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Table 7 Data extraction for the musculoskeletal studies

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


Author/ year

Study objective

Study design sample size intervention

Patient description/condition

Primary/main outcome(s)

Main results/conclusions

Adverse events


Nilgun B, et al. 2011 [28]

To determine efficacy of physical therapy, including manual mobilization, as adjunct to Ponseti technique in idiopathic clubfoot.


n = 29


Children ages 3 and under, Dimeglio Score of 17 or under with idiopathic clubfoot

Improvements in passive ranges of motion for plantar flexion, inversion, eversion, rear foot varus angle and forefoot adduction angle and decrease in Dimeglio Score

Treatment procured a statistically significant improvements in ranges of motion, Dimeglio Score and decrease of rear foot varus angle in the study group.

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

Cuboid Syndrome

Jennings J & Davies D, 2005 [29]

Describe the examination and treatment of the cuboid syndrome following lateral ankle sprain.

Interrupted Time Series (with comparison group)

n = 2


7 patients age range 15–36 (2 pediatric patients can be isolated), with cuboid syndrome

Visual Analog Scale: Pre- and post-treatment

All patients had substantial resolution of symptoms following cuboid manipulation.

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


Przekop P, et al. 2016 [30]

Evaluate and compare a multimodal with pharmacologic treatment for the prevention of chronic tension type headaches (CTTH) in adolescents.


n = 83


Children ages 13–18, diagnosed with CTTH

5 main effects: headache frequency, pain intensity, general health, pain restriction and number of tender points

Both approaches showed significant improvements across all 5 main effects outcomes, but multimodal treatments produced more favorable results in headache frequency, general health, and number of tender points.

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

Borusiak P, et al. 2010 [31]

To investigate the efficacy of spinal manipulative therapy in adolescents with recurrent headache.


n = 52


Adolescents ages 7–15, with cervicogenic headache

Assessment of; percentage of days with headache, total duration of headache, days with school absence due to headache, consumption of analgesics, and intensity of headache

No difference in any outcome measure between placebo and cervical spine manipulation.

No serious or moderate adverse events were noted. Minor adverse events occurred in both groups that included; hot skin in 15 patients (treatment group 6, placebo 9), dizziness in 11 patients (treatment group 7, placebo 4). There was reported transitory increase in headache intensity and frequency being reported for up to 4 days (treatment group 8, placebo 6).

Marchand A, et al. 2009 [32]

To conduct a retrospective file search of infants presenting with probable benign infantile headache at a chiropractic teaching clinic.


n = 13


Children ages 2 days - 8.5 months, with benign infant headache

Reduction in behavioral findings recorded verbatim by parents such as; grabbing holding face, ineffective latching, grimacing and positional discomfort, rapping head against floor, photophobia, and anorexia.

All 13 consecutive cases had favorable results based on parent report of outcomes.

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

Low Back Pain

Evans R, et al. 2018 [33]

To compare 12 weeks of chiropractic manipulative therapy combined with exercise therapy to exercise therapy alone in the treatment of chronic lower back pain in children.


n = 185


Children ages 12–18, with chronic lower back pain

Primary outcome - self-reported level of low back pain (11 box numerical rating scale), Secondary outcomes - patient-rated disability (18 item Roland-Morris Disability questionnaire), quality of life (23 item PedsQL), improvement (9-point scale), frequency of medication use for low back pain (days/week), patient satisfaction with care (7-point scale)

Chiropractic manipulative therapy plus exercise resulted in larger reduction in primary outcome of pain severity over the course of 1 year.

Side effects were similar in both groups, mild and self-limiting and occurred at a frequency comparable to adult population.

Walston Z & Yake D, 2016 [34]

To illustrate the feasibility and safety of lumbar manipulation as an adjunct to exercise for treatment of adolescent population with mechanical low back pain.

Interrupted Time Series (without comparison group)

n = 3


Adolescents ages 13–15, with mechanical low back pain

Pain measured on numerical pain rating scale and disability (Oswestry) for each patient

All outcome showed improvements (0/10 on numeric scale and 0% in the Oswestry disability index) for each patient.

No adverse reactions were reported or observed with any episode of manipulation.

Selhorst M & Selhorst B, 2015 [35]

To assess efficacy of lumbar manipulation in addition to a 4-week physical therapy exercise program.


n = 35


Adolescents ages 13–17, with mechanical low back pain of < 90 days

Patient Specific Functional Scale, pain (11-point Numerical Pain Rating Scale), and Global Rating of Chance scales

No difference between groups for Patient Specific Functional Scale, pain, or Global Rating of Chance scales. All patients improved.

Two patients in both the sham and manipulation group had an adverse reaction at 1 week. No patients in either groups reported adverse reactions at either 4 weeks or 6 months. They concluded that no additional risk of having an adverse reaction were noted in this study.

Hayden J, et al. 2003 [36]

To describe chiropractic management, outcomes, and factors associated with outcomes for low back pain in childhood.


n = 54


Children ages 4–18, with acute mechanical low back pain

Subjective assessment of improvement on a 5-point rating scale (Pediatric Visual Analog Scale)

Over a course of 4–6 weeks of chiropractic management, 55–62% of patients had improvement that met the study’s stringent criteria and 82–87% had much improvement.

Complications from chiropractic patient management were collected with none noted throughout the study data collection period.

Pulled Elbow

García-Mata S & Hidalgo-Ovejero A, 2014 [37]

To determine the relative efficacy of two pulled elbow reduction maneuvers, hyper pronation and supination-flexion.


n = 115


Children ages 1–5, with pulled elbow

Reduction of pulled elbow verified by observing active flexion and extension

Both maneuvers were effective with a higher first-attempt success rate with hyper pronation.

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

Bek D, et al. 2009 [38]

To compare the reduction efficiency of hyper pronation to supination-flexion maneuvers for a pulled elbow.


n = 66


Children ages 1–5, with pulled elbow

Reduction of pulled elbow indicated by child using the arm

Final reduction rates similar. Hyper pronation maneuver was more successful on the first attempt.

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

Temporomandibular Disorder

Monaco A et al. 2008 [39]

To evaluate the effects of osteopathic manipulative therapy on mandibular kinematics in patients with temporomandibular dysfunction.


n = 28


Children average age 12, diagnosed with TMD

Objective measures pre- and post-treatment using kinesiographic tracings to assess mandibular movement

Osteopathic manipulation made significant improvements in maximal mouth opening and in maximal mouth opening velocity.

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