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C O M M E N T A R Y Open Access
A united statement of the global
chiropractic research community against
the pseudoscientific claim that chiropractic
care boosts immunity
Pierre Côté
1,2,3*
, André Bussières
4,5
, J. David Cassidy
3
, Jan Hartvigsen
6,7
, Greg N. Kawchuk
8
, Charlotte Leboeuf-Yde
9
,
Silvano Mior
2,10
, Michael Schneider
11,12
and and more than 140 signatories# call for an end to pseudoscientific
claims on the effect of chiropractic care on immune function
Abstract
Background: In the midst of the coronavirus pandemic, the International Chiropractors Association (ICA) posted
reports claiming that chiropractic care can impact the immune system. These claims clash with recommendations
from the World Health Organization and World Federation of Chiropractic. We discuss the scientific validity of the
claims made in these ICA reports.
Main body: We reviewed the two reports posted by the ICA on their website on March 20 and March 28, 2020.
We explored the method used to develop the claim that chiropractic adjustments impact the immune system and
discuss the scientific merit of that claim. We provide a response to the ICA reports and explain why this claim lacks
scientific credibility and is dangerous to the public. More than 150 researchers from 11 countries reviewed and
endorsed our response.
Conclusion: In their reports, the ICA provided no valid clinical scientific evidence that chiropractic care can impact
the immune system. We call on regulatory authorities and professional leaders to take robust political and
regulatory action against those claiming that chiropractic adjustments have a clinical impact on the immune
system.
Keywords: Chiropractic, Spinal manipulation, Immunity, Pseudoscience, Coronavirus
Background
We are currently facing the greatest global public health
crisis in a century. Fighting the coronavirus pandemic
has required that we change the way we live and observe
strict public health guidelines. This is necessary because,
at this time, there are no effective vaccines, treatments
or cures for COVID-19 [1,2]. Chiropractors, as mem-
bers of the health care system, should disseminate the
best available public health information to the public [3].
Any attempt to behave otherwise can be misleading and
potentially dangerous to individual patients and the pub-
lic at large.
On March 20, 2020, the International Chiropractors
Association (ICA), a US based chiropractic organization,
posted a report claiming that chiropractic adjustments
can boost immune function with the implication that it
might be helpful in preventing COVID-19 [4]. In their
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data made available in this article, unless otherwise stated in a credit line to the data.
* Correspondence: pierre.cote@uoit.ca
1
Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
2
Centre for Disability Prevention and Rehabilitation at Ontario Tech
University and CMCC, Oshawa, Canada
Full list of author information is available at the end of the article
Côté et al. Chiropractic & Manual Therapies (2020) 28:21
https://doi.org/10.1186/s12998-020-00312-x
report, the ICA states that: “Although there are no clin-
ical trials to substantiate a direct causal relationship be-
tween the chiropractic adjustment and increased
protection from the COVID-19 virus, there is a growing
body of evidence that there is a relationship between the
nervous system and the immune system”and “The obser-
vation that those who use chiropractic regularly and do
not become ill with cold, flu, or other community shared
illnesses is frequent within the profession and should not
be ignored”[4]. The ICA position directly contradicts
the World Health Organization (WHO) that unequivo-
cally states that “there are no effective health interven-
tions to prevent or treat coronavirus infections”[1,2],
and the World Federation of Chiropractic (WFC) that
states that “there is no credible scientific evidence that
chiropractic spinal adjustments/manipulations confers or
boosts immunity”[3].
On March 28, 2020, the ICA posted a revised report
which reiterated the information included in the first re-
port, with the addition of references supporting the link
between chiropractic care and immune function [5]. In
both reports, the ICA claims that their review of the lit-
erature confirms “An association between spinal ma-
nipulation and the autonomic nervous system”and that
“These studies suggest mechanisms by which spinal influ-
ences may mediate a clinically significant impact on im-
mune function.”Therefore, the main message of both
reports is that chiropractic care can have a clinically
meaningful impact on immune system function. We dis-
cuss the scientific validity of the claims made by the
ICA.
Main body
We investigated the approach used by the ICA to sup-
port their claim that chiropractic adjustments impact
the immune system. We compared the ICA claim to the
findings and conclusions of one systematic review of the
literature on the effect of spinal manual therapies on
autonomic nervous system activity [6] and two system-
atic reviews on the efficacy and effectiveness of chiro-
practic treatment and manual therapy on the prevention
and treatment of non-musculoskeletal disorders [7,8].
