Chiropractic & Manual Therapies最新文献

{"title":"Visual monitoring in real-time improves consistency of 3D IASTM force applied to humans.","authors":"M Terry Loghmani, Rachael Powell, George J Eckert, Sarah Morgan, Abhinaba Bhattacharjee, Stanley Chien, Sohel Anwar","doi":"10.1186/s12998-026-00668-6","DOIUrl":"10.1186/s12998-026-00668-6","url":null,"abstract":"<p><strong>Background: </strong>Instrument-assisted soft tissue manipulation (IASTM) is widely used, yet clinicians mostly rely on their subjective perception of applied force which can lead to variability. No studies have determined intra- and inter-examiner reliability of three-dimensional (3D) IASTM force-motions applied to humans. The objective of this study was to evaluate whether real-time visual monitoring enhances consistency of applied IASTM force.</p><p><strong>Methods: </strong>This study was an observational reliability study with blinded assessors. 45 healthy adults were enrolled between June to December 2021. Clinicians (two novice, two experienced) applied 1-inch IASTM linear strokes using two quantifiable soft tissue manipulation (QSTM) smart devices (localized; dispersive) to lumbar and calf regions under two conditions: (1) applying self-perceived \"medium\" force without visual monitoring, and (2) applying force guided by real-time visual monitoring from a graphic visual interface (GVI). Triaxial (3D) average peak force (primary variable), stroke frequency, and angle were measured. Linear mixed models and variance components evaluated repeatability and reproducibility within and between clinicians and across two sessions.</p><p><strong>Results: </strong>Visual monitoring substantially reduced variability in average peak force across clinicians, regions, devices, and sessions. Standard deviations (SDs) were significantly larger and ranges meaningfully broader without monitoring compared to with monitoring. Monitoring improved intra- and inter-examiner consistency by ≥ 30% in nearly all conditions, with medium to very large effect sizes. Effects on stroke frequency were mixed, and influence on angle minimal.</p><p><strong>Conclusions: </strong>Visual monitoring in real-time significantly improved the consistency of 3D IASTM force applications on humans. Optimal reliability is foundational to practice fidelity, training, and more rigorous investigation of dose-force response relationships in manual therapy.</p><p><strong>Trial registration: </strong>The study was prospectively registered at ClinicalTrials.gov (Identifier: NCT04923633).</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"34 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13418447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing inappropriate lumbar MRI referrals: a Danish pre- and post-intervention study.","authors":"C Bell, S B Krogh, P Vedsted, R K Jensen, M Fenger-Grøn, T S Jensen","doi":"10.1186/s12998-026-00663-x","DOIUrl":"10.1186/s12998-026-00663-x","url":null,"abstract":"<p><strong>Background: </strong>Low back pain (LBP) is the leading cause of disability worldwide. Despite guidelines advising against routine imaging, a significant proportion of patients are referred for lumbar spine magnetic resonance imaging (MRI) without an appropriate indication. This study aims to assess the impact of the intervention on the appropriateness of referrals and the proportion of referred patients from general practitioners (GPs) who underwent lumbar MRI.</p><p><strong>Methods: </strong>A quasi-experimental design with pre- and post-intervention periods was employed. We included GP referrals for lumbar spine MRI at Silkeborg Regional Hospital, Denmark, among adults ≥ 18 years from 1 January 2019 to 31 August 2023. The intervention, which consisted of template-based correspondence letters and a guidance booklet, was implemented on 1 September 2022. Referrals were classified as either 'appropriate' or 'inappropriate' according to international guidelines. Interrupted time-series analysis with segmented regression was applied to evaluate change over time in referral appropriateness and the proportion of lumbar MRIs within 90 days of referral.</p><p><strong>Results: </strong>A total of 5222 referrals were received (80.6% pre and 19.4% post intervention). Patient characteristics were comparable across the periods. The proportion of appropriate referrals increased from 49.7 to 60.0%. At the onset of the intervention, the level of appropriate referrals increased by 6.50% points (95% CI 0.71, 12.29), and the trend changed by 0.98 (95% CI 0.36, 1.59), reaching 0.90 (95% CI 0.30, 1.49). This implied a continued increase in the pre-post difference. The proportion of referred patients having lumbar MRIs decreased from 92.2 to 75.7%. At intervention onset, the level of lumbar MRIs changed by - 17.06 (95% CI - 23.25, - 10.88). However, post-intervention the trend changed, becoming positive (0.66, 95% CI - 0.05, 1.37), implying that the number of lumbar MRIs could return to pre-intervention level over time.