What "CAM" we learn about the level of evidence from 60 years of research into manipulative and body-based therapies in sports and exercise medicine?

Abstract

Overview: Complementary and alternative medicine (CAM) is becoming increasingly accepted in modern western society, including amongst amateur and professional athletes, however, it has not yet been determined how CAM is reflected in scientific publications in sports and exercise medicine (SEM).

Aim: The aim of this study was to identify trends in the levels of evidence for manipulative and body-based therapies within the SEM literature.

Methods: The literature was systematically searched with no language restrictions in seven databases and retrieved articles were screened and classified according to their study design using the Oxford Centre for Evidence-Based Medicine system.

Results: From 6088 retrieved articles, 395 were retained for evaluation and these included 180 on massage, 96 on acupuncture and 95 on manipulation. The majority of the articles were published in English, with 88 in non-English languages. Level-1 evidence was available for acupuncture, manipulation, massage, and Pilates. From the nineteen-seventies onwards, a decreasing trend was observed for low evidence articles with a corresponding increasing trend for clinical trials. After the year 2000, over 50% of the published articles were clinical trials, RCTs or systematic reviews.

Conclusions: This review revealed an increase in the quantity and quality of published manipulative and body-based therapy articles in SEM over the last 60 years with the evidence level varying considerably between therapies. The timeframe associated with the development of evidence in CAM may reflect the move to provide scientific support for therapies previously justified primarily by anecdotal evidence, or traditional and cultural use.

Keywords: Complementary and alternative medicine; Evaluation report; Evidence-based practice; Levels of evidence; Sports and exercise medicine.