Abstract
BackgroundStudies on effectiveness and safety of specific spinal manual therapy (SMT) techniques in children, which distinguish between age groups, are lacking.ObjectiveTo conduct a systematic review of the evidence for effectiveness and harms of specific SMT techniques for infants, children and adolescents.MethodsPubMed, Index to Chiropractic Literature, Embase, CINAHL and Cochrane Library were searched up to December 2017. Controlled studies, describing primary SMT treatment in infants (<1 year) and children/adolescents (1–18 years), were included to determine effectiveness. Controlled and observational studies and case reports were included to examine harms. One author screened titles and abstracts and two authors independently screened the full text of potentially eligible studies for inclusion. Two authors assessed risk of bias of included studies and quality of the body of evidence using the GRADE methodology. Data were described according to PRISMA guidelines and CONSORT and TIDieR checklists. If appropriate, random-effects meta-analysis was performed.ResultsOf the 1,236 identified studies, 26 studies were eligible. Infants and children/adolescents were treated for various (non-)musculoskeletal indications, hypothesized to be related to spinal joint dysfunction. Studies examining the same population, indication and treatment comparison were scarce. Due to very low quality evidence, it is uncertain whether gentle, low-velocity mobilizations reduce complaints in infants with colic or torticollis, and whether high-velocity, low-amplitude manipulations reduce complaints in children/adolescents with autism, asthma, nocturnal enuresis, headache or idiopathic scoliosis. Five case reports described severe harms after HVLA manipulations in four infants and one child. Mild, transient harms were reported after gentle spinal mobilizations in infants and children, and could be interpreted as side effect of treatment.ConclusionsBased on GRADE methodology, we found the evidence was of very low quality; this prevented us from drawing conclusions about the effectiveness of specific SMT techniques in infants, children and adolescents. Outcomes in the included studies were mostly parent or patient-reported; studies did not report on intermediate outcomes to assess the effectiveness of SMT techniques in relation to the hypothesized spinal dysfunction. Severe harms were relatively scarce, poorly described and likely to be associated with underlying missed pathology. Gentle, low-velocity spinal mobilizations seem to be a safe treatment technique in infants, children and adolescents. We encourage future research to describe effectiveness and safety of specific SMT techniques instead of SMT as a general treatment approach.
Highlights
Is manual therapy effective in reducing or resolving complaints or symptoms in infants, children or adolescents? Is it a safe therapeutic approach? Which specific manipulative techniques are performed? In the field of pediatric care, these questions raise interest of healthcare professionals, parents and other stakeholders
Studies on effectiveness and safety of specific spinal manual therapy (SMT) techniques in children, which distinguish between age groups, are lacking
Based on GRADE methodology, we found the evidence was of very low quality; this prevented us from drawing conclusions about the effectiveness of specific SMT techniques in infants, children and adolescents
Summary
Is manual therapy effective in reducing or resolving complaints or symptoms in infants, children or adolescents? Is it a safe therapeutic approach? Which specific manipulative techniques are performed? In the field of pediatric care, these questions raise interest of healthcare professionals, parents and other stakeholders. Manipulative therapeutic techniques differ between professionals and health conditions, and between infants and children/adolescents.[3,4,5,6,7] Distinctions in techniques are made between high-velocity, low-amplitude (HVLA) manipulations[8] and low-velocity mobilizations which can be performed to the full spine or to specific spinal segments. Infants and children are frequently treated for musculoskeletal conditions, such as movement related complaints,[9] or non-musculoskeletal conditions, including colic, otitis media and asthma.[1, 4, 10] Adolescents are mainly treated for musculoskeletal conditions, such as scoliosis and headache.[1, 2, 4, 10] Non-musculoskeletal conditions as treatment indication in children differs from manipulative treatment approaches in adults, which are mainly focused on musculoskeletal conditions, such as headache, neck pain and low back pain.[11,12,13,14,15,16]. Studies on effectiveness and safety of specific spinal manual therapy (SMT) techniques in children, which distinguish between age groups, are lacking
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