</p><p><strong>Conclusion: </strong>The intervention increased the proportion of appropriate referrals for lumbar MRI. For the proportion of MRIs performed, we found an immediate reduction, but this may not be sustained over time.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148388347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of the imposter phenomenon among chiropractors in South Africa: a cross-sectional survey.","authors":"Tasmiya Hassen, Christopher Yelverton","doi":"10.1186/s12998-026-00665-9","DOIUrl":"10.1186/s12998-026-00665-9","url":null,"abstract":"<p><strong>Background: </strong>The Imposter Phenomenon (IP)-doubting one's abilities despite clear achievements-is well-documented among healthcare professionals but has never been studied among practicing chiropractors, who face unique challenges including professional isolation and ambiguous healthcare identity. This study aimed to determine IP prevalence among South African chiropractors and investigate associations with age, gender, years of experience, and province.</p><p><strong>Methods: </strong>A cross-sectional survey using the validated Clance Imposter Phenomenon Scale (CIPS) was distributed via email to all 960 chiropractors registered with the Allied Health Professions Council of South Africa. Data were collected online from 25 March to 17 May 2024. Descriptive statistics, independent-samples t-tests, and one-way ANOVA were used; results are interpreted through effect sizes (Cohen's d) and 95% confidence intervals, with exact p-values reported as continuous evidence measures. Cronbach's alpha assessed reliability. The study followed STROBE and CHERRIES guidelines.</p><p><strong>Results: </strong>Of 159 chiropractors (16.6% response rate), mean age was 37.8 years (SD = 10.8); 61.6% were female. Mean CIPS score was 50.78 (SD = 16.82), indicating moderate IP. Severity distribution: 33.3% few, 39.0% moderate, 22.6% frequent, 5.0% intense IP (66.6% at or above moderate threshold). Females scored higher than males (55.66 vs. 42.93; t(147.69)= - 5.25, p < 0.001; d = 0.85). Chiropractors  ≤ 35 years scored higher than those  > 35 years (53.52 vs. 47.95; t(152) = 2.05, p = 0.042; d = 0.33). Chiropractors with ≤ 10 years of experience showed a non-significant trend toward higher IP scores than those with  > 10 years (52.90 vs. 47.94; two-tailed p = 0.066; d = 0.30). No provincial differences were found (F(3,155) = 0.62, p = 0.601). Cronbach's α was 0.94.</p><p><strong>Conclusions: </strong>Moderate to intense IP affects two-thirds of chiropractors in this South African sample, particularly females and early-career practitioners. These findings highlight the need for targeted mental health interventions, mentorship, and peer support. This first study of IP among practicing chiropractors provides evidence for practitioner well-being initiatives with implications for chiropractic education, professional development, and retention.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does radiographic imaging for spinal pain in patients receiving chiropractic care change patient outcomes? A pilot randomised controlled trial.","authors":"Hazel J Jenkins, Mark Hancock, Aron Downie, Anika Young, Craig Moore, Stephney Whillier, Simon D French","doi":"10.1186/s12998-026-00662-y","DOIUrl":"10.1186/s12998-026-00662-y","url":null,"abstract":"<p><strong>Background: </strong>Imaging does not improve the management of non-specific spinal pain in randomised trials (RCTs) conducted in medical care settings. No RCTs have been performed to assess the benefit of imaging in chiropractic clinical settings, where it is postulated imaging may identify contraindications to, or inform application of, spinal manipulation. We aimed to assess the feasibility of performing a large-scale RCT to test whether obtaining spinal radiographs for patients receiving chiropractic care for spinal pain changes patient outcomes.</p><p><strong>Methods: </strong>Chiropractor and patient recruitment occurred from February 2021 to June 2022. Chiropractors from Sydney, Australia screened consecutive patients for inclusion in the pilot RCT. The key inclusion criteria were being an adult with a new episode of spinal pain and uncertain need for radiographs (i.e., no definitive indications or contraindications for imaging). Participants were randomised to receive spinal radiographs, or not. Clinical outcome data were collected at baseline, 2-, 6-, and 12-weeks. Chiropractors participated in semi-structured interviews regarding their experience in the trial. Feasibility outcomes were reported descriptively, including: proportion of chiropractors and patients agreeing to be involved, patient cross-over, loss to follow-up, and acceptability.</p><p><strong>Results: </strong>Eleven chiropractors screened 135 patients (mean 12, SD 17.0, range 0-56), with 33/135 (24%; 95%CI 18-32) meeting inclusion, and 20/33 (61%; 95%CI 44-75) participating in the trial (10 randomised to each group). Participating patients tended to be young and have low spine-related disability. 