Author Names
Theroux, J; Stomski, N; Dominique Losco, C; Khadra, C; Labelle, H; Le May, S
Reviewer Name
Timothy Dow, SPT
Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
Objective: The purpose of this study was to perform a systematic review of clinical trials of spinal manipulative therapy for adolescent idiopathic scoliosis. Methods: Search strategies were developed for PubMed, CINHAL, and CENTRAL databases. Studies were included through June 2016 if they were prospective trials that evaluated spinal manipulative therapy (eg, chiropractic, osteopathic, physical therapy) for adolescent idiopathic scoliosis. Data were extracted and assessed by 2 independent reviewers. Cochrane risk of bias tools were used to assess the quality of the included studies. Data were reported qualitatively because heterogeneity prevented statistical pooling. Results: Four studies satisfied the inclusion criteria and were critically appraised. The findings of the included studies indicated that spinal manipulative therapy might be effective for preventing curve progression or reducing Cobb angle. However, the lack of controls and small sample sizes precluded robust estimation of the interventions’ effect sizes. Conclusion: There is currently insufficient evidence to establish whether spinal manipulative therapy may be beneficial for adolescent idiopathic scoliosis. The results of the included studies suggest that spinal manipulative therapy may be a promising treatment, but these studies were all at substantial risk of bias. Further high-quality studies are warranted to conclusively determine if spinal manipulative therapy may be effective in the management of adolescent idiopathic scoliosis. (J Manipulative Physiol Ther 2017;40:452-458) Key Indexing Terms: Spinal Manipulation; Scoliosis; Adolescent; Cobb Angle; Systematic Review
NIH Risk of Bias Tool
Quality Assessment of Systematic Reviews and Meta-Analyses
- Is the review based on a focused question that is adequately formulated and described?
- Yes
- Were eligibility criteria for included and excluded studies predefined and specified?
- Yes
- Did the literature search strategy use a comprehensive, systematic approach?
- Yes
- Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?
- Yes
- Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?
- Were the included studies listed along with important characteristics and results of each study?
- Yes
- Was publication bias assessed?
- No
- Was heterogeneity assessed? (This question applies only to meta-analyses.)
- Cannot Determine, Not Reported, Not Applicable
Key Finding #1
Due to limited studies meeting inclusion criteria (4), small samples (5, 6, 42, 156), high risk of bias, studies assessing multiple interventions at once, and lack of control groups, the author concludes that the strength of evidence for spinal manipulative therapy as an effective treatment for adolescent idiopathic scoliosis is low and further high-quality research is required to assess this topic.
Key Finding #2
3 of the 4 studies utilized spinal manipulative therapy in conjunction with other interventions to measure Cobb angle outcomes. Thus, spinal manipulative therapy was not isolated in these studies to understand its effect on adolescent idiopathic scoliosis.
Key Finding #3
Cobb angle was the only outcome measure assessed in each of the studies. Future studies should include additional measures such as pain, disability, quality of life, aesthetic concern, and curve progression.
Please provide your summary of the paper
This study was a systematic review conducted to determine the effect of spinal manipulative therapy on adolescent idiopathic scoliosis. The study searched PubMed, CINHAL, and CENTRAL databases for relevant research studies on this topic that were reported in either English or French. 143 articles were identified in the search. After further screening of these studies, only 4 articles met the inclusion criteria. Of the four studies, one was a randomized controlled pilot study while the remaining three were nonrandomized trials. In each of the studies, the Cobb angle was the outcome measure that was assessed to determine the effectiveness of the spinal manipulative interventions. The author suggests that additional outcomes such as pain, disability, quality of life, aesthetic concern, and curve progression are other measures that are relevant to capture in addition to just Cobb angle. The sample sizes for studies included in this analysis were: 5, 6, 42, and 156. Therefore, the small sample sizes across three of these studies resulted in unreliable estimates of effect size. Two of the studies included a control group while two of the studies did not. Additionally, three of the four studies utilized other interventions in addition to spinal manipulative therapy, making causal relationships between treatments and outcomes difficult to assess. The author also reports substantial risk of bias among the studies included in the systematic analysis. Of the studies, two of them found that Cobb angle was significantly reduced and the other two studies found that there was no significant reduction in Cobb angle. The author concludes that the overall strength of evidence for spinal manipulative therapy as an effective treatment for adolescent idiopathic scoliosis is low. The author states that there may be a benefit of spinal manipulative therapy for adolescent idiopathic scoliosis but additional high-quality studies are needed to validate this claim.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
This study highlights the lack of high-quality research on the topic of spinal manipulative therapy and its effect on patients with adolescent idiopathic scoliosis. The search that these authors conducted yielded only 4 studies to be included in the systematic review and there were significant limitations to each of the studies. Small sample sizes, lack of isolating a single independent variable to study, high risk of bias, lack of control groups, a lack of diversity in patient outcome measures, and variable study results all combine to demonstrate that evidence for spinal manipulative therapy as an effective intervention for adolescent idiopathic scoliosis is currently unsupported. Two of the studies demonstrated significant results, however, due to the limitations listed above, it cannot be assumed that spinal manipulative therapy is an effective intervention for adolescent idiopathic scoliosis. This study ultimately demonstrates that further research is required to determine whether or not spinal manipulative therapy is an effective treatment strategy for adolescent idiopathic scoliosis. Therefore, spinal manipulative therapy cannot be recommended as an evidence-based treatment strategy for adolescent idiopathic scoliosis at this time.
