Table 2 Study details of articles that met final inclusion criteria (n = 21)

Bracher, 2000 (Brazil) [164]

SACT

15 (41 median)

Adults (27–82), in otorhinolaryngology practice, dizziness and diagnosis of cervical vertigo

Multimodal chiropractic (spinal manipulation, manual techniques, electrotherapy, medication (sedation), biofeedback, exercise)

Individual, as needed, mean 5 (3–10)

–

–

Vertigo severity, Musculo-skeletal Pain

Descriptive statistics reported from baseline to study completion:

• 9 patients (60%) reported complete remission of vertigo symptoms.

• 3 patients (20%) reported improved vertigo symptoms.

Hawk, 2007 (USA) [158]

RCT

11 (73.0)

Older adults (60+), OLST < 5 sec, ambulatory, no balance exercises

Multimodal (spinal manipulation, soft tissue and myofascial release, heat)

2x weekly, over 8 weeks (16 sessions total)

8 balance exercises

2x weekly, over 8 weeks (16 sessions total)

BBS, OLST, PDI, DHI, self-reported falls

Descriptive statistics reported little detectable change from baseline to study completion in the collected outcomes of intervention group:

• Change in DHI scores ranged: − 12 to 32.

• Change in BBS scores ranged: − 5 to 16.

• Change in OLST scores ranged: − 5 to 0.

• No trends observed in collected falls data.

Hawk, 2009 (USA) [159, 165]

SACT

14 (77.0)

Older adults (60+), OLST < 5 sec, ambulatory, no recent SM

Multimodal chiropractic, (HVLA, other manipulations, soft tissue treatment, hot packs)

2x weekly over 8 weeks (16 sessions total)

–

–

SF-BBS, OLST, PDI, DHI, GDS

Descriptive statistics reported from baseline to study completion:

• 3/6 patients with baseline DHI scores indicating dizziness, showed clinically significant reduction (> 18 points).

• Little to no trends observed in both SF-BBS and OLST scores.

Hawk 2009 (USA) [159, 165]

RCT

34 (80)

Older adults (60+), OLST < 5 sec, ambulatory, no balance exercises

Multimodal chiropractic (spinal manipulation, soft tissue and myofascial release, heat; hip, knee ankle)

GR1: 2x weekly, over 8 weeks (16 sessions total)

GR2: 2x weekly, over 8 weeks + 10 monthly visits, over 10 months (26 sessions total)

GR3: Home-based balance exercises

Over the study period, no established frequency

BBS, OLST, PDI, DHI, GDS, self-reported falls (in clinical notes)

Descriptive findings reported from baseline to study completion:

• Trend toward increasing BBS scores in GR2.

• DHI scores improved in GR1 and GR2.

• Reporting of falls was not equal among groups (GR1: 18 visits, 6 reported falls. GR2: 26 visits, 9 reported falls. GR3: 5 visits, 0 reported falls).

Herzog, 1988 (Canada) [167]

SACT

11 (−-)

Adults with unilaterally decreased mobility in sacroiliac joint

Spinal manipulation of sacroiliac joint

6 sessions over 2 weeks

–

–

Gait Symmetry, ^aVAS, ODI, palpation-based joint mobility

Reported observations from baseline to study completion:

• Improvements in symmetry observed in ML GRF between the involved and noninvolved sides.

• No detected differences for vertical or AP GRF.

Herzog, 1989 (Canada) [168]

SACT

11 (−-)

Chiropractic patients with sacroiliac problems

Spinal manipulation of sacroiliac joint

Single session

–

–

Gait Symmetry¹

• No changes observed from baseline to study completion in measures of gait symmetry or GRF.

Herzog, 1991 (Canada) [160]

RCT

37 (33.5)

Adults (18–50), ambulatory with chronic sacroiliac joint problems, nor obese

Spinal manipulation of sacroiliac joint

10 sessions over 4 weeks

Back school therapy program by PT (stretching, strengthening exercises, no manipulation)

10 sessions over 4 weeks

VAS, ODI, Gait Symmetry¹

• SM group showed improvements in gait symmetry (in all GRF components) from baseline to study completion.

• Back school therapy did not show improvement in gait measures.

Holt, 2011 (New Zealand) [34]

Observational

101 (72.0)

Older adults (65+), ambulatory, active in chiropractic care

Multimodal chiropractic care

Individual, as needed

–

–

History of falls, BBS, ABCs, Posturography^b

Descriptive statistics reported:

• 34.6% of the participants reported at least 1 fall in the prior year.

