No effect of osteopathic treatment on trunk morphology and spine flexibility in young women with adolescent idiopathic scoliosis

Effects of manual therapy on body posture: Systematic review and meta-analysis

BACKGROUND

Several clinical trials investigated the effectiveness of MT on body posture, but a systematic review grouping the results of these studies was not found in the literature.

RESEARCH QUESTION

Does manual therapy (MT) cause postural changes?

METHODS

Inclusion criteria were: randomized controlled trials in any population; studies in which the primary intervention was the use of any MT technique; studies that evaluated the immediate, short, medium, or long-term effects of interventions on body posture; and studies published in peer-reviewed scientific journals in any year and language. In March 2022, we conducted a search in the PUBMED, Cinahl, Embase, PEDro, and Cochrane Central databases that yielded 6627 articles, of which 38 including 1597 participants were eligible; of these, 35 could be grouped into 12 meta-analyses. The risk of bias was assessed using the PEDro scale and the certainty in the scientific evidence rated through the GRADE system.

RESULTS

The results allowed us to conclude with moderate certainty in the evidence that, when compared to no intervention or sham, in the short and medium term, MT reduced the forward head posture (14 studies, 584 individuals, 95%CI 0.38, 1.06), reduced thoracic kyphosis (5 studies, 217 individuals, 95%CI 0.37, 0.94), improved lateral pelvic tilt (5 studies, 211 individuals, 95%CI 0.11, 0.67) and pelvic torsion (2 studies, 120 individuals, 95%CI 0.44, 1.19) and increased plantar area (3 studies, 134 individuals, 95%CI 0.04, 0.74). With moderate certainty, there was no significant effect on shoulder protrusion (5 studies, 176 individuals, 95%CI -0.11, 0.61), shoulder alignment in the frontal plane (3 studies, 160 individuals, 95%CI -0.15, 0.52), scoliosis (2 studies, 26 individuals, 95%CI -1.57, 2.19), and pelvic anteversion (5 studies, 233 individuals, 95%CI -0.02, 0.51). With low certainty, MT had no effect on scapular upward rotation (2 studies, 74 individuals, 95%CI -0.76, 2.17). With low to very low certainty, it is possible to conclude that MT was not superior to other interventions in the short or medium term regarding the improvement of forward head posture (5 studies, 170 individuals, 95%CI -1.39, 0.67) and shoulder protrusion (3 studies, 94 individuals, 95%CI -4.04, 0.97).

SIGNIFICANCE

MT can be recommended to improve forward head posture, thoracic kyphosis and pelvic alignment in the short and medium term, but not shoulder posture and scoliosis. MT reduces the height of the plantar arch and this must be taken into account in physical therapy planning. PROSPERO registration number: CRD42021244423.

Benefits on pain and mental health of manual therapy for idiopathic scoliosis: A meta-analysis

BACKGROUND

Idiopathic scoliosis (IS) is a common spinal disorder. Although several studies have reported the benefits of manual therapy for patients with IS in improving pain, anxiety, depression, and spinal disorders, the efficacy of manual therapy in the management of IS remain controversial. Therefore, this review was conducted to assess effects of manual therapy in the management of IS, primarily on pain and mental health of the patients and secondarily on their spinal disorders.

METHODS

Six electronic databases were searched for randomized controlled trials of manual therapy in the management of IS. The methodological quality of the included studies was assessed using the Physiotherapy Evidence Database (PEDro) Scale. The meta-analysis was conducted depending on different outcomes and control therapies using Review Manager version 5.3 software.

RESULTS

Seventeen studies were included in the present review. The PEDro scores of the included studies ranged from 5-7 points. The aggregated results indicated that Tuina (a traditional Chinese manipulation technique) had valuable improvement effects on pain (standardized mean difference (SMD), 0.92; 95% confidence interval (CI), 0.59 to 1.25; P<0.00001), negative emotions (SMD, 0.82; 95% CI, 0.51 to 1.13; P<0.00001), and disability (SMD, 1.29; 95% CI, 0.39 to 2.19; P=0.005). For the radiographic outcomes including the Cobb angle and vertebral rotation, Tuina, especially when combined with other conservative therapies, showed potential complementary effects for patients with IS.

