Spinal manipulation and mobilisation in paediatrics - an international evidence-based position statement for physiotherapists.

The taskforce did not have access to the full text of the primary studies included in the scoping review, relying instead on the reviews themselves. Reporting of adverse events in the underlying clinical trials was poor, making it impossible to determine accurate risk rates. The Delphi panel was small (26 participants) and only 11 completed all three rounds. The position statement does not address client preferences, family-centered care, or shared decision-making processes. Many of the underlying studies had insufficient or inconclusive evidence, meaning the recommendations rely heavily on expert opinion and safety concerns rather than robust efficacy data.

The authors declare no competing interests. The work was commissioned by World Physiotherapy specialty groups (IFOMPT and IOPTP).

Do not interpret the 'may be appropriate' statements for adolescents as evidence that these treatments are proven effective. The guidance is based on a lack of high-certainty evidence and expert consensus, not on positive trial results. Furthermore, do not assume that because mobilisation is 'safer' than manipulation, it is risk-free; the paper notes that the risk of adverse events for mobilisation in infants is unknown and that severe adverse events have been reported in case studies.