Original research: Reporting of adverse events associated with spinal manipulation in randomised clinical trials: an updated systematic review

Lindsay M Gorrell; Benjamin T Brown; Roger Engel; Reidar P Lystad

doi:10.1136/bmjopen-2022-067526

Table 3

Univariable and multivariable logistic regression

Variable OR 95% CI P value aOR* 95% CI P value
ICMJE journal
Yes 1.08 0.55 to 2.16 0.821 – – –
No† – – – – – –

Risk of bias
Low risk 2.36 0.67 to 11.01 0.213 – – –
Some concerns 1.14 0.56 to 2.37 0.716 – – –
High risk† – – – – – –

Impact factor
Upper tertile 4.99 2.14 to 12.32 <0.001 5.72 2.23 to 15.85 <0.001
Middle tertile 3.32 1.52 to 7.48 0.003 3.52 1.51 to 8.57 0.004
Lower tertile† – – – – – –

Spinal region
Cervical 2.80 0.91 to 9.27 0.080 3.04 0.88 to 11.30 0.085
Thoracic 0.96 0.35 to 2.66 0.939 1.09 0.34 to 3.45 0.887
Lumbopelvic† – – – – – –
Mixed/unclear 2.83 1.15 to 7.11 0.025 3.18 1.16 to 9.05 0.027

Type of practitioner
Chiropractor 6.21 1.71 to 24.85 0.007 4.58 1.14 to 20.24 0.036
Osteopath† – – – – – –
Physiotherapist 1.88 0.60 to 6.19 0.282 1.35 0.37 to 5.18 0.648
Medical practitioner 1.20 0.22 to 6.53 0.831 0.81 0.12 to 5.47 0.829
Mixed/other/unclear 2.72 0.78 to 10.17 0.121 2.26 0.57 to 9.64 0.253

Sample size spinal manipulation group‡
Upper tertile 3.64 1.57 to 8.87 0.003 – – -
Middle tertile 1.27 0.58 to 2.79 0.544 – – -
Lower tertile† – – – – – –

*The final model was adjusted for impact factor, spinal region of manipulation, and type of practitioner, while ICMJE journal status, risk of bias and number of participants receiving spinal manipulation were omitted via backward elimination method.
†Reference group.
‡One study with unclear sample size excluded.
aOR, adjusted OR; ICMJE, International Committee of Medical Journal Editors.

Variable	OR	95% CI	P value	aOR*	95% CI	P value
ICMJE journal
Yes	1.08	0.55 to 2.16	0.821	–	–	–
No†	–	–	–	–	–	–

Risk of bias
Low risk	2.36	0.67 to 11.01	0.213	–	–	–
Some concerns	1.14	0.56 to 2.37	0.716	–	–	–
High risk†	–	–	–	–	–	–

Impact factor
Upper tertile	4.99	2.14 to 12.32	<0.001	5.72	2.23 to 15.85	<0.001
Middle tertile	3.32	1.52 to 7.48	0.003	3.52	1.51 to 8.57	0.004
Lower tertile†	–	–	–	–	–	–

Spinal region
Cervical	2.80	0.91 to 9.27	0.080	3.04	0.88 to 11.30	0.085
Thoracic	0.96	0.35 to 2.66	0.939	1.09	0.34 to 3.45	0.887
Lumbopelvic†	–	–	–	–	–	–
Mixed/unclear	2.83	1.15 to 7.11	0.025	3.18	1.16 to 9.05	0.027

Type of practitioner
Chiropractor	6.21	1.71 to 24.85	0.007	4.58	1.14 to 20.24	0.036
Osteopath†	–	–	–	–	–	–
Physiotherapist	1.88	0.60 to 6.19	0.282	1.35	0.37 to 5.18	0.648
Medical practitioner	1.20	0.22 to 6.53	0.831	0.81	0.12 to 5.47	0.829
Mixed/other/unclear	2.72	0.78 to 10.17	0.121	2.26	0.57 to 9.64	0.253

Sample size spinal manipulation group‡
Upper tertile	3.64	1.57 to 8.87	0.003	–	–	-
Middle tertile	1.27	0.58 to 2.79	0.544	–	–	-
Lower tertile†	–	–	–	–	–	–