Misleading Paper by Goertz et al

Goertz et al offered an alternate interpretation1Goertz CM Hurwitz EL Murphy BA Coulter ID Extrapolating beyond the evidence in a systematic review of spinal manipulation for non-musculoskeletal disorders: a fall from the summit.J Manipulative Physiol Ther. 2021; 44: 271-279https://doi.org/10.1016/j.jmpt.2021.02.003Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar of the data from the Global Summit on the efficacy and effectiveness of spinal manipulative therapy (SMT) for the prevention and treatment of non-musculoskeletal disorders.2Côté P Hartvigsen J Axén I et al.The global summit on the efficacy and effectiveness off spinal manipulative therapy for the prevention and treatment off non-musculoskeletal disorders: a systematic review of the literature.Chiropr Man Therap. 2021; 29: 8https://chiromt.biomedcentral.com/articles/10.1186/s12998-021-00362-9Crossref PubMed Scopus (13) Google Scholar Further, they concluded that “some statements generated from the summit event have extrapolated beyond the data” and that these “have the potential to misrepresent the literature.”1Goertz CM Hurwitz EL Murphy BA Coulter ID Extrapolating beyond the evidence in a systematic review of spinal manipulation for non-musculoskeletal disorders: a fall from the summit.J Manipulative Physiol Ther. 2021; 44: 271-279https://doi.org/10.1016/j.jmpt.2021.02.003Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar We find their article to be misleading the readers of the Journal of Manipulative and Physiological Therapeutics. Goertz stated that we used P-values alone to determine effectiveness or efficacy. This is incorrect, as we did not suggest that conclusions should be based on P-values alone.2 We considered statistical significance in connection with clinical significance reported as between-group mean differences. Importantly, none of the 6 included acceptable or high-quality articles reported any statistically or any clinically important differences between individuals who were treated with SMT and those who received a sham SMT or no treatment. Goertz questioned whether findings from only 6 studies can be considered generalizable. We reviewed almost 4000 titles and abstracts, assessed 219 articles in full text, and considered 32 for critical appraisal; however,16 of those were not eligible. Moreover, 10 had low or unacceptable quality, indicating that results could not be trusted. Therefore, our conclusions were based on 6 acceptable or high-quality RCTs. We did not suggest that these studies represented a large body of evidence; however, we presented the best available evidence that was available to inform policy. The 6 acceptable/high-quality randomized controlled trial (RCTs) dealt with various conditions using the same implied rationale, either that SMT improves the autonomic nervous system or that removal of subluxations improves health. Therefore, it was not necessary to conduct several RCTs on each condition. This would be equivalent to requiring testing of the effect of a painkiller for every painful condition. Consequently, 6 acceptable/high-quality studies, all pointing in the same direction, is fairly robust evidence, and to suggest otherwise is deceiving. Goertz et al selectively quoted Rothman.3Rothman KJ Six persistent research misconceptions.J Gen Intern Med. 2014; 29: 1060-1064Crossref PubMed Scopus (228) Google Scholar We agree that RCTs are “not perfect” and that “… they are subject to various errors.” Therefore, we evaluated the quality of included RCTs and excluded flawed studies. Goertz questioned whether our findings were robust enough to support the stated policy implications. We did not suggest that policy should be based on systematic reviews alone. Instead, we stated that “Governments, payers, regulators, educators, and clinicians should consider this evidence when developing policies about the use and reimbursement of SMT for non-musculoskeletal disorders.” Suggesting that clinicians, educators, and policymakers should not consider evidence is, in our opinion, irresponsible. In conclusion, we argue that Goertz et al provide no evidence or arguments to support that the methodology, conclusions, and recommendations from the Global Summit are not valid. Our article has been accessed over 14 000 times and is freely available as an open-access publication (link provided in references below).2Côté P Hartvigsen J Axén I et al.The global summit on the efficacy and effectiveness off spinal manipulative therapy for the prevention and treatment off non-musculoskeletal disorders: a systematic review of the literature.Chiropr Man Therap. 2021; 29: 8https://chiromt.biomedcentral.com/articles/10.1186/s12998-021-00362-9Crossref PubMed Scopus (13) Google Scholar We trust that people appreciate the scientific rigor that we applied instead of the misleading information provided by Goertz et al.

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