CONCLUSIONS

Tuina, as a complementary and alternative therapy, should be considered for the effective management of patients with IS, especially for the improvement of their pain and mental health. More randomized controlled trials are recommended to validate the current evidence.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, identifier CRD42020165220.

Physiotherapeutic scoliosis-specific exercises performed immediately after spinal manipulative therapy for the treatment of mild adolescent idiopathic scoliosis: study protocol for a randomized controlled pilot trial

BACKGROUND

Spinal manipulative therapy is commonly used in the treatment of adolescent idiopathic scoliosis. Some therapists also rely on physiotherapeutic scoliosis-specific exercise (PSSE). Combining these two modalities seems reasonable, but the effectiveness of this combination has never been rigorously tested. Here, a protocol for a pilot study is proposed to determine the feasibility of conducting a larger randomized trial. The pilot study was designed to test the hypothesis that spinal manipulative therapy followed by PSSE is more effective than PSSE alone in improving the Cobb angle, sensorimotor integration, the angle of trunk rotation (ATR), body symmetry, and quality of life.

METHODS

The protocol describes a randomized controlled pilot trial with 40 subjects divided into study and control groups. Both groups will receive 8 weeks of PSSE, but the study group will also receive spinal manipulative therapy during the first 2 weeks before PSSE. The primary outcome will be an estimate of the feasibility of conducting a full-scale experiment. The influencing factors will be the time to complete enrollment, the recruitment rate, subject retention, and adherence to the treatment allocations. The secondary outcomes that will be used to assess the efficacy of treatment will include the Cobb angle, somatosensory evoked potentials, ATR, three-dimensional postural parameters, and scores on the 22-item Scoliosis Research Society outcomes questionnaire. The Cobb angle will be measured at baseline and at the end of 8 weeks of training. The somatosensory evoked potentials will be measured at baseline and at the end of 2 weeks of training. The ATR, three-dimensional postural parameters, and scores on the 22-item Scoliosis Research Society outcomes questionnaire will be measured at baseline and at 2 weeks, 4 weeks, and 8 weeks of treatment.

DISCUSSION

This study will inform the design of a future full-scale trial. The outcomes will provide preliminary data about the efficacy of the combination of spinal manipulative therapy and exercise in treating scoliosis.

TRIAL REGISTRATION

Prospectively registered at Chinese clinical trial registry, ChiCTR1900027037 . Registered on 29 October 2019. http://www.chictr.org.cn/edit.aspx?pid=44954&htm=4.

Manual therapy for idiopathic scoliosis: A protocol for systematic review and meta-analysis

INTRODUCTION

More patients with idiopathic scoliosis (IS) preferred to choose manual therapy as a complementary conservative treatment, but the effects of manual therapy for IS remains controversial. The previous reviews could not draw reliable conclusion due to few eligible studies to perform a meta-analysis. In the last decade, however, several new studies were published that assessed the effects of manual therapy in the management of IS, especially in China. Therefore, the present systematic review and meta-analysis will be performed to examine whether manual therapy is effective for IS primarily in improving patient-centerd symptoms and secondarily in radiographic outcomes.

METHODS AND ANALYSIS

A computerized literature search will be performed in the following electronic databases from their inceptions to June 2020 to identify randomized controlled trials of manual therapy in the management of IS: PubMed, EMBASE, MEDLINE, Cochrane Central Register of Controlled Clinical Trials, China Knowledge Resource Integrated Database, Wanfang Data Information, and Weipu Database for Chinese Technical Periodicals. The quality of included studies will be assessed independently by 2 reviewers using the Physiotherapy Evidence Database scale. The meta-analysis will be performed with the Review Manager Version 5.3 software to assess the effects on patient-centred outcomes and radiographic outcomes of manual therapy for IS. The heterogeneity will be assessed using I statistic and Cochran Q statistic. The subgroup analysis will be conducted based on different control interventions and subpopulations. Quality of evidence will be assessed using the Grades of Recommendation, Assessment, Development and Evaluation.