Further, we used a list of warning signs of pseudoscience
to assess the scientific merit of the claims [9]. Finally,
153 researchers from 11 countries (8 co-authors and 145
signatories) who are involved in research relevant to
chiropractic reviewed and endorsed our response.
While the ICA states “that no claims can be made
about COVID-19 and chiropractic”,their report implies
that chiropractic adjustments can boost the immune sys-
tem through its effect on the nervous system. The ICA
claim rests on two assumptions: i) chiropractic adjust-
ments have a beneficial effect on the nervous system and
ii) chiropractic adjustments will improve the immune
system through the nervous system. These assumptions
are not supported by robust evidence that chiropractic
adjustments are efficacious or effective in improving im-
mune function [6–8]. We consider that proclaiming the
benefits of chiropractic adjustment/spinal manipulation
on immunity during a pandemic is plainly irresponsible
and demonstrates a lack of understanding of science, the
coronavirus pandemic and public health risks.
Our critical review of the reports suggest that the ICA
created a positive narrative for the effect of chiropractic
adjustments and immune function report by selectively
assembling a series of unconnected basic science studies
[4,5]. This strategy, called “emphasis on confirmation”,
is a warning sign of pseudoscience [9]. Moreover, this
approach fails to respect the established boundaries that
exist between basic and clinical research. For example,
two of the basic science studies included in the ICA re-
port were led by one of the signatories of this commen-
tary, Stephen Injeyan DC, PhD [10,11]. According to
Dr. Injeyan: “No published studies have so far demon-
strated the clinical significance of spinal manipulation
and immune enhancement, our research included. Our
studies were conducted in asymptomatic subjects, in vitro
cellular models, and the outcomes were measured shortly
following SMT. There are no parallels between our ex-
perimental research and clinical care.”By only citing
basic science experiments, the ICA appear to have over-
looked the WHO guidance on implementation research,
which clearly states that basic science experiments do
not provide relevant justification for implementation of
a health intervention [12].
Any health care intervention must be evaluated for its
clinical efficacy and effectiveness in well-designed ran-
domized controlled trials before it is implemented in
clinical practice [12]. This requirement is not new; it
was first implemented by the US Food and Drug Admin-
istration in 1962 [13]. With this in mind, it is all the
more noteworthy that none of the studies cited in the
ICA report provide evidence that chiropractic adjust-
ments actually prevent the onset of infectious diseases
in healthy individuals, or improve the health of pa-
tients suffering from a viral infection. We call on the
ICA to explain why it does not adhere to internation-
ally accepted standards of research implementation
but instead rely on unconnected basic science studies
when linking chiropractic care to immune system
function.
The ICA also relied on anecdotal evidence to support
their claim; this is another warning sign of pseudo-
science [9]. For example, the authors state: “The observa-
tion that those who use chiropractic regularly and do not
become ill with colds, flu, and other community shared
illnesses is frequent within the profession and should not
be ignored”[4,5]. At best, this type of anecdotal
Côté et al. Chiropractic & Manual Therapies (2020) 28:21 Page 2 of 5
evidence is useful to generate research hypotheses to be
tested in high quality randomized clinical trials. To our
knowledge, the hypothesis that chiropractic care reduces
the risk of becoming ill with viral colds, flu, and other
community shared illnesses has never been properly
tested. Any claims suggesting otherwise lack scientific
merit and should not be used to justify treating patients
with chiropractic adjustments.
Advancing extraordinary claims without providing
extraordinary evidence should raise significant con-
cerns about the scientific validity of the ICA’s
position. In their reports, the ICA claims that indi-
viduals who received chiropractic care during the
1918 Spanish flu pandemic were 51 to 91 times less
likely to die than those who were treated by medical
doctors [4,5]. These effect sizes are too large to be
trustworthy and are a red flag of pseudoscience, be-
cause extraordinary claims require extraordinary evi-
dence [9]. Using data from a 100-year-old non-
published, non-randomized controlled trial to
suggest that chiropractic adjustments reduces mor-
tality from the flu is scientifically and socially
irresponsible.
Pseudoscience has the potential to mislead and mis-
inform at any time; even more so in the midst of a
pandemic when the public is vulnerable. The current
coronavirus pandemic demands that we act respon-
sibly by adopting sound public health practices as
recommended by the WHO [14]. These include but
are not restricted to regular handwashing, respiratory
etiquette, physical distancing, staying at home, limit-
ing trips outside the home except to obtain food or
medicine and wearing a mask if symptomatic [14].
