or chiropractors (17.0%).ConclusionOur study showed that MSK physicians in The Netherlands used an array of SMT techniques. They embedded their SMT techniques in a broad array of other diagnostic and treatment options, part of which were limited to medical doctors. Most patients consulted MSK physicians with spinal pain of long duration with moderate functional impairment.

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Guideline for Reporting Interventions on Spinal Manipulative Therapy: Consensus on Interventions Reporting Criteria List for Spinal Manipulative Therapy (CIRCLe SMT)

Abstract: A valid criteria list was constructed with the aim of promoting consistency in reporting SMT intervention in scientific publications.

Cited by 25 publications

References 37 publications

Chiropractic management of dominating one-sided pelvic girdle pain in pregnant women; a randomized controlled trial

Chiropractic management of dominating one-sided pelvic girdle pain in pregnant women; a randomized controlled trial

The effect on clinical outcomes when targeting spinal manipulation at stiffness or pain sensitivity: a randomized trial

Physicians using spinal manipulative treatment in The Netherlands: a description of their characteristics and their patients

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