Primary and secondary prevention of musculoskeletal pain and disability in chiropractic, osteopathy, and physiotherapy: A scoping review

Abstract

Background

Musculoskeletal prevention is a key priority in public health and for national health systems due to the increasing number of people living with persistent conditions, including musculoskeletal (MSK) complaints. There is no robust review of the evidence on COP interventions and MSK prevention, such as what the current state of conceptual debate is about a possible role of COP interventions in prevention, where and how this has been studied, and what the evidence for effectiveness is.

Objectives

A scoping review was conducted to chart and appraise the available evidence regarding primary and secondary prevention in MSK care in the chiropractic, osteopathic and physiotherapy (COP) professions.

Methods

The review was prospectively registered (https://osf.io/bqe5x/). Studies were eligible if they were primary quantitative research on COP interventions for primary and secondary prevention, delivered in clinical settings, and to patients of any age who were asymptomatic or had any MSK pain or disability. Screening, data extraction, and risk of bias assessment were conducted in duplicate by independent reviewers. The data was synthesised narratively.

Results

Twenty-one articles were included in the final synthesis: 17 randomized controlled trials, 3 cross sectional studies, and 1 experimental study. Studies were mostly moderate-quality clinical trials (n = 17) on manual therapy (n = 14) for low back pain (n = 10) that measured prevention by assessing healthcare use (n = 14) or symptom recurrence (n = 11). Heterogeneity of methods, low numbers, and mixed quality did not allow for conclusions about the effectiveness of COP interventions in preventing MSK complaints.

Conclusions

The evidence base is heterogeneous and of moderate quality making clinical recommendations challenging, but future research priorities have been identified, including a need for further research into primary, but mostly in secondary and tertiary prevention in COP; future research in COP should be designed in line with best practices and existing guidelines; and a need for the development and validation of reliable tools to stratify risks and management options.