Keter Damian L, Bialosky Joel E, Brochetti Kevin, Courtney Carol A, Funabashi Martha, Karas Steve, Learman Kenneth, Cook Chad E
Physical Medicine and Rehabilitation Department, United States Department of Veterans Affairs, Cleveland, Ohio, United States of America.
Department of Physical Therapy, University of Florida, Gainesville, Florida, United States of America.
PLoS One. 2025 Mar 18;20(3):e0319586. doi: 10.1371/journal.pone.0319586. eCollection 2025.
Treatment mechanisms are the underlying process or pathway through which a treatment influences the body. This includes molecular, cellular and physiological processes or pathways contributing to treatment effect. Manual therapy (MT) evokes complex mechanistic responses across body systems, interacting with the individual patient and context to promote a treatment response. Challenges arise as mechanistic studies are spread across multiple professions, settings and populations. The purpose of this review is to summarize treatment mechanisms that have been reported to occur with MT application.
Four electronic databases were searched (Medline, CINAHL, Cochrane Library, and PEDro) for reviews investigating mechanistic responses which occur during/post application of MT. This review was registered a priori with PROSPERO (CRD42023444839). Methodological quality (AMSTAR-2) and risk of bias (ROBIS) were assessed for systematic and scoping reviews. Data were synthesized by mechanistic domain.
Sixty-two reviews were included. Systematic reviews (n = 35), narrative reviews (n = 24), and scoping reviews (n = 4) of asymptomatic (n = 37), symptomatic (n = 43), non-specified human subjects (n = 7) and animals (n = 7) were included. Reviews of moderate quality supported neurovascular, neurological, and neurotransmitter/neuropeptide changes. Reviews of low quality supported neuroimmunce, neuromuscular, and neuroendocrine changes. Reviews of critically low quality support biomechanical changes.
Findings support critically low to moderate quality evidence of complex multisystem mechanistic responses occurring with the application of MT. Results support peripheral, segmental spinal, and supraspinal mechanisms occurring with the application of MT, which can be measured directly or indirectly. The clinical value of these findings has not been well established. While MT has proven to be an effective intervention to treat conditions such as pain, the current body of literature leaves uncertainty as to 'why' MT interventions work, and future research should look to better define which mechanisms (or combinations of mechanisms) are mediators of clinical response.
治疗机制是指治疗影响身体的潜在过程或途径。这包括有助于治疗效果的分子、细胞和生理过程或途径。手法治疗（MT）会引发全身系统的复杂机制反应，与个体患者及其背景相互作用以促进治疗反应。由于机制研究分散在多个专业、环境和人群中，因此出现了挑战。本综述的目的是总结已报道的手法治疗应用中出现的治疗机制。
检索了四个电子数据库（Medline、CINAHL、Cochrane图书馆和PEDro），以查找调查手法治疗应用期间/之后发生的机制反应的综述。本综述预先在PROSPERO（CRD42023444839）上进行了注册。对系统评价和范围综述评估了方法学质量（AMSTAR-2）和偏倚风险（ROBIS）。数据按机制领域进行综合。
纳入了62篇综述。包括对无症状（n = 37）、有症状（n = 43）、未明确的人类受试者（n = 7）和动物（n = 7）的系统评价（n = 35）、叙述性综述（n = 24）和范围综述（n = 4）。中等质量的综述支持神经血管、神经和神经递质/神经肽的变化。低质量的综述支持神经免疫、神经肌肉和神经内分泌的变化。极低质量的综述支持生物力学的变化。
研究结果支持手法治疗应用时发生复杂多系统机制反应的极低至中等质量证据。结果支持手法治疗应用时发生的外周、节段性脊柱和脊髓上机制，这些机制可以直接或间接测量。这些发现的临床价值尚未得到充分确立。虽然手法治疗已被证明是治疗疼痛等病症的有效干预措施，但目前的文献对于手法治疗干预“为何”有效仍存在不确定性，未来的研究应更好地确定哪些机制（或机制组合）是临床反应的介导因素。