ETHICS AND DISSEMINATION

No ethical statement will be required for the performance of this review and meta-analysis. The results of this review will be published in an international peer-reviewed journal.INPLASY registration number: INPLASY202070058.

Manual therapy for the pediatric population: a systematic review

Background

This 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.

Methods

Six 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.

Results

Of 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.

Conclusions

Fifty 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 registration

PROSPERA registration number: CRD42018091835

Osteopathic manipulative treatment for pediatric conditions: a systematic review

BACKGROUND AND OBJECTIVES

Most osteopaths are trained in pediatric care, and osteopathic manipulative treatment (OMT) is available for many pediatric conditions. The objective of this systematic review was to critically evaluate the effectiveness of OMT as a treatment of pediatric conditions.

METHODS

Eleven databases were searched from their respective inceptions to November 2012. Only randomized clinical trials (RCTs) were included, if they tested OMT against any type of control in pediatric patients. Study quality was critically appraised by using the Cochrane criteria.

RESULTS

Seventeen trials met the inclusion criteria. Five RCTs were of high methodological quality. Of those, 1 favored OMT, whereas 4 revealed no effect compared with various control interventions. Replications by independent researchers were available for 2 conditions only, and both failed to confirm the findings of the previous studies. Seven RCTs suggested that OMT leads to a significantly greater reduction in the symptoms of asthma, congenital nasolacrimal duct obstruction (posttreatment), daily weight gain and length of hospital stay, dysfunctional voiding, infantile colic, otitis media, or postural asymmetry compared with various control interventions. Seven RCTs indicated that OMT had no effect on the symptoms of asthma, cerebral palsy, idiopathic scoliosis, obstructive apnea, otitis media, or temporomandibular disorders compared with various control interventions. Three RCTs did not perform between-group comparisons. The majority of the included RCTs did not report the incidence rates of adverse effects.

CONCLUSIONS

The evidence of the effectiveness of OMT for pediatric conditions remains unproven due to the paucity and low methodological quality of the primary studies.

Nonfusion treatment of adolescent idiopathic scoliosis by growth modulation and remodeling

BACKGROUND

Adolescent idiopathic scoliosis (AIS) is a common disorder in which the spine gradually develops a curvature that is first detected in patients between 11 and 17 years of age. The only accepted treatment methods are bracing and surgery. Whether brace treatment alters the natural history is being questioned, and patient compliance is low. Surgery usually includes a spinal fusion that creates a rigid spine and concentrates stresses at the ends.

METHODS

This study focuses on correlating the laboratory results with clinical reports for treating patients with AIS. In the laboratory, scoliosis with vertebral wedging has been created by asymmetric mechanical loading and has been corrected by reversing the loading. In the clinic, bracing and derotational casting have been successful in some reports, but compliance has been a problem with bracing and derotational casts have mainly been used in young children. Operative treatment has been successful, but a nonfusion operation remains elusive. FINDINGS AND RESULTS: In the laboratory, axial loading of growth plates altered growth according to the Hueter-Volkmann law, which states that compression decreases and distraction increases growth. Asymmetric loading of the spine caused asymmetric growth resulting in scoliosis with vertebral wedging. Asymmetric loading of tail vertebrae created vertebral wedging according to Wolff's law, which states that the bone remodels over time in response to prevailing mechanical demands. In the clinic, studies have shown that bracing may work if patients wore the brace as prescribed. Derotational casting in young children has been shown to prevent progression and even correct the scoliosis in some patients. Convex vertebral stapling has been successful in mild curves, but the results in larger curves have been disappointing. Anterolateral tethering has been successful in mild curves in young patients, but there is limited experience with this technique in patients with large curves.

CONCLUSIONS

A brace that applies the appropriate loading and is worn as prescribed may dramatically improve the results of brace treatment. A procedure using external fixation or adjustable anterolateral tethering may achieve a nonfusion correction of AIS.

LEVEL OF EVIDENCE

Level II.