We have seen widespread adherence to the guidance
around COVID-19, but as scientists and clinicians we
have a public health duty to sound the alarm and de-
nounce pseudoscientific claims such as the ones made
by the ICA in its reports.
Conclusion
We call on regulatory authorities and professional
leaders to take appropriate political and regulatory ac-
tion against those making direct or indirect unsubstanti-
ated claims that spinal adjustments can boost immunity,
or benefit patients with infectious diseases, especially
coronavirus infections. Above all, these actions must aim
to protect the safety and well-being of patients and the
public.
Abbreviations
FDA: Food and Drug Administration; ICA: International Chiropractors
Association; WHO: World Health Organization; WFC: World Federation of
Chiropractic
Acknowledgements
Not applicable.
#SIGNATORIES
The views and opinions expressed herein are those solely of the authors and
may not represent the views of their institution.
1. Luc Aillet, Private practice, Ghent, Belgium
2. Carlo Ammendolia, University of Toronto, Toronto, Canada
3. Bodil Arnbak, University of Southern Denmark, Odense, Denmark
4. Iben Axen, Karolinska Institute, Stockholm, Sweden
5. Mirjam Baechler; University of Zurich, Zurich, Switzerland
6. Florian Barbier-Cazorla, Institut Franco-Européen de Chiropraxie, Ivry-sur-
Seine, France
7. Gaëtan Barbier, Institut Franco-Européen de Chiropraxie, Toulouse, France
8. Cecilia Bergstrøm, Umeå University, Umeå, Sweden
9. Amber Beynon, Murdoch University, Perth, Australia
10. Marc-André Blanchette, Université du Québec à Trois-Rivières, Trois-
Rivières, Canada
11. Philip S Bolton, University of Newcastle, Callaghan, Australia
12. Alan Breen, AECC University College, Bournemouth, UK
13. Johanne Brinch, University of Southern Denmark and Spine Center of
Southern Denmark, Odense, Denmark
14. Gert Bronfort, University of Minnesota, Minneapolis, USA
15. Benjamin Brown, Macquarie University, Sydney, Australia
16. Paul Bruno, University of Regina, Regina, Canada
17. Mikkel Brunsgaard Konner, University of Southern Denmark and Spine
Center of Southern Denmark, Odense, Denmark
18. Christopher Burrell, Macquarie University, Sydney, Australia
19. Jason W. Busse, McMaster University, Hamilton, Canada
20. David Byfield, Welsh Institute of Chiropractic University of South Wales
Pontypridd, Wales UK
21. Marco Campello, NYU Robert I Grossman School of Medicine. New York, USA.
22. Carol Cancelliere, Ontario Tech University, Oshawa, Canada
23. Linda Carroll, University of Alberta, Edmonton, Canada
24. Christine Cedraschi, University of Geneva, Geneva, Switzerland
25. Charlène Chéron, French Chiropractic Association, Paris, France
26. Ngai Chow, Canadian Memorial Chiropractic College, Toronto, Canada
27. Henrik Wulff Christensen, Nordic Institute of Chiropractic and Clinical
Biomechanics, Odense, Denmark
28. Stine Claussen, University of Southern Denmark, Odense, Denmark
29. Melissa Corso, Ontario Tech University, Oshawa, Canada
30. Matthew A. Davis, University of Michigan Medical School, Ann Arbour, USA
31. Marine Demortier, Institut Franco-Européen de Chiropraxie, Ivry-sur-Seine,
France
32. Martin Descarreaux, Université du Québec à Trois-Rivières, Trois-Rivières,
Canada
33. Diana De Carvalho, Memorial University of Newfoundland, St. John’s, Canada
34. Katie de Luca, Macquarie University, Sydney, Australia
35. Annemarie de Zoete, Vrije University, Amsterdam, The Netherlands
36. Klaus Doktor, University of Southern Denmark, Odense, Denmark
37. Aron Downie, Macquarie University, Sydney, Australia
38. Alister du Rose, AECC University College, Bournemouth, UK
39. Andreas Eklund, Karolinska Institute, Stockholm, Sweden
40. Roger Engel, Macquarie University, Sydney, Australia
41. Mark Erwin, University of Toronto, Toronto, Canada
42. James E. Eubanks, University of Pittsburgh, Pittsburgh, USA
