Texas Children's Hospital, Department of Physical Medicine and Rehabilitation, Houston, Texas, USA.
Department of Rehabilitation Sciences, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.
Phys Ther. 2021 Apr 4;101(4). doi: 10.1093/ptj/pzab027.
Limited research has investigated the use of manual therapy to treat the preadolescent (0-12 years of age) population with musculoskeletal and neurological impairments. The purpose of this study was to identify the following among physical therapists holding advanced credentials in pediatrics, neurodevelopmental treatment, or manual therapy: (1) consensus regarding effective techniques in the preadolescent population, (2) differences in opinion, and (3) perceived decision-making barriers and factors regarding use of manual therapy techniques.
Credentialed physical therapists in the United States were recruited for a 3-round Delphi investigation. An electronic survey in Round 1 identified musculoskeletal and neurological impairments and the manual techniques considered effective to treat such conditions, in addition to factors and barriers. Responses were used to create the second round, during which a 4-point Likert scale was used to score each survey item. A third round of scoring established consensus. Descriptive statistics and composite scores were calculated for each manual technique by impairment. Between-group differences were calculated using the Mann-Whitney U test with Bonferroni correction.
Consensus was determined for several concepts. First, neuromuscular techniques were considered effective across all impairments, and joint mobilizations (grades I-IV) were believed to be effective to treat joint and muscle and myofascial impairments. Second, visceral manipulation and craniosacral therapy were considered ineffective in treating most impairments. There was lack of consensus and clear differences of opinion regarding the use of grade V mobilizations and dry needling. Significant barriers to use of manual therapy were: lack of knowledge, lack of evidence, and fear of litigation and harming patients.
This study is an initial step for developing manual therapy guidelines, research, and educational opportunities regarding manual therapy in pediatric physical therapy.
针对骨骼肌肉和神经功能障碍的青少年（0-12 岁）人群，有限的研究调查了手法治疗的应用。本研究旨在确定以下内容：（1）持有儿科、神经发育治疗或手法治疗高级证书的物理治疗师对手法治疗青少年人群的有效技术的共识；（2）意见分歧；（3）关于使用手法治疗技术的决策障碍和因素的看法。
在美国招募具有小儿科、神经发育治疗或手法治疗资质的认证物理治疗师参与三轮德尔菲调查。第一轮的电子调查确定了骨骼肌肉和神经功能障碍，以及被认为可有效治疗这些疾病的手法技术，同时还确定了相关因素和障碍。第二轮使用这些回复创建，在此轮中，使用 4 分李克特量表对每个调查项目进行评分。第三轮评分确定了共识。按损伤类型计算每个手法技术的描述性统计数据和综合评分。使用曼-惠特尼 U 检验和 Bonferroni 校正计算组间差异。
确定了几个概念的共识。首先，神经肌肉技术被认为对所有损伤都有效，关节松动术（I-IV 级）被认为可有效治疗关节、肌肉和肌筋膜损伤。其次，内脏手法和颅骶疗法被认为对大多数损伤无效。对于使用 V 级松动术和干针治疗，缺乏共识和明确的意见分歧。使用手法治疗的主要障碍包括：缺乏知识、缺乏证据以及担心法律诉讼和伤害患者。
本研究是制定小儿物理治疗中手法治疗指南、研究和教育机会的初步步骤。