• Mean BBS scores of 51.9 (SD 5.9) reported.

• 59.4% of participants exhibited posturographic measures categorized as severely or profoundly impaired or were unable to complete posturographic assessment (included in profound category).

Holt, 2016 (New Zealand) [114]

RCT

60 (72.2)

Older adults (65+), community dwelling, ambulatory

Multimodal chiropractic care chiropractic (HVLA, table and instruments adjustments)

Individual, as needed (range: 2–33)

Usual care (as prior to the study)

–

Joint position, stepping reaction time, static postural control², SF-36, multisensory processing^c

• Chiropractic treatment group showed improvements in choice stepping reaction time (p < 0.05) and in ankle joint position sense (p < 0.05) compared to usual care group.

Kendall, 2018 (Australia) [63]

RCT

22 (73)

Older adults (65–85) with neck pain and concomitant dizziness > 3 months

Activator II instrument assisted manipulation with joint mobilization, massage, ROM neck exercise or heat

1x weekly, over 4 weeks (4 sessions total)

Sham intervention (Activator II instrument impulses (set at zero) and gentle

placement of practitioner’s hands on the cervical and

thoracic spine

1x weekly, over 4 weeks (4 sessions total)

DHI, TUG, NDI, NRS, FES-I

Descriptive statistics reported [mean (SD)] from baseline to study completion:

• Improvements in DHI scores for both intervention [40.77 (12.48) to 28.33 (14.37)] and control groups [44.00 (16.97) to 36.40 (20.11)].

• Small improvements seen TUG test score in the intervention group [12.18 (2.07) to 11.87 (3.67)] but not in control group [12.09 (2.87) to 12.36 (411)].

Maiers, 2014 (USA) [161]

RCT

241 (71.7)

Older adults (65+) with neck pain, ambulatory, stable medications, MMSE score > = 20

GR1: SM with home exercise, GR2: SRE with home exercise

SM: Individualized (range 5–19)

Supervised rehabilitative exercise: 20, 1-hour sessions over 12 weeks

GR3: Home exercise

4x weekly for 45–60 minutes over 12 weeks

(48 sessions total)

NRS, NDI, SF-36, satisfaction, global improvement, medication use, ROM, strength, TUG

• Change in TUG test time was reported (Mean [95% CI]) as week 12 score minus baseline score, no significant between group differences reported:

• GR1: (−0.3 [− 0.8 to 0.2]).

• GR2: (− 0.3 [− 0.7 to 0.1]).

• GR3: (− 0.2 [− 0.7 to 0.3]).

Maiers, 2019 (USA) [174]

RCT

182 (71.1)

Older adults (65+), ambulatory, community dwelling, self-reported back and neck disability > = 12 weeks

SM (HVLA, soft tissue, thermal therapy, stretching) + SRE

GR1: 12 weeks of SM as needed + 1 hour SRE session 2x in 1st month, then 1x/month

GR2: 36 weeks of SM as needed + 1 hour SRE session 2x in 1st month, then 1x/month

–

–

Incidence of falls, ODI, NDI, NRS, EQ-5D, TSK, medication use, perceived improvement, self-efficacy, satisfaction, strength, SPPB, accelerometry

Incidence of falls measured through proportions and limited statistical analysis:

• GR1: Proportion of falls ranged from 6 to 13%.

• GR2: Proportion of falls ranged from 10 to 13%.

• Between group differences at each measurement were reported as: p = 0.4 at 12 weeks, p = 0.4 at 24 weeks, p = 0.7 at 36 weeks, p = 0.8 at 52 weeks, p = 0.3 at 78 weeks.

Malaya 2020 (USA) [171]

Crossover (RCT)

24 (29.5)

Healthy adults (21–40), not pregnant, no major injury to the extremities, no previous surgery, no known neurological or systemic disease

GR1: Lower extremity manipulations on day 1 and upper extremity manipulations on day 2

GR2: Upper extremity manipulations on day 1 and lower extremity manipulations on day 2

Single intervention of nonspecific long-axis distractions to lower extremity (ankle, knee, and hip) or upper extremity (shoulder, elbow, and wrist)

–

–

Static postural assessment^d

• No significant changes in pathlength or range of sway for the floor surface condition at any sensor location after manipulation.