30% of those randomised to radiography did not receive imaging (95%CI 11-60; 3/10). Conversely, 20% (95%CI 6-51; 2/10) of those from the no radiography group received imaging. Follow-up data were collected from 90% of patients (95%CI 70-97) at 2-weeks and 75% (95%CI 53-89) at 12-weeks. Complete follow-up data for patients was provided by all chiropractors at 2- and 6-weeks and 16/20 (80%; 95%CI 58-92) at 12-weeks. Patient reported outcomes improved in both groups, with infrequent and mild adverse events. Chiropractors thought the research question important but highlighted key feasibility issues impacting patient recruitment.</p><p><strong>Conclusion: </strong>Progression criteria to conduct a large-scale RCT were largely met; however, suitable strategies would be required to ensure feasibility of patient recruitment and reduce cross-over between groups.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Specific versus non-specific hospital-based spine diagnoses in children and adolescents: a nationwide register-based cohort study.","authors":"Freja Gomez Overgaard, Casper Nim, Laura Montgomery","doi":"10.1186/s12998-026-00661-z","DOIUrl":"10.1186/s12998-026-00661-z","url":null,"abstract":"<p><strong>Background: </strong>Paediatric spine pain is common, yet little is known about the influence of patient characteristics on diagnostic classification in hospital settings.</p><p><strong>Objective: </strong>Describe diagnostic code variation by age, sex, parental spine diagnoses, and child comorbidity burden.</p><p><strong>Methods: </strong>Nationwide historical (2007-2022) register-based cohort study including Danish 0-17-year-olds with a hospital-based spine-related diagnosis. Diagnoses were classified as specific or non-specific by ICD-10 codes. Patient characteristics were examined descriptively and with logistic regression.</p><p><strong>Results: </strong>Of 49,596 children, 63% received a non-specific diagnosis. Non-specific diagnoses were more common among older children (OR ~ 0.22-0.27), children with parental spine-related diagnoses (OR = 0.77), male children (OR = 1.07), or children with lower comorbidity burden (OR ~ 1.09-1.13).</p><p><strong>Conclusions: </strong>Diagnostic classification of paediatric spinal pain varies systematically by patient characteristics. Most children receive non-specific diagnoses, underscoring the need for the development of appropriate care pathways including greater use of primary care for non-specific spinal pain.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators to the delivery of rehabilitation in health systems by chiropractors: a SWOT analysis of perspectives from a world federation of chiropractic congress workshop.","authors":"Jordan A Gliedt, Afua Adjei-Kwayisi, Nora Bakaa, Jean-Luc Gauthier, Brett Guist, Katie de Luca","doi":"10.1186/s12998-026-00660-0","DOIUrl":"10.1186/s12998-026-00660-0","url":null,"abstract":"<p><strong>Background: </strong>Global unmet need for rehabilitation remains substantial. Chiropractors commonly manage musculoskeletal conditions that may benefit from rehabilitation. However, barriers and facilitators to chiropractors' delivery of rehabilitation in health systems have yet to be well described. Therefore, this study aimed to identify local, regional, and global barriers and facilitators to the delivery of rehabilitation within health systems.</p><p><strong>Methods: </strong>Data were collected from participants attending the 18th World Federation of Chiropractic (WFC) Biennial Congress, held in Copenhagen, Denmark, on May 10, 2025. A deductive, manifest-directed content analysis, framed by the Strengths, Weaknesses, Opportunities, and Threats (SWOT) framework, was conducted on responses collected during a rehabilitation workshop. Participants completed free-text responses to four SWOT-based prompts on the delivery of rehabilitation by chiropractors within health systems. Responses were categorized into SWOT domains and coded according to an adaptation of predefined barriers and facilitators to rehabilitation delivery.</p><p><strong>Results: </strong>A total of 369 responses were recorded and catalogued into strengths (n = 89), weaknesses (n = 103), opportunities (n = 84), and threats (n = 93). Commonly reported strengths included education, clinical, and leadership and policy categories. Weaknesses were primarily related to categories of facilities/logistics, finances, education, and leadership and policy. Opportunities primarily included facilities/logistics, leadership and policy, and education categories. Threats were primarily related to leadership and policy, cultural, and political categories.</p><p><strong>Conclusion: </strong>This study highlights local, regional, and global factors influencing the delivery of rehabilitation in health systems by chiropractors. Findings underscore the need for targeted implementation strategies, policy advocacy, and expanded professional training to optimize chiropractors' contributions to the global rehabilitation workforce.