Protocol for the development of a ‘trustworthy’ living systematic review and meta analyses of manual therapy interventions to treat neuromusculoskeletal impairments

ABSTRACT

Background

Preprocessed research resources are believed to be highly ‘trustworthy’ when translating research to clinical practice. However, the overall ‘trustworthiness’ is unknown if this evidence contains randomized clinical trials (RCTs) where prospective has not been/cannot be verified, has low confidence in estimated effects, and if they are not up to date.

Objectives

This protocol will be used to create a baseline benchmark for a series of trustworthy living systematic reviews (SRs) regarding manual therapy interventions.

Methods

Data will originate from RCTs related to manual therapy neuromusculoskeletal interventions, indexed in 6 search engines in English from 1 January 2010, to the present. Two blinded reviewers will identify the RCTs and extract data using Covidence. The data will be synthesized based on consensus and analyzed using the Cochrane collaboration’s Review Manager.

Expected outcomes

It is expected that there will be a shortage of RCTs with at least a moderate confidence in estimated effects that will allow for strong practice recommendations.

Discussion

Identifying evidence that can be translated into strong practice recommendations is essential to identify beneficial and harmful interventions, decrease practice variability, and identify neuromusculoskeletal manual therapy interventions that require further disciplined methodological focus.

KEYWORDS:

• Musculoskeletal manipulations
• physical therapists
• Systematic reviews
• randomized controlled trials
• registries

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

The primary author, Sean Riley, coordinated the development of the research questions and protocol with his coauthors. Brian Swanson identified which search engines would be used and developed the search strategies for each with the assistance of a professional librarian. Stephen Shaffer and Chad Cook reviewed the protocol to ensure methodological details related to the execution of the protocol were not missing. All authors were involved in drafting and revising the protocol for important intellectual content and agreed to be accountable for the accuracy and integrity of the work.

Support

Sources-The resources for gathering and inputting the randomized clinical trials into Covidence and the open access fees required for the public sharing of these systematic living reviews and their data will be provided by the University of Hartford.

Sponsor-The sponsors for this series of living systematic reviews are the Center of Excellence in Manual and Manipulative Therapy at Duke University and the University of Hartford.

Role of sponsor or funder- The funder, sponsor, and institutions were not involved in developing this protocol.

Data availability statement

The data collected and used to create this manuscript are available on request to the corresponding author. The data may be used for meta-analytical purposes and secondary analysis, with the recognition of the authorship team.

Additional information

Funding

The authors) reported there is no funding associated with the work featured in this article.

Notes on contributors

Sean P. Riley

Sean P. Riley is an Assistant Professor in the Doctor of Physical Therapy Program and a faculty member in the orthopaedic physical therapy residency at the University of Hartford. He is board certified in orthopaedics and a Fellow of the American Academy of Orthopaedic Manual Physical Therapists. Dr. Riley’s research interests include symptom modification approaches to evaluating and treating neuromusculoskeletal disorders, evidence-based practice, research methodology, and clinical reasoning.

Brian T. Swanson

Brian T. Swanson is an Associate Professor at the University of Hartford. He serves as Chair of the Department of Rehabilitation Sciences, Director of the Doctor of Physical Therapy program, and co-director of the University of Hartford/HHCRN orthopedic physical therapy residency program. He is board certified in orthopaedics and a Fellow of the American Academy of Orthopaedic Manual Physical Therapists. Dr. Swanson’s research interests include validating tests and measures in orthopedic manual physical therapy, developing a further understanding of the mechanisms of manual physical therapy interventions, and evidence-based practice/research methodology.

Stephen M. Shaffer

Stephen M. Shaffer is a residency and fellowship-trained clinical specialist, educator, and scientist with nineteen years of experience in the physiotherapy profession. He has worked primarily in orthopaedic settings, is an adjunct professor at the University of Hartford, and is a Fellow of the American Academy of Orthopaedic Manual Physical Therapists and the Canadian Academy of Manipulative Physiotherapy. Dr. Shaffer has co-authored numerous peer-reviewed scientific papers and has presented at local, state, national, and international venues.

Chad E. Cook

Chad E. Cook is a neuromusculoskeletal clinical researcher with foci in diagnosis, interventions, and outcomes assessment. As a productive researcher, he has published over 250 peer-reviewed papers and has an H index of 37. His earlier work involved validating outcome measures, including item response theory. Dr. Cook has completed several studies investigating commonly used tests and measures for orthopedic diagnoses. Recent investigations have included trials designed to investigate the effectiveness of manual therapy-based interventions of the spine and shoulder. His work has led to international recognition and collaborations in numerous countries.