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Abstract Background A small proportion of chiropractors, osteopaths, and other manual medicine providers use spinal manipulative therapy (SMT) to manage non-musculoskeletal disorders. However, the efficacy and effectiveness of these interventions to prevent or treat non-musculoskeletal disorders remain controversial. Objectives We convened a Global Summit of international scientists to conduct a systematic review of the literature to determine the efficacy and effectiveness of SMT for the primary, secondary and tertiary prevention of non-musculoskeletal disorders. Global summit The Global Summit took place on September 14–15, 2019 in Toronto, Canada. It was attended by 50 researchers from 8 countries and 28 observers from 18 chiropractic organizations. At the summit, participants critically appraised the literature and synthesized the evidence. Systematic review of the literature We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health, and the Index to Chiropractic Literature from inception to May 15, 2019 using subject headings specific to each database and free text words relevant to manipulation/manual therapy, effectiveness, prevention, treatment, and non-musculoskeletal disorders. Eligible for review were randomized controlled trials published in English. The methodological quality of eligible studies was assessed independently by reviewers using the Scottish Intercollegiate Guidelines Network (SIGN) criteria for randomized controlled trials. We synthesized the evidence from articles with high or acceptable methodological quality according to the Synthesis without Meta-Analysis (SWiM) Guideline. The final risk of bias and evidence tables were reviewed by researchers who attended the Global Summit and 75% (38/50) had to approve the content to reach consensus. Results We retrieved 4997 citations, removed 1123 duplicates and screened 3874 citations. Of those, the eligibility of 32 articles was evaluated at the Global Summit and 16 articles were included in our systematic review. Our synthesis included six randomized controlled trials with acceptable or high methodological quality (reported in seven articles). These trials investigated the efficacy or effectiveness of SMT for the management of infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. None of the trials evaluated the effectiveness of SMT in preventing the occurrence of non-musculoskeletal disorders. Consensus was reached on the content of all risk of bias and evidence tables. All randomized controlled trials with high or acceptable quality found that SMT was not superior to sham interventions for the treatment of these non-musculoskeletal disorders. Six of 50 participants (12%) in the Global Summit did not approve the final report. Conclusion Our systematic review included six randomized clinical trials (534 participants) of acceptable or high quality investigating the efficacy or effectiveness of SMT for the treatment of non-musculoskeletal disorders. We found no evidence of an effect of SMT for the management of non-musculoskeletal disorders including infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. This finding challenges the validity of the theory that treating spinal dysfunctions with SMT has a physiological effect on organs and their function. Governments, payers, regulators, educators, and clinicians should consider this evidence when developing policies about the use and reimbursement of SMT for non-musculoskeletal disorders.

Abstract Background In March 2020, the World Health Organization elevated the coronavirus disease (COVID-19) epidemic to a pandemic and called for urgent and aggressive action worldwide. Public health experts have communicated clear and emphatic strategies to prevent the spread of COVID-19. Hygiene rules and social distancing practices have been implemented by entire populations, including ‘stay-at-home’ orders in many countries. The long-term health and economic consequences of the COVID-19 pandemic are not yet known. Main text During this time of crisis, some chiropractors made claims on social media that chiropractic treatment can prevent or impact COVID-19. The rationale for these claims is that spinal manipulation can impact the nervous system and thus improve immunity. These beliefs often stem from nineteenth-century chiropractic concepts. We are aware of no clinically relevant scientific evidence to support such statements. We explored the internet and social media to collect examples of misinformation from Europe, North America, Australia and New Zealand regarding the impact of chiropractic treatment on immune function. We discuss the potential harm resulting from these claims and explore the role of chiropractors, teaching institutions, accrediting agencies, and legislative bodies. Conclusions Members of the chiropractic profession share a collective responsibility to act in the best interests of patients and public health. We hope that all chiropractic stakeholders will view the COVID-19 pandemic as a call to action to eliminate the unethical and potentially dangerous claims made by chiropractors who practise outside the boundaries of scientific evidence.

