Manual therapy for the pediatric population: a systematic review

Abstract

BackgroundThis systematic review evaluates the use of manual therapy for clinical conditions in the pediatric population, assesses the methodological quality of the studies found, and synthesizes findings based on health condition. We also assessed the reporting of adverse events within the included studies and compared our conclusions to those of the UK Update report.MethodsSix databases were searched using the following inclusion criteria: children under the age of 18 years old; treatment using manual therapy; any type of healthcare profession; published between 2001 and March 31, 2018; and English. Case reports were excluded from our study. Reference tracking was performed on six published relevant systematic reviews to find any missed article. Each study that met the inclusion criteria was screened by two authors to: (i) determine its suitability for inclusion, (ii) extract data, and (iii) assess quality of study.ResultsOf the 3563 articles identified, 165 full articles were screened, and 50 studies met the inclusion criteria. Twenty-six articles were included in prior reviews with 24 new studies identified. Eighteen studies were judged to be of high quality. Conditions evaluated were: attention deficit hyperactivity disorder (ADHD), autism, asthma, cerebral palsy, clubfoot, constipation, cranial asymmetry, cuboid syndrome, headache, infantile colic, low back pain, obstructive apnea, otitis media, pediatric dysfunctional voiding, pediatric nocturnal enuresis, postural asymmetry, preterm infants, pulled elbow, suboptimal infant breastfeeding, scoliosis, suboptimal infant breastfeeding, temporomandibular dysfunction, torticollis, and upper cervical dysfunction. Musculoskeletal conditions, including low back pain and headache, were evaluated in seven studies. Twenty studies reported adverse events, which were transient and mild to moderate in severity.ConclusionsFifty studies investigated the clinical effects of manual therapies for a wide variety of pediatric conditions. Moderate-positive overall assessment was found for 3 conditions: low back pain, pulled elbow, and premature infants. Inconclusive unfavorable outcomes were found for 2 conditions: scoliosis (OMT) and torticollis (MT). All other condition’s overall assessments were either inconclusive favorable or unclear. Adverse events were uncommonly reported. More robust clinical trials in this area of healthcare are needed.Trial registrationPROSPERA registration number: CRD42018091835

The global summit on the efficacy and effectiveness of spinal manipulative therapy for the prevention and treatment of non-musculoskeletal disorders: a systematic review of the literature

“…However, given the methodological limitations to studies included [ …] we consider these results to be preliminary” [ 91 ]. Finally, Parnell Prevost et al reviewed and critically appraised 50 studies of various designs dealing with manual therapy for a wide variety of pediatric conditions and concluded that the evidence was inconclusive but favorable for some non-musculoskeletal disorders including infantile colic (4 RCTs included), nocturnal enuresis (no RCTs included), sub-optimal infant breastfeeding (no RCTs included), respiratory, eyes, ears, nose and throat conditions (3 RCTs included) [ 43 ]. However, the review by Parnell Prevost et al suffers from significant methodological limitations [ 92 ].…”

Comparison of common interventions for the treatment of infantile colic: a systematic review of reviews and guidelines

“…Eight studies reported on the effectiveness of manual therapy for infantile colic. Two studies reported a favourable outcome,36 37 four were inconclusive,32 38–40 one study showed no beneficial effects over the control arm41 and one study reported an unfavourable outcome 2. Most of the reviews for manual therapy graded the RCT studies as low quality.…”

Methodological flaws on “manual therapy for the pediatric population: a systematic review” by Prevost et al. (2019)

“…We reviewed the systematic review by Prevost et al [ 1 ] and are concerned about its methodological quality. We critically appraised the systematic review using the Scottish Intercollegiate Guidelines Network (SIGN) criteria for systematic reviews.…”