Manual therapy for non-radicular cervical spine related impairments: establishing a ‘Trustworthy’ living systematic review and meta-analysis

ABSTRACT

Objectives

To establish a ‘trustworthy’ living systematic review (SR) with a meta-analysis of manual therapy for treating non-radicular cervical impairments.

Design

SR with meta-analysis

Literature Search

Articles published between January 2010 and September 2022 were included from: Cochrane Central Register of Controlled Trials (CENTRAL); CINAHL; MEDLINE; PubMed; PEDro, and ProQuest Nursing and Allied Health.

Methods

This SR included English-language randomized clinical trials (RCTs) of manual therapy involving adults used to treat non-radicular cervical impairments. The primary outcomes were pain and region-specific outcome measures. Cervicogenic headaches and whiplash were excluded to improve homogeneity. Two reviewers independently assessed RCTs. The prospective plan was to synthesize results with high confidence in estimated effects using GRADE.

Results

Thirty-five RCTs were screened for registration status. Twenty-eight were not registered or registered prospectively. In 5 studies, the discussion and conclusion did not match the registry, or this could not be determined. One study did not meet the external validity criterion, and another was rated as having a high risk of bias. One study met the inclusion and exclusion criteria, so practice recommendations could not be made. The remaining study did not identify any clinically meaningful group differences.

Discussion

Only one prospectively registered RCT met this SR’s strict, high-quality standards. The single identified paper provides initial high-quality evidence on this topic.

Conclusion

This SR establishes a foundation of trustworthiness and can be used to generate research agendas to determine the potential clinical utility of manual therapy directed at the cervical spine for non-radicular cervical complaints.

KEYWORDS:

• Manipulation
• spinal
• prospective studies
• randomized controlled trials
• registries

Acknowledgements

We thank Nick Wharton, MLIS, of the University of Hartford, for his help in developing the search strategy used to identify the systematic reviews that met the inclusion criteria for this study.

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. Margaret Hofbauer ensured that the full-text articles of interest were retrieved and uploaded into Covidence. Daniel Flowers and Stephen Shaffer screened the identified randomized clinical trials to determine if they met the inclusion and exclusion criteria. 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. The resources for gathering and inputting the randomized clinical trials into Covidence were provided by the University of Hartford, College of Education, Nursing, and Health Professions. 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. The funder, sponsor, and institutions were not involved in developing this systematic review

Disclosure statement

The primary author Sean P. Riley is an Associate Editor at the Journal of Manual and Manipulative Therapy (JMMT). He also contributes to the Duke Center for Excellence in Manual and Manipulative Therapy.

Supplemental Material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10669817.2023.2201917

Additional information

Funding

The author(s) 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.

Stephen M. Shaffer

Stephen M. Shaffer is a residency and fellowship-trained clinical specialist, educator, and scientist with twenty 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.

Daniel W. Flowers

Daniel W. Flowers is an Assistant Professor in the Doctor of Physical Therapy and PhD in Rehabilitation Sciences Programs at LSU Health Shreveport. He also serves as the program director of the orthopaedic residency. He is board-certified in orthopaedic physical therapy. His research interests include modifying the gait impairments of patients with knee osteoarthritis, post-traumatic rehabilitation, and educational outcomes of physical therapy students.

Margaret A. Hofbauer

Margaret A. Hofbauer is a second-year physical therapy doctorate student at the University of Hartford. She is the class president and is actively involved in the program. In addition, she aids in the Scientific Inquiry class for first-year DPT students as a teaching assistant. Margaret completed her research investigating communication methods for individuals with Alzheimer’s Disease for the Honors Program in 2021. Her research interests include orthopedics, neurologic degenerative disorders, and geriatrics.

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.