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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Chiropractic spinal manipulation for infant colic: a systematic review of randomised clinical trials

E Ernst.

Review published: 2009.

Link to full article: [Journal publisher]

CRD summary

This review evaluated the effectiveness of chiropractic spinal manipulation for treatment of infant colic. The author concluded that the available evidence failed to demonstrate the effectiveness of spinal manipulation in infant colic. This conclusion reflected the evidence presented, but its reliability is unclear given the possibility of publication bias.

Authors' objectives

To evaluate the effectiveness of chiropractic spinal manipulation for infant colic.

Searching

MEDLINE, EMBASE, AMED and CINHAL were searched in January 2009 for studies published in full in any language. Some details of the search strategy were reported. Bibliographies of review articles and the department files of the author were also searched for additional studies.

Study selection

Randomised clinical trials (RCTs) of spinal manipulation compared with control, in infants with a clinical diagnosis of colic, were eligible for inclusion. Eligible trials had to report outcomes of clinical importance.

The included trials were of infants aged 0 to 10 weeks; diagnostic criteria were crying more than three hours for three to five days per week. Spinal manipulation therapy regimes varied. Control interventions were dimethicone, holding of the infant by a nurse, and occipitosacral decompression. The outcomes were measured by crying diary and parent evaluation of severity.

The author did not state how the papers were selected for the review, or how many reviewers performed the selection.

Assessment of study quality

Methodological quality was assessed independently by two reviewers using the Jadad score and drop-outs were also reported.

Data extraction

Data were extracted for the outcomes reported. Two reviewers independently extracted data.

Methods of synthesis

The studies were combined in a narrative synthesis.

Results of the review

Three RCTs were included (n=198 infants; range 48 to 100). All had a Jadad score of 2; drop-outs ranged from five to nine.

Trial quality was low for all studies; sample sizes were small in two trials, two trials did not control for effects of placebo, one RCT was an equivalence trial that compared interventions of unknown effectiveness, and none of the outcome measures used were validated.

One of the three RCTs reported a significant reduction in crying in infants treated with spinal manipulation compared with dimethicone; the other two RCTs reported no significant difference between spinal manipulation and either holding infant or occipitosacral decompression.

Authors' conclusions

The available evidence failed to demonstrate the effectiveness of spinal manipulation in infant colic.

CRD commentary

The review question was supported by inclusion criteria for participants, intervention, outcomes and study design. Four relevant databases were searched for studies in all languages, reducing the possibility of language bias. However, only published studies were included, increasing the risk of publication bias. The author acknowledged the difficulty of locating all studies in the field of complementary medicine.

Data extraction and validity assessment were performed in duplicate, reducing the risk of error and bias, but this was not reported for study selection. Trial quality was assessed using a published tool and was taken into consideration in the results. Narrative synthesis appeared appropriate given the variety of comparators used.

The author's conclusion reflected the evidence presented, but its reliability is unclear given the possibility of publication bias.

Implications of the review for practice and research

Practice: The author did not state any implications for practice.

Research: The author stated that future studies should focus on minimising bias, be sufficiently powered, control for non-specific effects, blind parents and outcome assessors and use validated outcome measures.

Funding

Not stated.

Bibliographic details

Ernst E. Chiropractic spinal manipulation for infant colic: a systematic review of randomised clinical trials. International Journal of Clinical Practice 2009; 63(9): 1351-1353. [PubMed: 19691620]

Indexing Status

Subject indexing assigned by NLM

MeSH

Colic /therapy; Crying; Humans; Infant; Manipulation, Chiropractic; Randomized Controlled Trials as Topic; Treatment Outcome

AccessionNumber

12009109249

Database entry date

28/04/2010

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 19691620

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