Manual therapy for asthma.
BACKGROUND
A variety of manual therapies with similar postulated biologic mechanisms of action are commonly used to treat patients with asthma. Manual therapy practitioners are also varied, including physiotherapists, respiratory therapists, chiropractic and osteopathic physicians. A systematic review across disciplines is warranted.


OBJECTIVE
To evaluate the evidence for the effects of manual therapies for treatment of patients with bronchial asthma.


METHODS
Trials were searched in computerized general (EMBASE, CINAHL and MEDLINE) and specialized databases (Cochrane Complementary Medicine Field, Cochrane Rehabilitation Field, ICL, and MANTIS). In addition, bibliographies from included studies were assessed, and authors of known studies were contacted for additional information about published and unpublished trials. Date of most recent search: February 2002.


METHODS
Trials were included if they: (1) were randomised; (2) included asthmatic children or adults; (3) examined one or more types of manual therapy; and (4) included clinical outcomes.


METHODS
All three reviewers independently extracted data and assessed trial quality using a standard form.


RESULTS
From 393 unique citations, 59 full text articles were retrieved and evaluated, which resulted in nine citations to five RCTs (290 patients) suitable for inclusion. Trials could not be pooled statistically because studies that addressed similar interventions used disparate patient groups or outcomes. The methodological quality of one of two trials examining chiropractic manipulation was good and neither trial found significant differences between chiropractic spinal manipulation and a sham manoeuvre on any of the outcomes measured. Quality of the remaining three trials was poor. One small trial compared massage therapy with a relaxation control group and found significant differences in many of the lung function measures obtained. However, this trial had poor reporting characteristics and the data have yet to be confirmed. One small trial compared chest physiotherapy to placebo and one small trial compared footzone therapy to a no treatment control. Neither trial found differences in lung function between groups.


CONCLUSIONS
There is insufficient evidence to support the use of manual therapies for patients with asthma. There is a need to conduct adequately-sized RCTs that examine the effects of manual therapies on clinically relevant outcomes. Future trials should maintain observer blinding for outcome assessments, and report on the costs of care and adverse events. Currently, there is insufficient evidence to support or refute the use of manual therapy for patients with asthma.
Hondras
M A
MA
Consortial Center for Chiropractic, 30W009 Willow Court, Warrenville, Illinois 60555-1018, USA. mhondras@interaccess.com
Linde
K
K
Jones
A P
AP
D000328:Adult; D001249:Asthma / Q000534:rehabilitation / Q000628:therapy*; D002684:Chiropractic; D006801:Humans; D010021:Osteopathic Medicine; D026741:Physical Therapy Modalities; D016032:Randomized Controlled Trials as Topic; D012138:Respiratory Therapy