Table 5.
Quality rating of observational studies
| 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 |
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)
Interventions: CMT Chiropractic Manipulative Therapy, CST Craniosacral Therapy, MT Manual Therapy, OMT Osteopathic Manipulative Therapy