43. Roni Evans, University of Minnesota, Minneapolis, USA
44. Will Evans, Mississippi State University, Mississippi State, USA
45. Matthew Fernandez, Macquarie University, Sydney, Australia
46. Jonathan Field, University of Southampton, Southampton, UK 47. Gilles
Fournier, Parker Institute, Copenhagen University Hospital at Bispebjerg and
Frederiksberg, Denmark
48. Simon French, Macquarie University, Sydney, Australia
49. Signe Fuglkjaer, Private practice, Odense, Denmark
50. Olivier Gagey, University of Paris-Saclay, Orsay, France
51. Rosemary Giuriato, Macquarie University, Sydney, Australia
52. Jordan A. Gliedt, Medical College of Wisconsin, Milwaukee, USA
53. Christine Goertz, Duke University School of Medicine, Durham, USA
54. Guillaume Goncalves, Institut Franco-Européen de Chiropraxie, Ivry-sur-
Seine, France
55. Diane Grondin, Canadian Memorial Chiropractic College, Toronto, Canada
56. Mark Gurden, Royal College of Chiropractors, Reading, UK
57. Mitchell Haas, University of Minnesota, Minneapolis, USA
58. Scott Haldeman, World Spine Care, Los Angeles, USA
Côté et al. Chiropractic & Manual Therapies (2020) 28:21 Page 3 of 5
59. Steen Harsted, University of Southern Denmark, Odense, Denmark
60. Lisbeth Hartvigsen, Private Practice, Odense, Denmark
61. Jill Hayden, Dalhousie University, Halifax, Canada
62. Cesar Hincapié, University of Zurich, Zurich, Switzerland
63. Jeffrey J. Hébert, University of New Brunswick, Fredericton, Canada
64. Bue Hesby, University of Southern Denmark, Odense, Denmark
65. Lise Hestbæk, University of Southern Denmark and Nordic Institute of
Chiropractic and Clinical Biomechanics, Odense, Denmark
66. Sheilah Hogg-Johnson, Canadian Memorial Chiropractic College, Toronto,
Canada
67. Maria A. Hondras, University of Kansas Medical Center, Kansas City, USA
68. Margaux Honoré, Institut Franco-Européen de Chiropraxie, Ivry-sur-Seine,
France
69. Samuel Howarth, Canadian Memorial Chiropractic College, Toronto,
Canada
70. H. Stephen Injeyan, Canadian Memorial Chiropractic College, Toronto,
Canada
71. Stanley Innes, Murdoch University, Perth, Australia
72. Pernille Marie Irgens, University of Oslo, Oslo, Norway
73. Craig Jacobs, Canadian Memorial Chiropractic College, Toronto, Canada
74. Hazel Jenkins, Macquarie University, Sydney, Australia
75. Alan Jenks, Vrije University, Amsterdam, The Netherlands
76. Tue Secher Jensen, University of Southern Denmark and Silkeborg
Regional Hospital, Odense, Denmark
77. Melker Johhansson, University of Southern Denmark, Odense, Denmark
78. Alice Kongsted, University of Southern Denmark and Nordic Institute of
Chiropractic and Clinical Biomechanics, Odense, Denmark
79. Deborah Kopansky-Giles, Canadian Memorial Chiropractic College,
Toronto, Canada
80. Rikke Kryger, University of Southern Denmark and Nordic Institute of
Chiropractic and Clinical Biomechanics, Odense, Denmark
81. Arnaud Lardon, Institut Franco-Européen de Chiropraxie, Ivry-sur-Seine,
France
82. Henrik Hein Lauridsen, University of Southern Denmark, Odense, Denmark
83. Brent Leininger, University of Minnesota, Minneapolis, USA
84. Nadège Lemeunier, Institut Franco-Européen de Chiropraxie, Toulouse,
France
85. Christine Le Scanff, Université Paris-Saclay, Orsay, France
86. Eugene A. Lewis, Duke University School of Medicine, Durham, USA
87. Kathleen Linaker, Western Technical College, La Crosse, USA
88. Lise Lothe, Private Practice, Grimstad, Norway
89. Andrée-Anne Marchand, Université du Québec à Trois-Rivières, Trois-
Rivières, Canada
90. David McNaughton, Macquarie University, Sydney, Australia
91. Anne-Laure Meyer, Institut Franco-Européen de Chiropraxie, Ivry-sur-
Seine, France
92. Peter Miller, AECC University College, Bournemouth, England
93. Anne Mølgaard, University of Southern Denmark, Odense, Denmark
94. Craig Moore, Macquarie University, Sydney, Australia
95. Donald R. Murphy, Brown University, Providence, USA