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between low back pain and sleep quality in adults 60 years and older: a systematic review.","authors":"Pegah Rahbar, Jessica J Wong, Astrid DeSouza, Efrosini Papaconstantinou, Dan Wang, Sheilah Hogg-Johnson, Pierre Côté","doi":"10.1186/s12998-026-00656-w","DOIUrl":"10.1186/s12998-026-00656-w","url":null,"abstract":"<p><p>Poor sleep quality is a health concern in older adults, with low back pain (LBP) as a hypothesized risk factor. We aimed to synthesize evidence on the association between LBP and sleep quality among adults ≥ 60 years. We conducted a systematic review, registered protocol (Open Science framework #u7bc4) and reported it according to PRISMA. We searched MEDLINE, Embase, CINAHL, and PsycINFO (inception to December 2025). We included cross-sectional, cohort, and case-control studies on LBP and sleep quality among adults ≥ 60 years. We utilized a combination of OpenAI's ChatGPT and fluent members in our team to translate non-English studies after which we screened and assess their quality. We synthesized evidence from low and moderate risk of bias studies. Our search retrieved 2394 articles. After removing duplicates, we screened 2237 citations for eligibility, with 191 studies eligible for full-text screening. 13 studies were relevant and appraised. Our synthesis includes five studies of moderate to low risk of bias (three cross-sectional and two cohort studies). Although measures of LBP and sleep quality varied across the included studies, all demonstrated an overall positive small association between the two constructs. Chronic LBP is positively associated with poor sleep quality in aging adults. Our study highlights methodological limitations in existing research and calls for more rigorous epidemiological studies.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148319986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of lower limb joint manipulation on squat strength and ankle range of motion: a sham-controlled double-blind randomised cross-over trial.","authors":"Reneigh Morley-Hart, Barrett Losco, Alasdair R Dempsey, G Gregory Haff, Sasha L Aspinall","doi":"10.1186/s12998-026-00659-7","DOIUrl":"10.1186/s12998-026-00659-7","url":null,"abstract":"<p><strong>Background: </strong>The back squat is a commonly prescribed exercise for developing lower body strength. The ability to squat can be affected by reduced ankle dorsiflexion range of motion (DF-ROM), leading to limited squat depth and dysfunctional compensatory movement patterns.</p><p><strong>Objective: </strong>To investigate the effect of high-velocity low-amplitude lower limb manipulations on 1 repetition maximum (1RM) back squat strength, sagittal plane ankle kinematics during a squat, and active DF-ROM in individuals with asymptomatic deficits in DF-ROM.</p><p><strong>Methods: </strong>Twenty-six enrolled; Twenty-four analysed resistance-trained participants with asymptomatic deficits in DF-ROM participated in this double-blind randomised sham-controlled cross-over trial. Interventions involved high-velocity low-amplitude joint manipulations targeting ankle DF-ROM, and a sham which mimicked the manipulations using a mechanical drop mechanism. The primary outcome was a change in back squat 1RM between baseline to post-intervention, with secondary outcomes being maximal ankle DF-ROM during the 1RM squat using 3D motion capture, and change in DF-ROM during the weightbearing lunge test.</p><p><strong>Results: </strong>There was no statistically significant difference between interventions for back squat 1RM (p = 0.27). From baseline, the 1RM increased by 4.75 kg (3.6%) following manipulation and 2.75 kg (2.1%) following the sham. There were no statistically significant differences between interventions on maximal DF-ROM during the back squat (p = 0.24) and no statistically significant differences in ankle DF-ROM immediately following either intervention (p = 0.39).</p><p><strong>Conclusion: </strong>Based on these results a single session of high-velocity low-amplitude manipulations targeting ankle DF-ROM does not significantly improve 1RM back squat strength compared to sham, and does not influence short-term ankle DF-ROM. Trial registration The study was pre-registered with ANZCTR (ACTRN12622000811707).</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse event reporting in randomized trials of spinal manipulative therapy: a scoping review of practices and characteristics.","authors":"Martha Funabashi, Jacob Mangor Normand, Jonas Koch Kristensen, Casper Nim","doi":"10.1186/s12998-026-00658-8","DOIUrl":"10.1186/s12998-026-00658-8","url":null,"abstract":"<p><strong>Background: </strong>Despite the availability of guidelines such as the Consolidated Standards of Reporting Trials (CONSORT) Harms extension, adverse event (AE) reporting in randomized controlled trials (RCTs) of spinal manipulative therapy (SMT) remains inconsistent and incomplete. Many trials fail to provide essential AE details hindering the accurate assessment of SMT-related risks. Mapping the current landscape of AE reporting and identifying deficiencies is critical to improving transparency and advancing patient safety in SMT research and practice.