American Chiropractic Association

Abstract Background This systematic review updated adverse events (AEs) reporting in persons aged > 55 years who received chiropractic treatment, including spinal manipulation. Methods Protocol was registered prospectively with the Prospective Register of Systematic Reviews (PROSPERO)(CRD42024629286). Search strategy was audited with Peer Review of Electronic Search Strategies (PRESS) methodology. We searched PubMed, Cochrane Central Register of Controlled Trials, CINAHL, AMED, and Index to Chiropractic Literature on December 12, 2025. We included AEs attributed to treatment provided by chiropractors reported in randomized clinical trials (RCTs), observational studies, and case reports/series. We excluded non-clinical, pilot/feasibility studies, surveys, reviews, populations ≤ 55 years,and papers lacking chiropractic treatment or AE descriptions. Articles were screened and results synthesized by study design and AE characteristics. Study risk of bias (RoB) was assessed in duplicate using Scottish Intercollegiate Guideline Network checklists. Clinical Compass and NCMIC Foundation partially funded this study. Results We screened 2295 titles/abstracts, reviewed 125 full-text, and included 25 articles from 6 RCTs, 4 observational studies, and 15 case reports/series. One RCT had low RoB and five acceptable. Three observational cohorts had low RoB and 1 had acceptable. There were 412 study-related adverse events affecting older adult patients, of which 9 were severe, and none were catastrophic. Most adverse events were rated as mild-to-moderate in severity. Reported adverse events consisted of changes in pain quality, muscle or joint soreness or stiffness, numbness, weakness, fatigue, headache, dizziness, or lightheadedness. Several studies lacked AE definitions and/or data collection processes. Case reports described 6 severe AEs; four were vascular in nature. Twenty case reports involved spinal manipulation, one followed TENS application, and one repetitive shoulder abduction, while no case reports described AEs following chiropractor treatment with soft tissue techniques, exercise, or other modalities. Conclusion No catastrophic AEs were reported in older adults receiving chiropractic treatment services. Mild-to-moderate symptoms such as muscle soreness and stiffness were common. The lack of standardized AE definitions, severity classifications, and data collection processes across reports limits the certainty. Notable study limitations included a search strategy focused on spinal manipulation, exclusion of administrative database studies that may detect rare AEs, and numerical scoring of RoB checklists.

Supporting chiropractors to deliver Evidence Based Care (EBC) is an important role that professional organizations fulfill in the practice ecosystem. This is a journey that can be accelerated when there is a shared understanding of the elements of Evidence Based Practice (EBP) and the benefits that accrue when applied comprehensively to patient care. The Ontario Chiropractic Association (OCA) undertook a significant project to advance this understanding and enhance these benefits. This paper describes the principles, processes and outputs of our work, which is a series of papers examining the EBP framework in detail. It details why this work is necessary for the chiropractic profession, how it was accomplished, and introduces the themes of each of the six other papers in the series. We aim to support chiropractors in delivering comprehensive care through the application of the evidence-based framework enabling them to practice within the full chiropractic scope of practice in compliance with applicable regulations and legislations. Author’s Note:This paper is one of seven in a series exploring contemporary perspectives on the application of the evidence-based framework in chiropractic care. The Evidence Based Chiropractic Care (EBCC) initiative aims to support chiropractors in their delivery of optimal patient-centred care. We encourage readers to review all papers in the series.

The following is The John A. Sweaney Lecture delivered by Dr Michele Maiers at the biannual Congress of the World Federation of Chiropractic that was held virtually on September 25, 2021.

OBJECTIVES:To: 1) develop/adapt and validate an instrument to measure patient safety attitudes and opinions of community-based spinal manipulative therapy (SMT) providers; 2) implement the instrument; and 3) compare results among healthcare professions.METHODS:A review of the literature and content validation were used for the survey development. Community-based chiropractors and physiotherapists in 4 Canadian provinces were invited.RESULTS:The Agency for Healthcare Research and Quality's (AHRQ) Medical Office Survey on Patient Safety Culture was the preferred instrument. The survey was modified and validated, measuring 14 patient safety dimensions. 276 SMT providers volunteered to respond to the survey. Generally, SMT providers had similar or better patient safety dimension scores compared to the AHRQ 2016 medical offices database.DISCUSSION:We developed the first instrument measuring patient safety attitudes and opinions of community-based SMT providers. This instrument provides understanding of SMT providers' opinions and attitudes on patient safety and identifies potential areas for improvement.

The craniocervical junction (CCJ) is a potential choke point for craniospinal hydrodynamics and may play a causative or contributory role in the pathogenesis and progression of neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, MS, and ALS, as well as many other neurological conditions including hydrocephalus, idiopathic intracranial hypertension, migraines, seizures, silent-strokes, affective disorders, schizophrenia, and psychosis. The purpose of this paper is to provide an overview of the critical role of the CCJ in craniospinal hydrodynamics and to stimulate further research that may lead to new approaches for the prevention and treatment of the above neurodegenerative and neurological conditions.