SPINAL MANIPULATION AND MOBILISATION IN THE TREATMENT OF INFANTS, CHILDREN, AND ADOLESCENTS: A SYSTEMATIC SCOPING REVIEW

N. Milne¹, L. Longeri¹, A. Patel¹, J. Pool², K. Olson³, A. Basson⁴, A. Gross⁵

¹Bond University, Physiotherapy Department, Gold Coast, Australia, ²Utrecht University of Applied Sciences, Research Group Lifestyle and Health, Institute of Human Movement Studies, Utrecht, Netherlands, ³International Federation of Orthopaedic Manipulative Physical Therapy, Northern Rehab Physical Therapy Specialists, DeKalb, United States, ⁴University of Witwatersrand, Physiotherapy Department, Johannesburg, South Africa, ⁵McMaster University, Physiotherapy Department, Hamilton, Canada

Background: Various healthcare professionals utilise manual therapy including spinal manipulation and or mobilisation as a treatment modality for musculoskeletal and non-musculoskeletal conditions. These treatment modalities are being utilised to treat paediatric clients, including infants, young children and adolescents with a variety of acute and chronic conditions. There is great controversy regarding the safety and efficacy of spinal manipulation in paediatric populations. This systematic scoping review was planned as a joint investigation by the International Federation of Orthopaedic Manipulative Physical Therapists [IFOMPT] and International Organisation of Physiotherapists in Paediatrics [IOPTP] to inform future position statements on this clinical practice topic and guide more focused research investigations if warranted.

Purpose: To
i) identify and map the available evidence regarding effectiveness and harms of spinal manipulation and mobilisation for infants, children and adolescents with a broad range of conditions;
ii) identify and synthesise policies, regulations, position statements and practice guidelines informing their clinical use.

Methods: A systematic scoping review was undertaken according to the PRISMA extension for scoping reviews (PRISMA-ScR), applying a levels-of-evidence approach, and utilising four electronic databases (PubMed, Embase, CINHAL and Cochrane) and grey literature via Google from root to 4th February 2021.

Results: Eighty-seven articles were included. Methodological quality of articles varied. Spinal manipulation and mobilisation are being utilised clinically by a variety of health professionals to manage paediatric populations with adolescent idiopathic scoliosis (AIS), asthma, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), back/neck pain, breastfeeding difficulties, cerebral palsy (CP), dysfunctional voiding, excessive crying, headaches, infantile colic, kinetic imbalances due to suboccipital strain (KISS), nocturnal enuresis, otitis media, torticollis and plagiocephaly. The descriptive synthesis revealed: no evidence to explicitly support the effectiveness of spinal manipulation or mobilisation for any condition in paediatric populations. Mild transient symptoms were commonly described in randomised controlled trials and on occasion, moderate-to-severe adverse events were reported. There was strong to very strong evidence for ‘no significant effect’ of spinal manipulation for managing asthma (pulmonary function), headache and nocturnal enuresis, and inconclusive or insufficient evidence for all other conditions explored. There is insufficient evidence to draw conclusions regarding spinal mobilisation to treat paediatric populations with any condition.

Conclusions: Whilst some individual high-quality studies demonstrate positive results for some conditions, our descriptive synthesis revealed no evidence to support the effectiveness of spinal manipulation or mobilisation in paediatric populations for any condition. Increased reporting of adverse events is required to determine true risks. Randomised controlled trials examining effectiveness of spinal manipulation and mobilisation in paediatric populations are warranted.

Implications: The results from this large systematic scoping review, provide the physiotherapy profession with a descriptive synthesis of all available high-quality evidence regarding the use of spinal manipulation and mobilisation to treat a variety of musculoskeletal and non-musculoskeletal conditions. These findings provide critical information which can be utilised in World Physiotherapy subgroup position statements on this topic.

Funding acknowledgements: No funding was obtained to support this research being undertaken.

Keywords:
Paediatric
Spinal
Manipulation

Topics:
Paediatrics
Musculoskeletal: spine

Did this work require ethics approval? No

Reason: This abstract provides the methods and results from a Systematic Scoping Review.