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KMID : 1035420210090010203
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Journal of The Korean Society of Integrative Medicine
2021 Volume.9 No. 1 p.203 ~ p.217
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Effects of Manual Therapy on Musculoskeletal Diseases: A meta-analysis
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Lee Jeong-Woo
Gong Kwang-Sik
Kim Dong-Yeon
Koh Un
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Abstract
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Purpose : The purpose of this meta-analysis was to examine the effects of manual therapy on musculoskeletal diseases.
Methods : Domestic databases (RISS, NDSL, KISS, KCI, Kmbase, and DBpia) were searched for studies that conducted clinical trials associated with manual therapy on chronic musculoskeletal diseases. A total of 591 studies published between 2005 and 2018 were identified, with 18 studies satisfying the inclusion data. The studies were classified according to patient, intervention, comparison, and outcome (PICO). The search outcomes were items associated with pain and physical function. The 18 studies that were included in the study were evaluated using R meta-analysis (version 4.0). The quality of 18 randomized control trials was evaluated using Cochrane risk of bias (ROB). Effect sizes were computed as the corrected standard mean difference (SMD). A random-effect model was used to analyze the effect size because of the high heterogeneity among the studies. Sub-group and meta-regression analysis were also used. Egger’s regression test was carried out to analyze the publishing bias. Cumulative meta-analysis and sensitivity analysis were also done to analyze a data error.
Results : The following factors had a large effect size of manual theapy on chroinc musculoskeletal diseases: pain (Hedges’s g=2.66, 95 %CI=1.47~3.85), and physical function (Hedges’s g=2.15, 95 % CI: 1.22~3.08). The sub-group analysis only showed a statistical difference in the type of manual therapy (pain) and outcome (physical function). No statistically significant difference was found in the meta-regression analysis. Publishing bias was found in the data, but the results of the trim-and-fill method showed that such bias did not large affect the obtained data. Also, the cumulative meta-analysis and sensitivity analysis showed no data errors.
Conclusion : This study provides evidence for the effectiveness of manual therapy on chronic musculoskeletal diseases in pain and physical function. Subgroup analysis suggest that only the type of manual therapy in pain and the type of outcome in physical function differed in effect size.
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KEYWORD
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musculoskeletal disease, manual therapy, mobilization, meta-analysis
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