Comment about Extrapolating Beyond the Data

To the EditorMy spirits were heartened after reading the article by Goertz et al.

Goertz CM, Hurwitz E, Murphy B, Coulter I. Extrapolating beyond the data in a systematic review of spinal manipulation for nonmusculoskeletal disorders: a fall from the summit [e-pub ahead of print]. J Manip Physiol Ther. doi: https://doi.org/10.1016/j.jmpt.2021.02.003. Accessed April 17, 2021.

I would like to add my support and concern from a basic sciences perspective about the lack of biological plausibility of collapsing 5 different clinical disorders, namely infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine, into a single category. Goertz et al rightly point out that there is no biologically plausible reason for considering these 5 different clinical entities as 1 condition.

Goertz CM, Hurwitz E, Murphy B, Coulter I. Extrapolating beyond the data in a systematic review of spinal manipulation for nonmusculoskeletal disorders: a fall from the summit [e-pub ahead of print]. J Manip Physiol Ther. doi: https://doi.org/10.1016/j.jmpt.2021.02.003. Accessed April 17, 2021.

The scientific literature does not yet fully understand the mechanisms of why some people develop these conditions and based on what we do know, there are vastly different pathophysiological etiologies for each of these conditions. There are most likely multiple reasons why each of these conditions arise.On top of this, our fundamental knowledge of spinal dysfunction is far from complete. There is evidence that spinal dysfunction appears to alter central neural processingSensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control.,Uthaikhup S Jull G Sungkarat S Treleaven J. The influence of neck pain on sensorimotor function in the elderly. and that spinal manipulation has central neural effects.The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control. Yet, we far from fully understand this effect on clinical conditions. The central neural effects of spinal adjustments may clinically impact only a small portion of people who have a particular clinical condition, in that there may be those who respond and those who do not to chiropractic care for any given condition. The potential clinical impact would likely depend on the etiology of that person's clinical problems. The results of chiropractic adjustments for an individual may depend on the central neural effects that those adjustments have for that individual. There are multiple influencing factors that likely impact these central neural effects that have not yet been fully explored scientifically. These factors include not only an individual's current biological and pathophysiological state but also include the chiropractor's choice of technique, force applied, whether or not the intervention is directed at dysfunction or at the part of the spine that hurts, and so on.We do not yet fully understand the mechanisms for infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. Nor do we fully understand the mechanisms of spinal adjustments and the clinical impact they have. It is far too early to make broad-reaching conclusions about whether or not chiropractic care can or cannot help people with these conditions. A systematic review of only clinical literature cannot, in any case, inform readers about the mechanisms around how spinal dysfunction and the autonomic nervous system are connected. A systematic review limited to only a few clinical trials should not make any comments whatsoever about basic science mechanisms, which would require a review of the basic science literature, not a review consisting exclusively of clinical studies.The basic science/clinical science interface and treatment development.Going beyond systematic reviews: realist and meta-narrative reviews.Systematic reviews: the good, the bad, and the ugly.References

Goertz CM, Hurwitz E, Murphy B, Coulter I. Extrapolating beyond the data in a systematic review of spinal manipulation for nonmusculoskeletal disorders: a fall from the summit [e-pub ahead of print]. J Manip Physiol Ther. doi: https://doi.org/10.1016/j.jmpt.2021.02.003. Accessed April 17, 2021.

Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control.

Man Ther. 13: 2-11Uthaikhup S Jull G Sungkarat S Treleaven J.

The influence of neck pain on sensorimotor function in the elderly.

Arch Gerontol Geriatr. 55: 667-672

The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control.

J Electromyogr Kinesiol. 22: 768-776

The basic science/clinical science interface and treatment development.

Clin Psychol Sci Pract. 11: 263-266

Going beyond systematic reviews: realist and meta-narrative reviews.

Stud Health Technol Inform. 222: 275-287

Systematic reviews: the good, the bad, and the ugly.

ACG. 104: 1086-1092Article InfoPublication History

Published online: June 15, 2021

Accepted: April 19, 2021

Received: April 19, 2021

Publication stageIn Press Corrected ProofIdentification

DOI: https://doi.org/10.1016/j.jmpt.2021.04.001

Copyright

© 2021 by National University of Health Sciences.

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