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Saedt E.R.I.C.1, Driehuis F.2, Hoogeboom T.J.2, van der Woude B.H.1, de Bie R.A.3, Nijhuis-van der Sanden M.W.G.2
1European Workgroup for Manual Medicine, Arnhem, Netherlands, 2Radboud University Medical Center, Institute for Health Sciences, IQ Healthcare, Nijmegen, Netherlands, 3Maastricht University, Department of Epidemiology, Caphri Research School, Maastricht, Netherlands
Background: Many infants are being treated by manual therapists (MTs). Between 2006 and 2015, almost 75,000 infants were registered for manual therapeutic treatment in the Netherlands. In the current treatment of infants, only spinal mobilization techniques are applied, where high-velocity thrust manipulation is avoided due to the risk of adverse effects. Although a large number of infants are referred for manual therapy yearly, the therapeutic procedure and process of clinical reasoning in common practice are still scarcely described.
Purpose: To describe common practice of manual therapists in infants with assumptive upper cervical dysfunction, in the Netherlands.
Methods: A prospective observational cohort study sampled between 2006 and 2007, was used to get insight in patient characteristics and outcomes in infants ( 27 weeks) referred to MTs for positional preference of the head (PP), assumed to be caused by an upper cervical dysfunction. Data was collected by two descriptive questionnaires; one for parents, and one for MTs. Parents and MTs completed the questionnaire separately, and were blinded for each others answers. Each questionnaire consisted of two parts: one pre-treatment-part, and one post-treatment-part. Before treatment, parents reported information about infant demographics and symptoms, and about pregnancy and delivery. MTs described their diagnostic process by reporting observations of posture and movement, and pre-treatment measurements. After the last treatment session, parents were requested to complete the second part of the questionnaire to evaluate infants current health status and perceived treatment effect, using the GPE on PP and VAS on symptom reduction. MTs completed their questionnaire concerning post-treatment measurements, outcomes, treatment techniques, number of treatment sessions, and secondary effects.
Results: Data of 307 infants (mean age: 11.2 weeks) were collected by parents and MTs. Most frequent reasons for seeking care were PP, restlessness and/or abnormal head position. MTs observed active, spontaneous and provoked mobility. Passive upper cervical mobility was examined using the Flexion-Rotation-Test (FRT) and the Lateral-Flexion-Test (LFT). Based on outcomes of the FRT and/or LFT, 295 infants (96.1%) showed restricted upper cervical mobility, and were diagnosed with upper cervical dysfunction. After treatment with gentle mobilization techniques of the upper spine, restricted upper cervical mobility was reduced. Positive scores on the FRT decreased from 80.6% to 7.3% in infants with PP, and from 64.7% to 2.9% in infants without observed PP. For the LFT, the decrease was 92.7% to 6.6%, and 82.4% to 2.9%, respectively. All parents perceived positive treatment effects and symptom reduction. The greatest effect was perceived after 1.8 treatment session. No adverse effects were reported.
Conclusion(s): This is the first study which describes common clinical practice of infants referred for manual therapy in the Netherlands. Infants with PP and upper cervical dysfunction were mainly treated with upper cervical mobilization techniques, without adverse effects. To examine reliability of the diagnostic tests the FRT and LFT, and to investigate effectiveness of manual therapy in infants with PP and assumptive upper cervical dysfunction, further research is necessary.
Implications: This study clarifies common practice of manual therapy in infants, and describes treated infants. Future research is recommended.
Funding acknowledgements: This study was funded by two of the authors (ES, BW).
Topic: Musculoskeletal: spine
Ethics approval: The study was approved by the Dutch Central Committee of Research Involving Human Subjects (CCMO: dd. March 15, 2007).
All authors, affiliations and abstracts have been published as submitted.
