Abstract
IntroductionThe burden of musculoskeletal disorders increases every year, with low back and neck pain being the most frequently reported conditions for seeking manual therapy treatment. In recent years, manual therapy research has begun exploring the dose-response relationship between spinal manipulation treatment characteristics and both clinical and physiological response to treatment.ObjectiveThe purpose of this scoping review was to identify and appraise the current state of scientific knowledge regarding the effects of spinal manipulation frequency and dosage on both clinical and physiological responses.MethodsA scoping review was conducted to identify all available studies pertaining to our research question. Retrieved papers were screened using a 2-phase method, a selective sorting with titles and abstracts. Potentially relevant studies were read, and data was extracted for all included studies. Randomized control trials were assessed using the Cochrane Risk of Bias Tool for quality assessment.ResultsThe search yielded 4854 publications from which 32 were included for analysis. Results were sorted by dosage or frequency outcomes, and divided into human or animal studies. Animal studies mainly focused on dosage and evaluated physiological outcomes only. Studies investigating spinal manipulation dosage effects involved both human and animal research, and showed that varying thrust forces, or thrust durations can impact vertebral displacement, muscular response amplitude or muscle spindle activity. Risk of bias analysis indicated only two clinical trials assessing frequency effects presented a low risk of bias. Although trends in improvement were observed and indicated that increasing the number of SM visits in a short period of time (few weeks) decreased pain and improve disability, the differences between the studied treatment frequencies, were often not statistically significant and therefore not clinically meaningful.ConclusionThe results of this study showed that SM dosage and frequency effects have been mostly studied over the past two decades. Definitions for these two concepts however differ across studies. Overall, the results showed that treatment frequency does not significantly affect clinical outcomes during and following a SM treatment period. Dosage effects clearly influence short-term physiological responses to SM treatment, but relationships between these responses and clinical outcomes remains to be investigated.
Highlights
The burden of musculoskeletal disorders increases every year, with low back and neck pain being the most frequently reported conditions for seeking manual therapy treatment
Out of the 32 studies included for this scoping review, 22 were experimental studies, seven were randomized control trials (RCT), two were crossover studies, and one was a non-randomized control trial
All these studies were randomized control trials conducted on human participants with either cervicogenic headaches [16,17,18], chronic low back pain [14, 15] or lumbar spine stenosis [13], with the main outcomes being self-reported levels of pain and disability
Summary
The burden of musculoskeletal disorders increases every year, with low back and neck pain being the most frequently reported conditions for seeking manual therapy treatment. Several evidence-based practice guidelines for back and neck pain management have been published in the last decade [3,4,5,6] They clearly highlight the complex nature of back and neck pain clinical management while providing guidance and potential care pathways for patients-clinicians shared decision-making. Most of these recent guidelines are based on low to moderate evidence, the vast majority of them suggests that conservative treatments, including manual therapies, are effective options to treat acute, subacute, and chronic spinal disorders
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