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Table 5 Quality rating of observational studies

From: Manual therapy for the pediatric population: a systematic review

Author/year

Study design type

Condition sample size (n)

Result summary

Intervention

Include/exclude

Recruitment strategy

Comparison selection

Blinded outcome assessor(s)

Valid, reliable measures

Length of follow-up

Missing outcomes

Missing harms/ adverse events

Missing confounding variables

Overall quality rating

Gastrointestinal/Urinary

 Tarsuslu T, et al. 2009 [18]

Interrupted time series (with comparison group)

Constipation and Cerebral Palsy (n = 13)

No difference

OMT

L does not vary

H not described

H not described

H not blinded

U-PN property measurements not fully evaluated for children

L consistent

L all outcomes discussed

H adverse events not reported

U-PN dietary

Medium

 Wiberg K & Wiberg J, 2010 [20]

Interrupted time series (without a comparison group)

Infantile colic (n = 749)

No improvement

CMT

NA

NA

NA

H not blinded

U-PN property measurements not fully evaluated for children

H not discussed

L all outcomes discussed

H adverse events not reported

U- PN co-interventions missing

Low

 van Poecke A & Cunliffe C, 2009 [25]

Before-after

Nocturnal Enuresis (n = 33)

Improvement

CMT

NA

NA

NA

H not blinded

U-PN property measurements not fully evaluated for children

L consistent

L all outcomes discussed

H adverse events not reported

U- PN dietary

Medium

 Miller J, et al. 2009 [26]

Before-after

Suboptimal Infant Breastfeeding (n = 114)

Improvement

CMT

NA

NA

NA

H not blinded

U-PN property measurements not fully evaluated for children

H not discussed

L all outcomes discussed

L adverse events reported

L confounding variables accounted for

Medium

 Vallone S, 2004 [27]

Before-after

Suboptimal Infant Breastfeeding (n = 25)

Improvement

CMT/CST

NA

NA

NA

H not blinded

U-PN property measurements not fully evaluated for children

H not discussed

U-PN different outcomes for participants

H adverse events not reported

H no confounding variables included

Low

Musculoskeletal

 Jennings J & Davies G, 2005 [29]

Interrupted time series (without comparison group)

Cuboid Syndrome (n = 2)

Improvement

MT

NA

NA

NA

H not blinded

U-PN property measurements not fully evaluated for children

U-PY not different but not specified

L all outcomes discussed

H adverse events not reported

U-PN variables that may influence outcome discussed but no adjustment to outcome taken into account

Medium

 Przekop P, et al. 2016 [30]

Before-after

Chronic tension-type headache (n = 83)

Improvement

OMT

NA

NA

NA

H not blinded

U-PN property measurements not fully evaluated for children

L consistent

L all outcomes discussed

H adverse events not reported

L confounding variables accounted for

Medium

 Marchand A, et al. 2009 [32]

Before-after

Benign infant headache (n = 13)

Improvement

CMT

NA

NA

NA

H not blinded

U-PN property measurements not fully evaluated for children

H not discussed

L all outcomes discussed

H adverse events not reported

H medication not accounted for

Low

 Walston Z & Yake D, 2016 [34]

Interrupted time series (without comparison)

Mechanical Low Back Pain (n = 3)

Improvement

MT

NA

NA

NA

H not blinded

U-PN property measurements not fully evaluated for children

H not consistent

L all outcomes discussed

L adverse events reported

U-PN information not consistently collected

Medium

 Hayden J, et al. 2003 [36]

Before-after

Mechanical Low Back Pain (n = 54)

Improvement

CMT

NA

NA

NA

H not blinded

U-PN property measurements not fully evaluated for children

L consistent

U-PN not all cases collected

H adverse events not reported

U-PY retrospective data, information not consistently collected

Medium

Respiratory

 Degenhardt B & Kuchera M, 2006 [45]

Before-after

Otitis media (n = 8)

Improvement

OMT/CST

NA

NA

NA

H not blinded

U-PN property measurements not fully evaluated for children

L consistent

L all outcomes discussed

H adverse events not reported

U-PN natural course of OM diagnosis, differences in AOM and OM, dietary considerations

Medium

 Zhang JQ & Snyder BJ, 2004 [46]

Before-after

Otitis media (n = 22)

Improvement

CMT

NA

NA

NA

H not blinded

U-PN property measurements not fully evaluated for children

H not discussed

L all outcomes discussed

L adverse events reported

H several confounding varaibles missing

Medium

Special Needs

 Bramati-Castellarin I, et al. 2016 [49]

Interrupted time series (without comparison)

Autism (n = 49)

Improvement

VOMT

NA

NA

NA

H not blinded

U-PN property measurements not fully evaluated for children

L follow up consistent

L all outcomes discussed

H adverse events not reported

U-PY not all confounding variables known

Medium

Structural

 Lessard S, et al. 2011 [59]

Before-after

Cranial asymmetry (nonsynostotic plagiocephaly) (n = 12)

Improvement

OMT

NA

NA

NA

L blinded

U-PN property measurements not fully evaluated for children

L follow-up consistent

L all outcomes discussed

H adverse events not reported

U-PN natural course

Medium

 Byun S & Han D, 2016 [61]

Before-after

Scoliosis (n = 5)

Improvement

CMT

NA

NA

NA

H not blinded

L Cobb angle

L follow-up consistent

L all outcomes discussed

H adverse events not discussed

H confounding variables not accounted for, no mention of natural course

Medium

 Morningstar M, et al. 2004 [63]

Before-after

Scoliosis (n = 6)

Improvement

CMT

NA

NA

NA

H not blinded

L Cobb angle

H length of follow-up similar but some patients had received prior treatment

L all outcomes discussed

H adverse events not reported

H confounding variables not accounted for, no mention of natural course

Low

 Lantz C & Chen J, 2001 [64]

Before-after

Scoliosis (n = 42)

No improvement

CMT

NA

NA

NA

L blinded

L Cobb angle

H follow-up not consistent

L all outcomes discussed

H adverse events not reported

H confounding variables missing, no mention of natural course

Medium

 Saedt E, et al. 2018 [67]

Before-after

Upper cervical dysfunction (n = 307)

Improvement

MT

NA

NA

NA

L blinded

U-PN property measurements not fully evaluated for children

L follow-up consistent

L all outcomes discussed

L adverse events discussed

U-PY not all confounding variables known

High

  1. Legend: H-High risk of bias; L-Low risk of bias; NA-Not applicable; U-Unclear; PN-Probably No (high risk of bias); PY-Probably Yes (low risk of bias)
  2. Interventions: CMT Chiropractic Manipulative Therapy, CST Craniosacral Therapy, MT Manual Therapy, OMT Osteopathic Manipulative Therapy