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Table 10 Data extraction for structural studies

From: Manual therapy for the pediatric population: a systematic review



Study objective

Study design sample size intervention

Patient description/ condition

Primary/main outcome(s)

Main results/conclusions

Adverse events

Cranial Asymmetry

Cabrera-Martos I, et al. 2016 [58]

Evaluate the effects of manual therapy as an adjuvant option on treatment duration and motor development in infants with severe nonsynostotic plagiocephaly.


n = 46


Infants ages 4–8 months, with severe nonsynostotic plagiocephaly

Treatment duration and motor development assessed with Alberta Infant Motor Scale

Treatment duration was significantly reduced in manual therapy group (109.84 +/− 14.45) compared to the control group (148.65 +/− 11.53) days. Asymmetry after the treatment was minimal Type 0 or Type 1. Motor behaviour was normal in all the infants after treatment.

Study reported no adverse effects were seen during the treatment period.

Lessard S, et al. 2011 [59]

Does osteopathic manipulation alter cranial asymmetry in infants.


n = 12


Infants ages < 6.5 months, diagnosed with nonsynostotic plagiocephaly

Anthropometric changes

Osteopathic treatment led to improvements in cranial asymmetry.

There is no mention of adverse events made in this study.

Postural Asymmetry

Philippi H, et al. 2006 [60]

To assess the therapeutic efficacy of osteopathic manipulation in infants with postural asymmetry.


n = 32


Infant ages 6–12 weeks, with postural asymmetry

Video-based measurements

Significant improvement in postural asymmetry (mean 5.9 points) observed with osteopathic manipulation.

“At least two of the seven vegetative symptoms aggravated for 2 days after the interventions in six patients of the control group and in four patients of the treatment group. Otherwise no adverse effects were seen.”


Byun S & Han D, 2016 [61]

Examine whether chiropractic techniques would reduce the curvature of idiopathic scoliosis.


n = 5


Children ages 10–13, with Cobb angles > 10 degrees

Reduction in Cobb angle

No significant difference in Cobb angle was noted after the 4th week of chiropractic manipulation.

There is no mention of adverse events made in this study.

Hasler C, et al. 2010 [65]

Test to see if osteopathy alters trunk morphology, to unload the concave side of the scoliosis to halt curve progression.


n = 20


Post-pubertal females ages 12–18, with Cobb angles 20–40

Trunk morphology, spine flexibility and scoliometer measurements

Repeat measurements revealed no therapeutic effect on rib hump, lumbar prominence, plumb line, sagittal profile and global flexibility.

“No intervention-related side effects or complications were noted”

Rowe D, et al. 2006 [62]

To conduct a pilot (feasibility) study and explore issues of patient safety, patient recruitment and compliance, treatment standardization, sham treatment refinement, interprofessional cooperation, quality assurance, and outcome measure selection.


n = 6


Children ages 10–16, with Cobb angles 20–40 degrees

Reduction in Cobb angle

Feasible to recruit AIS patients for a randomized clinical trial to compare chiropractic care and standard medical treatment.

CMT delivered on 52 visits resulted in two benign reactions one with moderate pain lasting 24 h; the other produced mild pain lasting 6 h.

Morningstar M, et al. 2004 [63]

Evaluate of scoliosis treatment using a combination of manipulative and rehabilitative therapy.


n = 19 (6 pediatrics)


Scoliotic patients aged 15–65 (6 patients 18 and under- identified in Table 3 of study)

Reduction in Cobb angle

Reduction in Cobb angles in all patients.

There is no mention of adverse events made in this study.

Lantz C & Chen J, 2001 [64]

Effect of chiropractic manipulation on small scoliotic curves in younger subjects.


n = 42


Children aged 6–17, with Cobb angles 6–25

Reduction in Cobb angle

No overall reduction in Cobb angle after 6.5–28.5 months of care.

There is no mention of adverse events made in this study.


Haugen E, 2011 [66]

Evaluate measurement methods and examine short-time effect of manual therapy in addition to physiotherapy in infants with torticollis.


n = 32


Infant aged 3–6 months, diagnosed with torticollis

Primary outcome: Videoclip recordings, Secondary outcomes: 12 parameters of body function, activity, participation

No significant difference in primary outcome. Found non-significant tendency to greater improvement in lateral flexion and head righting in intervention group.

There is no mention of adverse events made in this study.

Upper Cervical Dysfunction

Saedt E, et al. 2018 [67]

To gain insight into the patient characteristics and reasons for seeking care in infants with indications of upper cervical dysfunction referred for manual therapy.


n = 295


Infants aged < 27 weeks, with positional preference, restlessness, abnormal head position, excessive crying

Improved flexion-rotation test and lateral flexion tests Parental perception of treatment effects Pre- and post treatment self-reported questionnaires

Flexion- rotation test decreased from 78.8 to 6.8%. Lateral flexion test decreased from 91.5% tp 6.2%. All parents perceived positive treatment effects.

No serious adverse events were reported during this study.