https://orcid.org/0000-0003-0409-7658
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ABSTRACT
Objective
The aim of this study was to establish international consensus regarding the use of spinal manipulation and mobilisation among infants, children, and adolescents among expert international physiotherapists.
Methods
Twenty-six international expert physiotherapists in manual therapy and paediatrics voluntarily participated in a 3-Round Delphi survey to reach a consensus via direct electronic mail solicitation using Qualtrics®. Consensus was defined a-priori as ≥75% agreement on all items with the same ranking of agreement or disagreement. Round 1 identified impairments and conditions where spinal mobilisation and manipulation might be utilised. In Rounds 2 and 3, panelists agreed or disagreed using a 4-point Likert scale.
Results
Eleven physiotherapists from seven countries representing five continents completed all three Delphi rounds. Consensus regarding spinal mobilisation or manipulation included:
Manipulation is not recommended: (1) for infants across all conditions, impairments, and spinal levels; and (2) for children and adolescents across most conditions and spinal levels.
Manipulation may be recommended for adolescents to treat spinal region-specific joint hypomobility (thoracic, lumbar), and pain (thoracic).
Mobilisation may be recommended for children and adolescents with hypomobility, joint pain, muscle/myofascial pain, or stiffness at all spinal levels.
Conclusion
Consensus revealed spinal manipulation should not be performed on infants regardless of condition, impairment, or spinal level. Additionally, the panel agreed that manipulation may be recommended only for adolescents to treat joint pain and joint hypomobility (limited to thoracic and/or lumbar levels). Spinal mobilisation may be recommended for joint hypomobility, joint pain, muscle/myofascial pain, and muscle/myofascial stiffness at all spinal levels among children and adolescents.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Supplementary material
Supplemental data for this article can be accessed online at https://doi.org/10.1080/10669817.2024.2327782.
Funding
The author(s) reported that there is no funding associated with the work featured in this article.
Additional information
Notes on contributors
Jenifer L. Dice
Jenifer Dice PT, ScD is an Assistant Professor at Texas Woman’s University Doctor of Physical Therapy (DPT) program in Houston, Texas, and continues private outpatient pediatric physiotherapy with more than 20 years of experience.
Jean-Michel Brismée
Jean-Michel Brismée PT, ScD is a Professor in the Doctor of Philosophy (PhD) and Doctor of Science (ScD) in Rehabilitation Sciences Programs at Texas Tech University Health Sciences Center (TTUHSC) in Lubbock, Texas. He is the Editor-in-Chief of the Journal of Manual and Manipulative Therapy.
Frédéric P. Froment
Frédéric Froment PT, ScD is currently a member of the board of directors of OMT-France (IFOMPT MO). He is fully involved in the development of orthopedic manual therapy in France with the IAMPT as President and is also co-pilot of a Task Force for the development of the specialization of physiotherapists in his country. He is also a member of the editorial board of the Journal of Manual and Manipulative Therapy. Additionally, he maintains his clinical practice treating temporomandibular dysfunctions and associated pathologies in the private sector.
Janis Henricksen
Janis Henricksen PT, DPT, ScD is an Assistant Professor at the University of St. Augustine with more than 20 years of clinical experience.
Rebecca Sherwin
Rebecca Sherwin PT, ScD is an adjunct professor at the University of the Cumberlands DPT program as well as full-time clinician practicing in an outpatient setting with 25 years of clinical experience.
Jan Pool
Jan Pool PT, MT, MSc epidemiology, PhD em Senior Researcher Institute of Movement Sciences University of Applied Sciences Utrecht, The Netherlands. Special interest in clinometric issues. Former member of the board of the Dutch Association of Manual Therapy (NVMT) and former member of the IFOMPT Standard Committee. Clinical practitioner 35 years.
Nikki Milne
Nikki Milne BExSci, MPhysT, PhD is an Associate Professor of Physiotherapy in Paediatrics at Bond University, Australia. She develops and teaches pediatric physiotherapy curriculum and is an active pediatric researcher who advocates for safe and effective care of infants, children, and adolescents.
Derek Clewley
Derek Clewley PT, DPT, PhD is an Assistant Professor at Duke University in Durham, North Carolina, USA. He is the Associate Director of the Duke Center for Excellence in Manual and Manipulative Therapy. He is on the executive board for the American Academy of Manual Physical Therapists.
Annalie Basson
C. Annalie Basson BSc, MPhysT, PhD, is a clinician working in private practice, sessional lecturer, and Associate Editor of the South African Journal of Physiotherapy.
Kenneth A. Olson
Kenneth A. Olson PT, DHSc is a private practitioner with Northern Rehab Physical Therapy Specialists and an adjunct faculty member at Northern Illinois University. He is past president of the International Federation of Orthopaedic Manipulative Physical Therapists.
Anita R. Gross
Anita Gross PT, MSc is an Associate Clinical Professor at McMaster University and lecturer at Western University and Canadian Physiotherapy Association – AIM program. She is the chair of the IFOMPT/IOPTP Taskforce on Pediatric Manipulation informing PT policy with systematic reviews and evidence gap maps. She is a clinician-scientist and educator with over 140 peer reviewed publications. She coordinates an International Network -the Cervical Overview Group- that maintains Cochrane systematic reviews on neck pain. She is a private practitioner and Fellow of the Canadian Academy of Manipulative Physiotherapy.