</p><p><strong>Purpose: </strong>To provide a comprehensive overview of AE reporting in randomized controlled trials (RCTs) investigating high-velocity, low-amplitude SMT for spinal pain, including AE types, characteristics and reporting practices.</p><p><strong>Study design/setting: </strong>Scoping review based on a previous systematic review.</p><p><strong>Methods: </strong>We searched PubMed and Epistemonikos for systematic reviews indexed up to February 2022 and conducted an updated systematic search in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Index to Chiropractic Literature from January 1, 2018, to September 12, 2023, with a final update on March 8, 2026. Eligible studies were RCTs involving SMT for spinal pain in adults, including multimodal SMT trials. Studies were included if published in English, Spanish, Portuguese, French, German, Norwegian, Swedish, or Danish. AE data were extracted in three steps: whether AEs were mentioned, collected, and reported. For studies reporting AEs, detailed data on type, severity, duration, onset, relatedness, and additional care were categorized into meaningful subgroups. Summary statistics and visualizations were used to describe reporting patterns.</p><p><strong>Results: </strong>Of 253 included RCTs, 55% mentioned AEs, 53% collected them, and only 28% reported their occurrence. AE characteristics were inconsistently reported, with wide variation in terminology and classification. Pain-related AEs were most common, typically described as mild in severity. However, characteristics such as duration, onset, and additional care required were often omitted. Relatedness was also inconsistently assessed.</p><p><strong>Conclusion: </strong>AE reporting in SMT RCTs remains suboptimal and inconsistent with established standards. Improved adherence to standardized reporting frameworks, such as the CONSORT Harms extension, and a cultural shift toward treating AE monitoring as a core component of trial design are urgently needed to enhance transparency and strengthen patient safety.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chiropractic's role in strengthening rehabilitation in health systems.","authors":"Katie de Luca, Afua Adjei-Kwayisi, Nora Bakaa, Christoffer Andre Børsheim, Amy Bowzaylo, Richard Brown, Raul Carrillo, Patricia Estrada, Jean-Luc Gauthier, Jordan A Gliedt, Brett Guist, Neil Langridge, Peter Tuchin, Michael Vianin, Arnold Y L Wong","doi":"10.1186/s12998-026-00654-y","DOIUrl":"10.1186/s12998-026-00654-y","url":null,"abstract":"<p><strong>Background: </strong>Rehabilitation is described as the care needed when a person is experiencing, or is likely to experience, limitations in everyday functioning. In 2019, it was estimated that 2.4 billion people were living with a condition that could benefit from rehabilitation. Chiropractors have contributed meaningfully to the delivery of rehabilitation due to their training in musculoskeletal health and person-centred care. Building on the World Federation of Chiropractic's chiropractic rehabilitation competency framework, this commentary highlights chiropractic's role in strengthening rehabilitation in health systems. Under the \"Role of Chiropractic in Rehabilitation\", we explore the postoperative setting, sports injury recovery, and neurorehabilitation. We share how the \"Integration of Chiropractors into Health Systems\" exists in multidisciplinary rehabilitation teams, publicly funded health systems and in hospitals. We discuss the \"Economic and Social Impacts\" of the chiropractic profession in low- and middle-income countries, for equity, diversity and inclusion, and regarding cultural competencies. We present \"Challenges for the Chiropractic Profession\" that include varying legislations within and between countries, limited recognition among other healthcare professionals, and advanced integration within multidisciplinary rehabilitation programs. Finally, we make a \"Call to Action\" for theory driven implementation strategies, to advocate for improved recognition of the chiropractic profession, and to enhance interprofessional education and advance rehabilitation in chiropractic curricular.</p><p><strong>Conclusions: </strong>Chiropractors can play an important role in strengthening rehabilitation in health systems as they deliver interventions for rehabilitation for people with health conditions throughout the life course, and across the continuum of care. However, barriers remain. As a profession we must align with global rehabilitation priorities and uptake taxonomies to enable equitable access to chiropractors focused on optimising function and participation.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"34 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13264824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148254051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}