• Lower extremity manipulation affected sway dynamics of the trunk for the floor surface condition

• Significant results reported for the AP rocker board surface condition after upper extremity manipulation at the trunk sensor (path p < 0.05 main effect; range p < 0.05 interaction effect) and surface sensor (path p < 0.05 main effect)

• Significant main effect results reported for the AP rocker board surface condition after lower extremity manipulation at the trunk sensor (SampEn p < 0.05 interaction effect)

Malaya 2021 (USA) [172]

Crossover (RCT)

23 (27.4)

Healthy adults (21–35), not pregnant, no known musculoskeletal, neurologic or visual impairment

GR1: Lower extremity manipulations on day 1 and upper extremity manipulations on day 2

GR2: Upper extremity manipulations on day 1 and lower extremity manipulations on day 2

Single intervention of nonspecific long-axis distractions to lower extremity (ankle, knee, and hip) or upper extremity (shoulder, elbow, and wrist)

–

–

Static postural assessment⁴, COP

• Reduction in ML COP pathlength (p = 0.005) observed after both upper and lower extremity manipulation.

• No significant change observed for range or SampEn in either group.

Osterbauer, 1993 (USA) [173]

Case series

10 (38.0)

Adults with chronic, phase 1 SIJ syndrome

Spinal manipulation (mechanical force, manually assisted, short lever adjustments)

3x weekly, over 5 weeks, 1 year follow up as needed

–

–

Slow-walking gait symmetry¹, VAS, ODI

• No changes observed from baseline to study completion in gait symmetry or GRF.

Palmgren, 2009 (Sweden) [170]

Crossover (Time Series)

6 (34.67)

Healthy adults (28–45)

GR1: Facet nerve block then late SM to C5/C6

GR2: Early SM to C5/C6 then facet nerve block

Single manipulation/single nerve block

–

–

Posturography², Head positioning ^e

• No changes observed between subgroups in measures of posturography with eyes open or closed.

Robinson, 1987 (USA) [169]

SACT

9 (−-)

Adults (20–40), chronic LBP, unilateral decreased interarticular mobility of SI joint

Spinal manipulation of the sacroiliac joint

Single manipulation

–

–

Gait symmetry¹

• Gait symmetry data showed trends toward improvement between measures taken at baseline and study completion (χ² = 13.1).

Strunk, 2009 (USA) [166]

SACT

19 (70 median)

Adults (40+) with recurrent dizziness (self-reported) with neck pain

Multimodal chiropractic (SM, flexion distraction, soft tissue therapy, heat)

2x weekly, over 8 weeks (16 sessions total)

–

–

DHI, SF-BBS, NDI, FABQ

Descriptive statistics reported from baseline to study completion:

• Median change in DHI score of 7. 3 participants showed clinically significant improvements in DHI scores from baseline to visit 16. 4 additional participants improved scores.

• Mean change in SF-BBS score of 3 recorded from the 15 patients that performed SF-BBS. 7 of these patients showed a 4-point improvement from baseline to week 8.

Vining 2020 (USA) [46]

RCT

109 (30)

Active-duty military personnel with LBP

Multimodal chiropractic (clinical evaluation, HVLA SM, education, self-management advice)

Individualized frequency 4 week duration (mean 5.3 visits)

Wait-list control

4 week duration

Strength, single-leg balance with eyes open and eyes closed, endurance, VAS, RMDQ, PROMIS-29, FABQ

• Significant improvement in single-leg balance with eyes closed in chiropractic group.

• No significant improvement seen in single-leg balance with eyes open in chiropractic group (p = 0.43).

Ward 2013 (USA) [162]

RCT

11 (28.0)

Healthy adults (18–45), college students, no CMT on the study day

HVLA, superior ilium elongation

Single manipulation

No manipulation, participants with one short leg or no short legs

–

Gait variability, ^f joint angles, DS time, stance time

• No significant results to report.

• Minor trends seen in the treatment group from baseline to study completion with an identified right short leg: increases in step length and stride length, decreases in right hip angle, and changes in double support time.

Ward 2014 (USA) [163]

RCT

21 (25.0)

Healthy adults (18–45), college students, no CMT on the study day

HVLA, Bilateral SI join manipulation

Single manipulation

No manipulation, participants with one short leg or no short legs

–

Gait variability⁶, joint angles, DS time, stance time

• No changes observed from baseline to study completion in intervention group joint angles and gait parameters.