96. Corrie Myburgh, University of Southern Denmark, Odense, Denmark
97. Birgitte Myhrvold, University of Oslo, Oslo, Norway
98. Dave Newell, AECC University College, Bournemouth, UK 99. Genevieve
Newton, University of Guelph, Guelph, Canada
100. Casper Nim, University of Southern Denmark and Spine Center of
Southern Denmark, Odense, Denmark
101. Margareta Nordin, New York University, New York, USA
102. Luana Nyiro, University of Zurich, Zurich, Switzerland
103. Søren O'Neill, University of Southern Denmark and Spine Center of
Southern Denmark, Odense, Denmark
104. Cecilie Øverås, University of Southern Ddenmark, Odense, Denmark
105. Isabelle Pagé, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
106. Mégane Pasquier, Institut Franco-Européen de Chiropraxie, Toulouse,
France
107. Charles W. Penza, Miami Veterans Administration Medical Center, Miami,
USA
108. Stephen M. Perle, University of Bridgeport, Bridgeport, USA
109. Mathieu Picchiottino, Institut Franco-Européen de Chiropraxie, Ivry-sur-
Seine, France
110. Mathieu Piché, Université du Québec à Trois-Rivières, Trois-Rivières,
Canada
111. Erik Poulsen, University of Southern Denmark, Odense, Denmark
112. Jeffrey Quon, University of British Columbia, Vancouver, Canada
113. Tim Raven, University of Oslo, Oslo, Norway
114. Mana Rezai, Centre for Disability Prevention and Rehabilitation at
Ontario Tech University and CMCC Toronto, Canada
115. Eric J. Roseen, Boston University School of Medicine, Boston, MA, USA
116. Sidney Rubinstein, Vrije University, Amsterdam, The Netherlands
117. Louis-Rachid Salmi, Université de Bordeaux, Inserm and CHU de
Bordeaux, France
118. Petra Schweinhardt, University of Zurich, Zurich, Switzerland
119. Heather M. Shearer, University of Toronto, Toronto, Canada
120. Laura Sirucek, University of Zurich, Zurich, Switzerland
121. Delphine Sorondo, Institut Franco-Européen de Chiropraxie, Toulouse,
France
122. Paula J. Stern, Canadian Memorial Chiropractic College, Toronto, Canada
123. Joel Stevans, University of Pittsburgh, Pittsburgh, USA
124. Mette Jensen Stochkendahl, University of Southern Denmark and Nordic
Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
125. Kent Stuber, Canadian Memorial Chiropractic College, Toronto, Canada
126. Maja Stupar, Canadian Memorial Chiropractic College, Toronto, Canada
127. John Srbely, University of Guelph, Guelph, Canada
128. Michael Swain, Macquarie University, Sydney, Australia
129. Julita Teodorczyk-Injeyan, Canadian Memorial Chiropractic College,
Toronto, Canada
130. Jean Théroux, Murdoch University, Perth, Australia
131. Haymo Thiel, AECC University College, Bournemouth, UK
132. Lars Uhrenholt, University of Aarhus, Aarhus, Denmark
133. Anneke Verbeek, Private practice, Ghent, Belgium
134. Leslie Verville, Ontario Tech University, Oshawa, Canada
135. Karl Vincent, Institut Franco-Européen de Chiropraxie, Ivry-sur-Seine,
France
136. Andrew L. Vitiello, CQUniversity, Sydney, Australia
137. Dan Wang, Ontario Tech University, Oshawa, Canada
138. Kenneth A. Weber, Stanford University School of Medicine, Palo Alto, USA
139. James M. Whedon, Southern California University of Health Sciences,
Whittier, USA
140. Jessica Wong, University of Toronto, Toronto, Canada
141. Francesca Wuytack, Trinity College, Dublin, Ireland
142. James Young, University of Southern Denmark, Odense, Denmark
143. Hainan Yu, Ontario Tech University, Oshawa, Canada
144. Dorte Ziegler, University of Southern Denmark and Spine Center of
Southern Denmark, Odense, Denmark
145. Kristina Boe Dissing, University of Southern Denmark, Odense, Denmark
Authors’contributions
All authors (Pierre Côté, André Bussières, J. David Cassidy, Jan Hartvigsen,
Greg Kawchuk, Charlotte Leboeuf-Yde, Silvano Mior, Mike Schneider) devel-
oped, wrote, edited and proofread the commentary. All signatories reviewed
the commentary and endorsed its content. The author(s) read and approved
the final manuscript.
