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Driehuis F.1, Hoogeboom T.J.1, Staal J.B.1,2, de Bie R.A.3, Nijhuis-van der Sanden M.W.G.1
1Radboud University Medical Center, Institute for Health Sciences, IQ Healthcare, Nijmegen, Netherlands, 2HAN University of Applied Sciences, Faculty of Health and Social Studies, Musculoskeletal Rehabilitation, Nijmegen, Netherlands, 3Maastricht University, Department of Epidemiology, Caphri Research School, Maastricht, Netherlands
Background: Currently, many infants ( 1 year), children (1-12 years), and adolescents (12-18 years) are being treated with manual therapy (MT). Internationally, MT is provided by healthcare professionals with different backgrounds, each with several conceptions towards underlying therapeutic rationale and treatment techniques. Previous research indicated questions towards safety, by showing that MT in infants and children could provoke adverse effects, mainly caused by high-velocity thrust manipulations. However, there is an extensive difference in manual therapeutic techniques between healthcare professionals, and a significant difference in treatment techniques between infants and children. Interestingly, therapeutic indications of infants, children and adolescents treated with manual therapy vary a lot; both musculoskeletal/biomechanical and non-musculoskeletal conditions are being treated. In conclusion, MT is being performed in children with various ages, by different healthcare professionals, and with many different approaches and indications. Until now, no study has investigated effectiveness and safety, classified by manual therapeutic approach.
Purpose: To summarize the evidence of spinal manual therapy in infants, children and adolescents in terms of therapeutic indications, interventions, hypothesized dysfunction and treatment outcomes.
Methods: The following databases were electronically searched up to October 2016: PubMed, Index to Chiropractic Literature, Medline, Embase, Cinahl, and Cochrane Library. Gray literature, books and clinical protocols/guidelines were searched using Google Scholar. Reference tracking was used to detect potential studies that were missed with the initial search strategy. Inclusion criteria for studies were: published after 1990 in English, German or Dutch language, described interventions of manual therapy, conducted in infants and/or children (0-18 years), and unique studies with original data. In order to limit studies with poor methodological quality, studies with a case series ( 10 participants) or case report design were excluded. Studies that met the inclusion criteria were screened on title and abstract by two authors (FD, TH).
Currently, the full text of each study are being analyzed to identify therapeutic indication of interest, hypothesized dysfunction, performed intervention, and treatment outcomes. In addition, the methodological quality of relevant studies will be assessed independently by two authors, using a quality measure instrument. Discrepancies in quality scores between authors will be discussed until consensus is reached.
Results: The results of this systematic review will be presented for the first time on the WCPT-congress 2017, and summarizes the evidence of spinal manual therapy in children (0-18 years). This study classifies treatment outcomes by therapeutic indication, hypothesized dysfunction, and provided therapeutic intervention. A distinction will be made between high-velocity thrust manipulation and mobilizations of the spine, and musculoskeletal and non-musculoskeletal indications. Adverse effects will be assigned to the specific therapeutic indication and intervention.
Conclusion(s): We will provide interesting new insights in the effectiveness and safety of manual therapy in infants, children and adolescents, highly relevant for clinical practice and scientific research.
Implications: Healthcare professionals and policymakers will be informed about effective and safe treatment techniques in pediatric manual therapy. To clarify the knowledge and evidence, and classifying it by therapeutic indication and intervention, manual therapy in infants, children and adolescents can be more effectively performed. Importantly, adverse effects can be prevented.
Funding acknowledgements: This study was funded by the Dutch Association of Manual Therapy (NVMT).
Topic: Paediatrics
Ethics approval: Ethical approval by the Dutch Central Committee of Research Involving Human Subjects (CCMO) was not required.
All authors, affiliations and abstracts have been published as submitted.
