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

SYSTEMATIC REVIEW

Chiropractic spinal manipulation for infant colic: a systematic review of randomised clinical trials
E. Ernst
Linked Comment: Underwood. Int J Clin Pract 2009; 63: 1272–4.

SUMMARY Some chiropractors claim that spinal manipulation is an effective treatment for infant colic. This systematic review was aimed at evaluating the evidence for this claim. Four databases weresearched and three randomised clinical trials met all the inclusion criteria. The totality of this evidence fails to demonstrate the effectiveness of this treatment. It is concluded that the above claim is not based on convincing data from rigorous clinical trials.

Review Criteria
Randomised studies testing the effectiveness of spinal manipulation for infant colic were evaluated.

ComplementaryMedicine, Peninsula Medical School, Universities of Exeter & Plymouth, Exeter, UK Correspondence to: E. Ernst, Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth, 25 Victoria Park Road, Exeter EX2 4NT, UK Tel.: +44 1392 424989 Fax: +44 1392 427562 Email: edzard.ernst@pms.ac.uk Disclosure None.

Message for the Clinic
There is no good evidence to show thatspinal manipulation is effective for infant colic.

Infant colic occurs in about 10–30% of all infants with a peak around the age of 6 weeks (1). The syndrome is characterised by paroxysms of inconsolable crying, often accompanied by flushing of the face, meteorism, drawing-up of the legs and flatulence (2). The aetiology of infant colic is not clear and a range of causes are being discussed: lactoseintolerance, dysmotility, gastro-oesophageal reflux, hormonal imbalances, aberrant microflora of the gut, feeding disorders, food hypersensitivity and psychological factors (2). The optimal therapy is not yet known and many experts believe that a multifactorial management strategy might be the best option (3). Chiropractic spinal manipulation is being recommended as a treatment of infant colic byprofessional bodies of chiropractic. Case reports and case series also seem to suggest that spinal manipulation is an effective therapeutic option (e.g. 4,5). One retrospective survey suggested that 91% of patients show a positive response (6). However, a health technology assessment concluded that ‘there is no convincing evidence that spinal manipulation alone can affect the duration of infantilecolic symptoms’ (7). This report included studies up to April 2003. As new data have become available since then, it requires updating. The aim of this systematic review was to critically evaluate the data from randomised clinical trials of chiropractic spinal manipulation as a treatment of infant colic.

(using the Ovid interface) and Cinahl (using the Ebsco interface). The search terms wereconstructed over two concepts: spinal manipulation and infant colic. Our own, extensive department files were handsearched and the bibliographies of review articles and other relevant literature were also screened. No language or time limitations were imposed. The abstracts of the articles thus located were screened in End Note to remove duplicates and overtly irrelevant studies. To get included, aclinical trial had to be randomised, test the effectiveness of spinal manipulation, focus on infants with the clinical diagnosis of colic and include outcome measures which are of clinical importance. Any type of control intervention was admissible. Studies of chiropractic or osteopathic treatments not including spinal manipulation were excluded. Trials which failed to include clinical endpoints orwhich were not fully published (e.g. available as an abstract only) were also excluded (8). Key data of the included trials were extracted according to prespecified criteria (Table 1). Data extraction was performed by two independent reviewers. The methodological quality of all reviewed studies was estimated using the Jadad score (9). Again this was performed by two independent reviewers. A...