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Spinal manual therapy interventions for pediatric patients: a systematic review
Daniel W Vaughn1, Lisa K Kenyon, Corey M Sobeck
1Grand Valley State University, Grand Rapids, MI, USA.
Insights
Limited research exists on spinal manual therapy (SMT) for pediatric headaches and spinal pain. More studies are needed to determine the efficacy and safety of SMT in children and adolescents.
Area of Science:
- Pediatric physical therapy
- Evidence-based medicine
- Manual therapy research
Background:
- Efficacy of manual therapy for adult headaches and spinal pain is well-documented.
- Limited research exists on manual therapy interventions for pediatric populations.
Purpose of the Study:
- To systematically review the evidence for spinal manual therapy (SMT) in pediatric patients aged 4-17 years.
- To evaluate SMT interventions for headaches and/or mechanical spinal pain in children.
Main Methods:
- Searched multiple databases (MEDLINE, CINAHL, Cochrane, PEDro, PubMed, Sports Discus) for English articles from the past 15 years.
- Included studies with pain, function, or quality of life outcomes; excluded post-operative or spinal curvature interventions.
- Four studies (2 RCTs, 2 prospective cohort) were evaluated using GRADE criteria.
Main Results:
- Only four studies met the inclusion criteria for the review.
- The available evidence base for SMT in pediatric patients is currently very limited.
- Included studies varied in their level of evidence, with two RCTs and two lower-level studies.
Conclusions:
- Insufficient data exists to support or refute the use of SMT for pediatric headaches and spinal pain.
- Further high-quality research is necessary to establish an evidence-based foundation for SMT in children.
- The current evidence does not provide strong guidance for clinicians regarding SMT in pediatric populations.
Objective:
Although much has been written about the efficacy of manual therapy interventions for adults with headaches or spinal pain, little research has focused on the use of these interventions in pediatric patients. The purpose of this systematic review was to evaluate the evidence for spinal manual therapy (SMT) interventions in patients 4-17 years old with headaches and/or mechanical spinal pain.
Methods:
A search for relevant studies published in the past 15 years was conducted on MEDLINE, CINAHL, Cochrane Central Register of Randomized Control Trials, PEDro, PubMed, and Sports Discus. Only English language articles were reviewed. Studies had to include at least one outcome measure for pain, function, or quality of life. Studies evaluating post-operative interventions, or those in which the interventions were directed at influencing excessive spinal curvatures, were excluded. Case reports and studies that did not limit analysis of the results to the pediatric population were also excluded.
Results:
Two randomized control trials and two studies offering lower levels of evidence were identified in the literature search. The latter studies were prospective cohort studies. The four studies were evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria.
Discussion:
There are very little data in the literature to support or refute the use of SMT interventions in pediatric patients. Further research is required to establish a strong evidence-based foundation for use of these interventions in children.
