Effect of manual manipulation on mechanical gait parameters.

IF 1.4 Q2 MEDICINE, GENERAL & INTERNAL Journal of Osteopathic Medicine Pub Date : 2024-05-30 eCollection Date: 2024-10-01 DOI:10.1515/jom-2023-0203
Solomon B Yanuck, Sarah K Fox, Bethany R Harting, Thomas M Motyka
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Abstract

Context: A variety of manual manipulation techniques are utilized in clinical practice to alleviate pain and improve musculoskeletal function. Many manual practitioners analyze gait patterns and asymmetries in their assessment of the patient, and an increasing number of gait motion capture studies are taking place with recent improvements in motion capture technology. This study is the first systematic review of whether these manual modalities have been shown to produce an objectively measurable change in gait mechanics.

Objectives: This study was designed to perform a systematic review of the literature to assess the impact of manual medicine modalities on biomechanical parameters of gait.

Methods: A master search term composed of keywords and Medical Subject Headings (MeSH) search terms from an initial scan of relevant articles was utilized to search six databases. We screened the titles and abstracts of the resulting papers for relevance and then assessed their quality with the Cochrane Risk of Bias Tool. Clinical trials that featured both a manual manipulation intervention and multiple mechanical gait parameters were included. Case reports and other studies that only measured gait speed or other subjective measures of mobility were excluded.

Results: We included 20 studies in our final analysis. They utilize manipulation techniques primarily from osteopathic, chiropractic, massage, and physiotherapy backgrounds. The conditions studied primarily included problems with the back, knee, and ankle, as well as healthy patients and Parkinson's patients. Control groups were highly variable, if not absent. Most studies measured their gait parameters utilizing either multicamera motion capture systems or force platforms.

Conclusions: Twelve of 20 papers included in the final analysis demonstrated a significant effect of manipulation on gait variables, many of which included either step length, walking speed, or sagittal range of motion (ROM) in joints of the lower extremity. However, the results and study design are too heterogeneous to draw robust conclusions from these studies as a whole. While there are initial indications that certain modalities may yield a change in certain gait parameters, the quality of evidence is low and there is insufficient evidence to conclude that manual therapies induce changes in biomechanical gait parameters. Studies are heterogeneous with respect to the populations studied and the interventions performed. Comparators were variable or absent across the studies, as were the outcome variables measured. More could be learned in the future with consistent methodology around blinding and sham treatment, and if the gait parameters measured were standardized and of a more robust clinical significance.

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手动操作对机械步态参数的影响
背景:在临床实践中,有多种手法操作技术可用于缓解疼痛和改善肌肉骨骼功能。许多手法医师在对患者进行评估时会对步态模式和不对称进行分析,随着近年来动作捕捉技术的发展,步态动作捕捉研究的数量也在不断增加。本研究是对这些徒手疗法是否能客观地测量步态力学变化的首次系统性回顾:本研究旨在对文献进行系统回顾,以评估徒手医学模式对步态生物力学参数的影响:方法:利用由相关文章初步扫描中的关键词和医学主题词表(MeSH)检索词组成的主检索词对六个数据库进行检索。我们对检索到的论文标题和摘要进行了相关性筛选,然后使用 Cochrane 偏倚风险工具对论文质量进行了评估。同时包含人工操作干预和多种机械步态参数的临床试验均被纳入其中。病例报告和其他仅测量步速或其他主观活动度的研究被排除在外:我们在最终分析中纳入了 20 项研究。这些研究采用的手法主要来自整骨疗法、脊椎推拿、按摩和物理疗法。研究的病症主要包括背部、膝关节和踝关节问题,以及健康患者和帕金森病患者。对照组即使不存在,也存在很大差异。大多数研究利用多摄像头运动捕捉系统或力平台测量步态参数:在最终分析的 20 篇论文中,有 12 篇论文证明了手法对步态变量的显著影响,其中许多变量包括步长、行走速度或下肢关节的矢状运动范围 (ROM)。然而,这些研究的结果和研究设计差异太大,因此无法从整体上得出可靠的结论。虽然有初步迹象表明某些方式可能会导致某些步态参数发生变化,但证据的质量较低,没有足够的证据得出徒手疗法会导致生物力学步态参数发生变化的结论。在研究人群和干预措施方面,研究结果不尽相同。各项研究的比较对象各不相同或不存在比较对象,测量的结果变量也是如此。如果能在盲法和假治疗方面采用一致的方法,如果所测量的步态参数标准化并具有更强的临床意义,那么未来就能学到更多东西。
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来源期刊
Journal of Osteopathic Medicine
Journal of Osteopathic Medicine Health Professions-Complementary and Manual Therapy
CiteScore
2.20
自引率
13.30%
发文量
118
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