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Research - Manual Therapy and Childhood Respiratory Disease May/June 2013
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May/June 2013

Manual Therapy and Childhood Respiratory Disease

Summary provided by Dean L. Smith, D.C., Ph.D.


National estimates indicate that 2.3 million children (2.3%) in the United States used chiropractic or osteopathic medicine in 2007. In chiropractic practice, spinal manipulative therapy is often used in the treatment of musculoskeletal disorders in pediatric patients.

Chiropractors are experts in musculoskeletal diagnosis and treatment. We offer an integrated approach to health care, including manual treatment and patient education addressing lifestyle factors such as diet and exercise that help with both musculoskeletal and non-musculoskeletal conditions. Prevention and reduction of musculoskeletal complaints in children have the potential to reduce the occurrence of these disorders in adulthood and to improve general health by reducing the risk of obesity, cardiovascular disease, and other chronic noninfectious disease related to reduced physical activity.

While anecdotal reports of success with pediatric illness is common, few studies have been published in the scientific literature that have concentrated on the effects of chiropractic care or spinal manipulation in children. In recent years, spinal manipulation has been used as a complementary treatment to pharmacologic therapy to help in the management of respiratory diseases in adults and children.

Some studies have documented the benefits of manual therapy on children with pulmonary diseases. For example, one clinical trial found that the quality of life of children with asthma improved after 3 months of treatment with spinal chiropractic techniques. Even the pulmonary function of healthy individuals have benefited from a chiropractic approach. A study with asthmatic children found that their peak expiratory flow (PEF) improved after treatment with manipulative therapy. The objective of the paper reviewed here by Pepino et al (2013) was to systematically study the evidence for the effects of manipulative therapy in children with respiratory disease.

Three scientific databases were searched for information pertaining to this topic which included: SciELO (Scientific Electronic Library Online), PEDro (Physiotherapy Evidence Database) and MEDLINE. The authors did not limit the dates in their search. Two independent researchers selected the potentially relevant studies based on titles retrieved from the search. Selected papers were retrieved for final decision whether they fit the inclusion/exclusion criteria. All clinical trials using manual therapy techniques on children with respiratory diseases were reviewed. All children aged 0 to 17 years (including preterm infants) were included. Studies using manual procedures related to respiratory physiotherapy techniques and/or resources were not included.

Analysis of the methodological quality of the included studies was derived from the PEDro Assessment Scale. This scale gives a score between 0 and 10 that reflects potential bias involved in the study, with 10 being the best possible score (best quality) and 0 the worst possible score (worst quality).

There were 1,147 relevant titles found in these three scientific databases; 103 were selected for abstract assessment, and of these, 24 were selected for full-text assessment. After critical analysis, 8 studies were included in the review and 16 were excluded (1 was about conventional physiotherapy, 7 did not concern the studied participant, and 8 included adults). Of the 8 studies included, 5 involved asthmatic children and the remainder involved children with other pulmonary diseases.

The methodological quality of the 8 included studies were as follows: four scored 5/10, two scored 4/10, one scored 2/10, and only one scored more than 5 points (7/10). The manipulative therapies used in these studies were also diverse and involved chiropractic (2 studies), osteopathy (2 studies) and massage (4 studies).

A study that investigated the effects of chiropractic manipulation on pulmonary function and quality of life of asthmatic children did not find significant differences between the treated and the control groups (Balon, NEJM 1998). However, the children in the control group were given massage, which is another intervention method, so it is not possible to state that the results of this study refute manipulative therapy. Another study that used a questionnaire to assess the use of chiropractic on asthmatic children found that chiropractic improves quality of life and reduces asthma severity (Bronfort, JMPT 2001).

An osteopathic study found that an improvement in the peak expiratory flow (PEF) of asthmatic children significantly, from 7 to 9 L/min, measured before and after the intervention (Guiney, JAOA 2005). Another two studies investigated the effects of massage on asthmatic children. In these studies, massage was found to have a positive impact on the spirometric data of children and also reduced their anxiety (Field, J Pediatr 1998; Nekooee, Ir J Pediatr 2008).

In summary, this systematic review found that there is some evidence, although from low-quality studies, suggesting that manual therapy has some beneficial effect on children with respiratory disease. Chiropractic, massage and osteopathy are the most used therapeutic modalities.

Reference: Pepino VC, Ribeiro JD, de Oliveira Ribeiro MA, de Noronha M, Mezzacappa MA, Schivinski CI. Manual therapy for childhood respiratory disease: a systematic review. J Manipulative Physiol Ther. 2013 Jan;36(1):57-65.



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