Spinal manipulation and mobilisation among infants, children, and adolescents: an international Delphi survey of expert physiotherapists.
Jenifer L Dice, Jean-Michel Brismée, Frédéric P Froment and 8 others
PMID 38484120WHAT IT FOUND
Expert physiotherapists reached consensus that spinal manipulation is not appropriate for infants and most children, and that mobilisation is not appropriate for most conditions in infants.
Mobilisation was considered appropriate for joint pain, hypomobility, and muscle stiffness in children and adolescents.
Key findings
01Consensus was that spinal manipulation at any level is not appropriate for treating infants for any condition.
02Consensus was that spinal mobilisation can be recommended for managing spinal joint hypomobility, spinal joint pain, muscle/myofascial pain, and muscle/myofascial stiffness at all spinal levels in children.
03Consensus was that spinal mobilisation across all spinal levels can be recommended for treating spinal joint hypomobility, spinal joint pain, muscle/myofascial pain, and stiffness in adolescents.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The findings represent expert consensus and opinions, not evidence of clinical effectiveness or safety. The study had significant attrition, with only 11 of the 20 experts who completed Round 1 finishing Round 3, which may have skewed the results. The expert panel was limited to eight countries and required English proficiency, which restricts the generalisability of the findings internationally. The initial list of experts was identified by the task force, which may have introduced selection bias. The Delphi process did not split mobilisation into grades, which may limit the specificity of the recommendations for mobilisation. There is a substantial lack of empirical research regarding the mobilisation of the infant spine, which likely contributed to the lack of consensus in some areas.
Declared interests
The paper does not report any funding sources or conflicts of interest.
The easy way to misread this
Do not interpret these consensus recommendations as evidence that spinal manipulation or mobilisation is effective or safe for the conditions and impairments listed. The authors explicitly state that these recommendations are based on expert opinion due to a sparsity of robust literature, and that sound clinical reasoning is required.