Funding
No funding was obtained for this commentary.
Availability of data and materials
Not applicable.
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
PC reports research grants unrelated to this work from Aviva Canada,
Canadian Institutes of Health Research-Canada Research Chair Program, Can-
adian chiropractic Association, Canadian Chiropractic Research Foundation,
College of Chiropractors of British Columbia, Et liv i bevegelse”(ELIB), French
Chiropractic Association, Financial Services Commission of Ontario, Ontario
Ministry of Finance, Ontario Trillium Foundation; travel expenditures unre-
lated to this work from Griffith University - Whiplash Symposium 2017,
Côté et al. Chiropractic & Manual Therapies (2020) 28:21 Page 4 of 5
Eurospine, Southern Denmark University, Institut Franco-Europeen de Chiro-
praxie, Karolinska Institutet, North American Spine Society, University of
Quebec-Trois-Rivieres, University of Zurich, World Federation of Chiropractic;
fees medical-legal expertise from the Canadian Chiropractic Protective Asso-
ciation. He is the Chair of the World Federation of Chiropractic Research Dis-
ability and Rehabilitation Committee. AB reports research grants unrelated to
this work from University of Quebec-Trois-Rivieres, McGill University, Centre
de recherche interdisciplinaire en réadaptation du Montréal métropolitain,
Canadian Institutes of Health Research; fees medical-legal expertise from the
Canadian Chiropractic Protective Association. GNK reports active research
grants unrelated to this work from The Natural Sciences and Engineering Re-
search, The National Institutes of Health, The Alberta Spine Foundation, The
American Orthotic and Prosthetic Association, The New Frontiers in Research
Fund and the Canadian Chiropractic Research Foundation. Travel expendi-
tures unrelated to this work in the past year include Kiropraktik i Sverige Live,
Et liv i bevegelse”(ELIB), the Nordic Institute of Chiropractic and Clinical Bio-
mechanics, The American Chiropractic Association, The National Institutes of
Health, The British Columbia Chiropractic Association, and The World Feder-
ation of Chiropractic. He is the Chair of the World Federation of Chiropractic
Research Council. Fees for medical-legal expertise unrelated to this work
from the Canadian Chiropractic Protective Association. JH reports that he
holds multiple research grants from Danish and international funding agen-
cies and charities. He has received coverage of travel expenditures from mul-
tiple sources internationally in connection with speaking engagements.
Within the past year he has received speaking fees from Parker Seminars and
Novartis. He is member of the World Federation of Chiropractic Research
Council. SM reports research grants unrelated to this work from Ontario
Chiropractic Association, Canadian Chiropractic Association, and Canadian
Spinal Research Foundation. MS reports support from research grants unre-
lated to this work from the National Institutes of Health, Patient Centered
Outcomes Research Institute, University of Pittsburgh and NCMIC Founda-
tion; honoraria from NCMIC speaker’s bureau; fees from medico-legal con-
sulting services. JDC and CLY declare that they have no competing interests.
Author details
1
Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada.
2
Centre for Disability Prevention and Rehabilitation at Ontario Tech
University and CMCC, Oshawa, Canada.
3
Division of Epidemiology, Dalla Lana
School of Public Health, University of Toronto, Toronto, Canada.
4
Département chiropratique, Université du Québec à Trois-Rivières,
Trois-Rivières, Canada.
5
School of Physical and Occupational Therapy, Faculty
of Medicine McGill University, Montreal, Canada.
6
Department of Sports
Science and Clinical Biomechanics, University of Southern Denmark, Odense,
Denmark.
7
Nordic Institute of Chiropractic and Clinical Biomechanics,
Odense, Denmark.
8
Faculty of Rehabilitation Medicine, University of Alberta,
Edmonton, Canada.
9
Institute for Regional Health Research, University of
Southern Denmark, Odense, Denmark.
10
Canadian Memorial Chiropractic
College, Toronto, Canada.
11
School of Health and Rehabilitation Sciences,
University of Pittsburgh, Pittsburgh, USA.
12
Clinical and Translational Science
Institute, University of Pittsburgh, Pittsburgh, USA.
Received: 6 April 2020 Accepted: 15 April 2020
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