J Orthop Sports Phys Ther. 2018 Jan;48(1):8-18. doi: 10.2519/jospt.2018.7476. Epub 2017 Oct 15.
Synopsis Manual therapy interventions are popular among individual health care providers and their patients; however, systematic reviews do not strongly support their effectiveness. Small treatment effect sizes of manual therapy interventions may result from a "one-size-fits-all" approach to treatment. Mechanistic-based treatment approaches to manual therapy offer an intriguing alternative for identifying patients likely to respond to manual therapy. However, the current lack of knowledge of the mechanisms through which manual therapy interventions inhibit pain limits such an approach. The nature of manual therapy interventions further confounds such an approach, as the related mechanisms are likely a complex interaction of factors related to the patient, the provider, and the environment in which the intervention occurs. Therefore, a model to guide both study design and the interpretation of findings is necessary. We have previously proposed a model suggesting that the mechanical force from a manual therapy intervention results in systemic neurophysiological responses leading to pain inhibition. In this clinical commentary, we provide a narrative appraisal of the model and recommendations to advance the study of manual therapy mechanisms. J Orthop Sports Phys Ther 2018;48(1):8-18. doi:10.2519/jospt.2018.7476.
概要 手法治疗干预在个体医疗保健提供者及其患者中很受欢迎；然而，系统评价并不强烈支持其有效性。手法治疗干预的小治疗效果可能源于“一刀切”的治疗方法。基于机制的手法治疗方法为识别可能对手法治疗有反应的患者提供了一种有趣的选择。然而，目前对手法治疗干预抑制疼痛的机制知之甚少，限制了这种方法的应用。手法治疗干预的性质进一步使这种方法变得复杂，因为相关机制很可能是与患者、提供者和干预发生环境相关的多种因素的复杂相互作用。因此，需要一种模型来指导研究设计和结果的解释。我们之前提出了一个模型，该模型表明手法治疗干预的机械力会导致全身神经生理反应，从而抑制疼痛。在本临床评论中，我们对手法治疗机制的模型进行了叙述性评估，并提出了一些建议。 美国矫形运动物理治疗杂志 2018；48（1）：8-18.doi：10.2519/jospt.2018.7476.
