Author Names

Yan Sun , Yong Zhang, Haoning Ma, Mingsheng Tan, and Zhihai Zhang

Reviewer Name

Kelly Anne Faulk, SPT

Reviewer Affiliation(s)

Duke Doctor of Physical Therapy Program

 

Paper Abstract

Objective. We conducted this meta-analysis to provide better evidence of the efficacy of manual therapy (MT) on adolescent idiopathic scoliosis (AIS). Methods. All RCTs of MT for the management of patients with AIS were included in the present study. The treatment difference between the experimental and control group was mainly MT. The outcomes consisted of the total effective rate, the Cobb angle, and Scoliosis Research Society-22 (SRS-22) questionnaire score. Electronic database searches were conducted from database inception to July 2022, including the Cochrane Library, PubMed, Web of Science, Embase, Wanfang Data, CNKI, and VIP. The pooled data were analyzed using RevMan 5.4 software. Results. Four RCTs with 213 patients in the experimental group were finally included. There are 2 studies of standalone MT in the experimental group and 3 studies of MT with identical conservative treatments in the control group. Three trials reported total effective rate, and a statistically significant difference was found (P = 0:004). Three trials reported Cobb angle, and a statistical difference was found (P = 0:01). Then, sensitivity analysis showed that there was a significant difference in the additional MT subgroup (P < 0:00001) while not in the standalone MT subgroup (P = 0:41). Three trials reported SRS-22 scores (P = 0:55) without significant differences. Conclusion. There is insufficient data to determine the effectiveness of spinal manipulation limited by the very low quality of included studies. High-quality studies with appropriate design and follow-up periods are warranted to determine if MT may be beneficial as an adjunct therapy for AIS. Currently, there is no evidence to support spinal manipulation.

 

NIH Risk of Bias Tool

Quality Assessment of Systematic Reviews and Meta-Analyses

  1. Is the review based on a focused question that is adequately formulated and described?
  • Yes
  1. Were eligibility criteria for included and excluded studies predefined and specified?
  • Yes
  1. Did the literature search strategy use a comprehensive, systematic approach?
  • Yes
  1. Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?
  • Yes
  1. Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?
  • Yes
  1. Were the included studies listed along with important characteristics and results of each study?
  • Yes
  1. Was publication bias assessed?
  • Yes
  1. Was heterogeneity assessed? (This question applies only to meta-analyses.)
  • Yes

 

Key Finding #1

Since the 4 RCTs were of low quality with insufficient data, the effectiveness of treating adolescent idiopathic scoliosis with manual therapy could not be determined.

Key Finding #2

Currently there is no evidence to support spinal manipulation in regards to treating adolescent idiopathic scoliosis.

 

Please provide your summary of the paper

This meta-analysis aimed to provide better evidence to support the effectiveness of manual therapy for adolescent idiopathic scoliosis. After analysis, only 4 low quality RCT’s from China fit the criteria involving subjects age 10 to 19 with a Cobb angle of >10 degrees. Across these 4 studies the following outcomes were investigated: the total effective rate, the Cobb angle, and the Scoliosis Research Society-22 (SRS-22) questionnaire score. The effective rate and Cobb angle were found to have a statistically significant difference, while the SRS-22 did not. The primary limitations of this meta-analysis were insufficient long follow up periods, a lack of standard definition of manual therapy, and an exclusion of side effects from manual therapy treatment. Overall, this meta-analysis was unable to find evidence to support spinal manipulation for adolescent idiopathic scoliosis. In the future more high-quality RCT’s will help determine if manual therapy is beneficial as an adjunct therapy for adolescent idiopathic scoliosis.

 

Please provide your clinical interpretation of this paper.  Include how this study may impact clinical practice and how the results can be implemented.

Although this study did not provide evidence to support manipulation for adolescent idiopathic scoliosis, it can serve as encouragement for physical therapists to explore adjunct treatment options for their patients. Such as looking into manual therapy treatments targeted at pain relief as opposed to curve reduction for adolescent idiopathic scoliosis patients.