Lima Carla Rigo, Martins Daniel Fernandes, Reed William Ray
Rehabilitation Science Program, University of Alabama at Birmingham, Birmingham, AL, United States.
Postgraduate Program in Health Sciences, Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça, Brazil.
Front Neurosci. 2020 May 8;14:430. doi: 10.3389/fnins.2020.00430. eCollection 2020.
Physiological responses related to manual therapy (MT) treatment have been investigated over decades using various animal models. However, these studies have not been compiled and their collective findings appraised. The purpose of this scoping review was to assess current scientific knowledge on the physiological responses related to MT and/or simulated MT procedures in animal models so as to act as a resource to better inform future mechanistic and clinical research incorporating these therapeutic interventions. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Embase, and Index of Chiropractic Literature (ICL) were searched from database inception to August 2019. Eligible studies were: (a) published in English; (b) non-cadaveric animal-based; (c) original data studies; (d) included a form of MT or simulated MT as treatment; (e) included quantification of at least one delivery parameter of MT treatment; (f) quantification of at least one physiological measure that could potentially contribute to therapeutic mechanisms of action of the MT. MT studies were categorized according to three main intervention types: (1) mobilization; (2) manipulation; and (3) massage. Two-phase screening procedures were conducted by a pair of independent reviewers, data were extracted from eligible studies and qualitatively reported. The literature search resulted in 231 articles of which 78 met inclusion criteria and were sorted by intervention type. Joint mobilization induced changes in nociceptive response and inflammatory profile, gene expression, receptor activation, neurotransmitter release and enzymatic activity. Spinal manipulation produced changes in muscle spindle response, nocifensive reflex response and neuronal activity, electromyography, and immunologic response. Physiological changes associated with massage therapy included autonomic, circulatory, lymphatic and immunologic functions, visceral response, gene expression, neuroanatomy, function and pathology, and cellular response to simulated massage. Pre-clinical research supports an association between MT physiological response and multiple potential short-term MT therapeutic mechanisms. Optimization of MT delivery and/or treatment efficacy will require additional preclinical investigation in which MT delivery parameters are controlled and reported using pathological and/or chronic pain models that mimic neuromusculoskeletal conditions for which MT has demonstrated clinical benefit.
几十年来，人们使用各种动物模型对与手法治疗（MT）相关的生理反应进行了研究。然而，这些研究尚未得到整理，其研究结果也未得到综合评估。本综述的目的是评估动物模型中与MT和/或模拟MT程序相关的生理反应的现有科学知识，以便为未来纳入这些治疗干预措施的机制研究和临床研究提供更好的参考。检索了PubMed、护理学与健康相关文献累积索引（CINAHL）、Cochrane、Embase和脊椎按摩文献索引（ICL），检索时间从数据库建立至2019年8月。符合条件的研究包括：（a）以英文发表；（b）基于非尸体动物；（c）原始数据研究；（d）包括一种MT形式或模拟MT作为治疗方法；（e）包括对MT治疗的至少一个实施参数的量化；（f）对至少一种可能有助于MT治疗作用机制的生理指标的量化。MT研究根据三种主要干预类型进行分类：（1）松动术；（2）整复手法；（3）按摩。由两名独立评审员进行两阶段筛选程序，从符合条件的研究中提取数据并进行定性报告。文献检索共得到231篇文章，其中78篇符合纳入标准，并按干预类型进行了分类。关节松动术可引起伤害性反应、炎症反应、基因表达、受体激活、神经递质释放和酶活性的变化。脊柱整复手法可引起肌梭反应、防御性反射反应和神经元活动、肌电图及免疫反应的变化。与按摩疗法相关的生理变化包括自主神经、循环、淋巴和免疫功能、内脏反应、基因表达、神经解剖、功能和病理学以及细胞对模拟按摩的反应。临床前研究支持MT生理反应与多种潜在的短期MT治疗机制之间的关联。MT实施和/或治疗效果的优化将需要进一步的临床前研究，其中MT实施参数应使用模拟MT已显示出临床益处的神经肌肉骨骼疾病的病理和/或慢性疼痛模型进行控制和报告。
