title: Does postural sway change in association with manual therapeutic interventions? A review of the literature.
abstract: METHODS
  Literature Review
  
  
  OBJECTIVE
  The objective of this literature review was to determine if postural sway changes in association with manual therapeutic interventions and to investigate whether any changes occur in healthy individuals or in association with pain intensity.
  
  
  BACKGROUND
  Improving postural stability has been proposed as a goal of manual therapeutic interventions. So far, no literature review has addressed whether there is supportive evidence for this and if so, what factors may be associated or causative for observed sway alterations.
  
  
  METHODS
  Seven online databases (PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, ScienceDirect and the Cochrane library) were systematically searched followed by a manual search of the retrieved papers.
  
  
  METHODS
  Studies comparing postural sway derived from bipedal force plate measurements in association with a manual therapeutic intervention, ideally compared to a control group.
  
  
  METHODS
  Two reviewers independently screened titles and abstracts for relevance, conducted the data extraction and the risk of bias assessment which was conducted using the RTI item bank. A descriptive analysis was conducted as the heterogeneous study designs prevented pooling of data.
  
  
  RESULTS
  Nine studies of varying methodological quality met the inclusion criteria. No direct comparison of data across the studies was possible. There was no evidence that manual interventions lead to a change in postural sway in healthy individuals regardless of the body regions addressed by the intervention. There was some indication that postural sway may change at follow-up measurements in pain sufferers; however, this may be due to variations in pain intensity rather than resulting from the intervention itself.
  
  
  CONCLUSIONS
  There is no conclusive scientific evidence that manual therapeutic interventions may exhibit any immediate or long-term effect on COP excursions. Any changes in sway may be attributable to decreases in pain intensity.
authors: School of Health Professions, Murdoch University, Murdoch, Western Australia, Australia. alexander_ruhe@hotmail.com.
authors: Alexander
authors: A
authors: Ruhe
authors: René
authors: R
authors: Fejer
authors: Bruce
authors: B
authors: Walker
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