Résumé Introduction Une hypothèse récente propose que la manipulation vertébrale causerait des changements neurophysiologiques au niveau du cerveau. En Neurologie Fonctionnelle, approche principalement présente en chiropraxie, l’utilisation de la manipulation vertébrale est déjà promue comme capable d’améliorer le fonctionnement du cerveau. A ce jour, aucune revue systématique de la littérature n’a été conduite afin de connaître l’étendue et la qualité de l’évidence scientifique susceptible de justifier cet usage de la manipulation vertébrale. Objectif Déterminer, à travers une revue systématique et critique de la littérature, si la manipulation vertébrale a un effet (spécifique) sur le cerveau et, si oui, si celui-ci est associé à un effet clinique. Méthode Le moteur de recherche PubMed et deux bases de données, Embase et PEDro, ont fait l’objet d’une recherche bibliographique (actualisée en février 2018). Les critères d’inclusion étaient: essais contrôlés, randomisés ou non, dans lesquels la manipulation vertébrale avait été comparée à un placébo ou à un autre type de contrôle, chez des sujets symptomatiques ou asymptomatiques. La manipulation vertébrale pouvait avoir été effectuée au niveau de n’importe quelle région de la colonne vertébrale et les critères de jugement utilisés devaient être indiqués comme capables de mesurer, directement ou indirectement, une forme ‘d’activité cérébrale’. La qualité méthodologique des études a été évaluée de manière indépendante par au moins deux chercheurs à l’aide d’une grille de qualité créée pour les besoins de cette revue. Les études ont été classifiées comme étant de qualité méthodologique ‘acceptable’, ‘moyenne’, ou ‘faible’. Les résultats ont été rapportés de façon narrative, en fonction du type de contrôle utilisé (placébo, ‘inactif’, ou ‘autre stimulus physique’) et du type de sujets d’étude (sans problème de santé, symptomatiques, ou présentant des « douleurs rachidiennes subcliniques »), en tenant compte de la qualité méthodologique. Seuls les résultats issus de comparaisons inter-groupes ont été pris en compte dans notre analyse finale. Résultats Dix-huit articles parmi les 1514 titres obtenus ont été inclus. Les études étaient pour la plupart de qualité méthodologique ‘faible’ ou ‘moyenne’ et avaient principalement comparé la manipulation vertébrale à une intervention autre que placébo. Les résultats rapportés dans 13 des 18 articles inclus ont finalement été pris en compte. Un effet transitoire sur différentes formes ‘d’activité cérébrale’ a été rapporté à l’issue de trois études dans lesquelles la manipulation vertébrale avait été comparée à un placébo (de crédibilité cependant incertaine), chez des sujets présentant des « douleurs rachidiennes subcliniques » (n = 2) ou souffrant de cervicalgies non spécifiques aiguës / subaiguës (n = 1). Une potentielle association avec un effet clinique n’a pas été étudiée dans ces trois études, de qualité méthodologique ‘moyenne’ (n = 2) ou ‘acceptable’ (n = 1). Dans les 10 études restantes, la plupart de qualité méthodologique ‘faible’ ou ‘moyenne’, la manipulation vertébrale avait été comparée à un contrôle ‘inactif’ ou à un ‘autre stimulus physique’. Des différences inter-groupes y ont également été rapportées, parfois de façon inconsistante. Conclusion La littérature scientifique suggère que des changements neurophysiologiques surviennent au niveau du cerveau en réponse à la manipulation vertébrale mais, de façon inconsistante. La pertinence clinique de ces changements n’est pas connue. Ainsi, il est prématuré d’attribuer à la manipulation vertébrale des bénéfices cliniques via un effet sur le cerveau.

Abstract Background Functional Neurology (FN), a seemingly attractive treatment approach used by some chiropractors, proposes to have an effect on a multitude of conditions but some of its concepts are controversial. Objectives and design A scoping review was performed to describe, in the context of chiropractic manual therapy, 1) the FN theories, and 2) its clinical applications (i.e. its indications, examination procedures, treatment modalities, treatment plans, and clinical outcomes) using four sources: i) one key textbook, ii) the scientific peer-reviewed literature, iii) websites from chiropractors using FN, and iv) semi-structured interviews of chiropractors using FN. Methods The scientific literature was searched in PubMed, PsycINFO, and SPORTDiscus, completed by a hand search in the journal Functional Neurology, Rehabilitation and Ergonomics (November 2016 and March 2017, respectively). The only textbook on the topic we found was included and articles were chosen if they had an element of manual therapy. There was no restriction for study design but discussion papers were excluded. Websites were found in Google using the search term “Functional Neurology”. Chiropractors, known to use FN, were invited based on their geographical location. Theories were mainly uncovered in the textbook as were all aspects of the clinical applications except treatment plans. The other three sources were used for the five aspects of clinical applications. Results were summarized and reported extensively in tables. Results Eleven articles were included, five websites scrutinized, and four semi-structured interviews performed. FN is based on the belief that reversible lesions in the nervous system are the cause of a multitude of conditions and that specific clusters of neurons can be positively affected by manipulative therapy, but also by many other stimuli. Diagnostic procedures include both conventional and unusual tests, with an interpretation specific to FN. Initial treatment is intense and clinical outcomes reported as positive. Conclusion FN gives the impression to be a complex alternative to the old variant of the chiropractic subluxation model, in which the vertebral subluxation is replaced by “physiological lesions” of the brain, and the treatment, spinal adjustments, are complemented by various neurological stimuli. Both models purport to treat not the symptoms but the cause. We conclude there is a need for more scientific documentation on the validity of FN.