Perceived factors and barriers affecting physiotherapists' decision to use spinal manipulation and mobilisation among infants, children, and adolescents: an international survey.
Jenifer L Dice, Jean-Michel Brismee, Frédéric P Froment and 8 others
PMID 38940281WHAT IT FOUND
Expert physiotherapists said they decide on paediatric spinal techniques by patient presentation, handling tolerance, diagnosis, mechanism of injury and their own technique knowledge.
For infants, many saw manipulation as inappropriate; barriers included training, mentorship, consent and fear of harm.
Key findings
01Across all paediatric ages and spinal levels, patient presentation (>90%) and tolerance to handling (>90%) were dominant factors, along with mechanism of injury (>80%), medical diagnosis (≥75%), and therapist knowledge of techniques (≥75%).
02For infants and children, dominant barriers were lack of knowledge or training in techniques (infants 100%, children >80%), lack of mentorship (>80%), unclear medical diagnosis (≥75% for mobilisation, >90% for manipulation), and poor understanding by patient or guardian (≥75%).
03All respondents considered cervical spinal manipulation inappropriate for infants, and more than 90% considered thoracic and lumbar manipulation inappropriate for infants.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The findings are the opinions of a small group of expert physiotherapists, not measured patient outcomes, so they cannot show whether spinal mobilisation or manipulation is safe or effective. Attrition between Round 1 and Round 2 was 40%, and the authors suggest the large number of survey items may have caused dropouts. The survey was embedded in a larger Delphi process but did not follow the formal Delphi procedure; feedback from Round 1 to Round 2 may have influenced answers. Only English-speaking experts were included, and the panel was selected for expertise, so results may not apply to ordinary physiotherapy practice. Respondents treated different age groups and spinal levels, and opinions were especially diverse for adolescents, so infant and child findings should not be generalised to adolescents.
Declared interests
The authors reported no funding associated with the work.
The easy way to misread this
Do not read these expert opinions as evidence that spinal mobilisation or manipulation is safe or effective for children. The survey reports what a small group of physiotherapists considered when deciding to use or avoid these techniques, not patient outcomes.