Rehabilitation Sciences, McMaster University, Hamilton, Canada.
Northern Rehab Physical Therapy Specialists, DeKalb, Illinois, USA.
J Man Manip Ther. 2024 Jun;32(3):211-233. doi: 10.1080/10669817.2024.2332026. Epub 2024 Jun 10.
An international taskforce of clinician-scientists was formed by specialty groups of World Physiotherapy - International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) & International Organisation of Physiotherapists in Paediatrics (IOPTP) - to develop evidence-based practice position statements directing physiotherapists clinical reasoning for the safe and effective use of spinal manipulation and mobilisation for paediatric populations (<18 years) with varied musculoskeletal or non-musculoskeletal conditions.
A three-stage guideline process using validated methodology was completed: 1. Literature review stage (one scoping review, two reviews exploring psychometric properties); 2. Delphi stage (one 3-Round expert Delphi survey); and 3. Refinement stage (evidence-to-decision summative analysis, position statement development, evidence gap map analyses, and multilayer review processes).
Evidence-based practice position statements were developed to guide the appropriate use of spinal manipulation and mobilisation for paediatric populations. All were predicated on clinicians using biopsychosocial clinical reasoning to determine when the intervention is appropriate.1. It is not recommended to perform:• Spinal manipulation and mobilisation on infants.• Cervical and lumbar spine manipulation on children.•Spinal manipulation and mobilisation on infants, children, and adolescents for non-musculoskeletal paediatric conditions including asthma, attention deficit hyperactivity disorder, autism spectrum disorder, breastfeeding difficulties, cerebral palsy, infantile colic, nocturnal enuresis, and otitis media.2. It may be appropriate to treat musculoskeletal conditions including spinal mobility impairments associated with neck-back pain and neck pain with headache utilising:• Spinal mobilisation and manipulation on adolescents;• Spinal mobilisation on children; or• Thoracic manipulation on children for neck-back pain only.3. No high certainty evidence to recommend these interventions was available.Reports of mild to severe harms exist; however, risk rates could not be determined.
Specific directives to guide physiotherapists' clinical reasoning on the appropriate use of spinal manipulation or mobilisation were identified. Future research should focus on trials for priority conditions (neck-back pain) in children and adolescents, psychometric properties of key outcome measures, knowledge translation, and harms.
由世界物理治疗师协会-国际骨科手法物理治疗师联合会（IFOMPT）和国际儿科物理治疗师组织（IOPTP）的专业小组组成的国际临床医生科学家工作组制定了循证实践立场声明，指导物理治疗师对患有各种肌肉骨骼或非肌肉骨骼疾病的儿科人群（<18 岁）安全有效地使用脊柱手法治疗和运动疗法进行临床推理。
使用经过验证的方法完成了三个阶段的指南制定过程：1. 文献回顾阶段（一项范围综述，两项探索心理测量特性的综述）；2. 德尔菲阶段（三轮专家德尔菲调查）；3. 完善阶段（证据决策综合分析、立场声明制定、证据差距图分析以及多层审查程序）。
制定了循证实践立场声明，以指导对儿科人群进行脊柱手法治疗和运动疗法的合理应用。所有声明都基于临床医生使用生物心理社会临床推理来确定干预措施是否适用。1. 不建议对婴儿进行：• 脊柱手法治疗和运动疗法；• 儿童颈椎和腰椎手法治疗。2. 不建议对患有非肌肉骨骼儿科疾病（包括哮喘、注意力缺陷多动障碍、自闭症谱系障碍、母乳喂养困难、脑瘫、婴儿绞痛、夜间遗尿和中耳炎）的婴儿、儿童和青少年进行脊柱手法治疗和运动疗法：• 颈椎和腰椎手法治疗。3. 可能适合治疗肌肉骨骼疾病，包括与颈背痛和头痛相关的脊柱活动度障碍，可使用：• 青少年脊柱运动疗法；• 儿童脊柱运动疗法；或• 仅用于颈背痛的儿童胸椎手法治疗。4. 没有高质量证据推荐这些干预措施。虽然存在轻度至重度危害的报告，但无法确定风险率。
确定了指导物理治疗师对脊柱手法治疗或运动疗法的合理应用进行临床推理的具体指导方针。未来的研究应侧重于儿童和青少年颈背痛等优先条件的试验、关键结局测量的心理测量特性、知识转化和危害。
