Author (Year)	Study Type	CAMs	Population	Outcomes and Limitations
Crow WT et al. (2009) [31]	Observational study	Osteopathy	Human calvarial structures	Outcomes:
				Statistically significant changes in cranial area.
				Changes above the resolution threshold of the MRI scanner (0.898 mm/pixel).
				Limitations:
				Limited resolution of the MRI scanner used.
				Small sample size (20 participants).
Mirtz et al. (2009) [42]	Epidemiological Review	Chiropractic	General chiropractic	Outcomes:
				Evaluated chiropractic subluxation using Hill’s causation criteria, concluding it lacks validity as a disease cause.
				Limitations:
				Based on theoretical application without experimental data; potentially subjective interpretations.
Homola (2013) [40]	Commentary/Review	Chiropractic	General chiropractic	Outcomes:
				Critiqued the concept of “vertebral manipulation” in chiropractic, pointing out lack of scientific evidence for “vertebral subluxation”.
				Limitations:
				No original research data provided.
				Findings are interpretive and based on existing literature, introducing potential bias.
Homola (2016) [41]	Narrative review	Pediatric chiropractic	Pediatric population	Outcomes:
				Criticized “vertebral subluxation” concept in pediatric chiropractic care, emphasizing lack of scientific support.
				Discussed potential health risks for children and need for appropriate medical referral.
				Limitations:
				No original research data provided.
				Findings are interpretive and based on existing literature, introducing potential bias.
Horton (2015) [33]	Clinical review	Visceral Mobilization therapy (VMT)	General population, focused on pelvic dysfunctions	Outcomes:
				Identified potential clinical applications of VMT in treating genitourinary dysfunction.
				Outlined some clinical evidence supporting VMT for genitourinary and pelvic dysfunction.
				Limitations:
				Evidence limited primarily to case reports and observational studies.
				Lacks robust clinical and experimental trials.
				Effectiveness for specific conditions remains speculative.
				Proposed biological mechanisms lack empirical support.
Côté P et al. (2020) [38]	Commentary/Review	Chiropractic	General population	Outcomes:
				Data linking chiropractic manipulation to immune system are unreliable.
				Lack of biological plausibility in relationship between chiropractic manipulation and immune system.
				Limitations:
				Does not provide new experimental data on biological mechanisms, relying on previous reviews and expert opinions.
Nim et al. (2021) [43]	Systematic review	Spinal manipulation	Patients with spinal pain	Outcomes:
				No significant difference between targeted and non-targeted manipulation sites, suggesting specificity may not impact treatment effectiveness.
				Limitations:
				Limited by small number of studies (10) and high variability in study designs.
				Differences in patient populations and protocols impact consistency of findings.
Requena-García J et al. (2021) [32]	Educational Model validation	Cranial osteopathy	Students learning cranial osteopathy	Outcomes:
				Relationship found between therapist experience and reliability in palpating cranial movements.
				Limitations:
				Use of cadaveric model limits transferability to real clinical situations.
				Variations in cranial movement, measured in microns, probably not perceptible by therapists.
Consorti G et al. (2023) [37]	Conceptual/Theoretical study	Somatic dysfunction	General population	Outcomes:
				Presents an enactive theoretical framework on “osteopathic dysfunction”.
				Limitations:
				Lacks evidence on proposed potential neurobiological mechanisms.
				Does not establish clear relationship between proposed mechanisms and clinical situation.
Bordoni B, Escher AR. (2023) [30]	Review	Cranial osteopathy	General population	Outcomes:
				Inconsistencies in PRM theory highlighted.
				Cerebrospinal fluid (CSF) movement is inhomogeneous both centrally and peripherally.
				Limitations:
				No evidence that CSF movement is detectable by palpation.
				Strong suspicion that spheno-occipital synchondrosis is incapable of moving sacrum.
Hidalgo D et al. (2024) [35]	Narrative review	Osteopathy	Not applicable	Outcomes:
				Examines concept of “anatomical possibilism” in osteopathy.
				Argues this approach may lead to unsupported diagnostic and treatment practices.
				Emphasizes need for osteopathic interventions based on rigorous scientific evidence.
				Limitations:
				Lacks empirical data and relies on theoretical critique, which may introduce interpretative bias.