title: Spinal manual therapy interventions for pediatric patients: a systematic review.
abstract: OBJECTIVE
  Although much has been written about the efficacy of manual therapy interventions for adults with headaches or spinal pain, little research has focused on the use of these interventions in pediatric patients. The purpose of this systematic review was to evaluate the evidence for spinal manual therapy (SMT) interventions in patients 4-17 years old with headaches and/or mechanical spinal pain.
  
  
  METHODS
  A search for relevant studies published in the past 15 years was conducted on MEDLINE, CINAHL, Cochrane Central Register of Randomized Control Trials, PEDro, PubMed, and Sports Discus. Only English language articles were reviewed. Studies had to include at least one outcome measure for pain, function, or quality of life. Studies evaluating post-operative interventions, or those in which the interventions were directed at influencing excessive spinal curvatures, were excluded. Case reports and studies that did not limit analysis of the results to the pediatric population were also excluded.
  
  
  RESULTS
  Two randomized control trials and two studies offering lower levels of evidence were identified in the literature search. The latter studies were prospective cohort studies. The four studies were evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria.
  
  
  CONCLUSIONS
  There are very little data in the literature to support or refute the use of SMT interventions in pediatric patients. Further research is required to establish a strong evidence-based foundation for use of these interventions in children.
authors.affiliation: Grand Valley State University, Grand Rapids, MI, USA.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Vaughn
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Kenyon
authors.forename: Corey M
authors.initials: CM
authors.lastname: Sobeck
authors.forename: Robyn E
authors.initials: RE
authors.lastname: Smith
keywords: Headaches; Manipulation; Pediatrics; Spine; Systematic review
references.citation: Baillieres Clin Rheumatol. 1992 Oct;6(3):575-93
references.pmid: 1477892
references.citation: BMJ. 2008 Apr 26;336(7650):924-6
references.pmid: 18436948
references.citation: J Orthop Sports Phys Ther. 2003 Sep;33(9):513-22
references.pmid: 14524510
references.citation: Allergy. 2009 May;64(5):669-77
references.pmid: 19210357
references.citation: J Child Neurol. 2009 Apr;24(4):406-9
references.pmid: 19339283
references.citation: J Am Osteopath Assoc. 2010 Jul;110(7):376-80
references.pmid: 20693569
references.citation: J Orthop Sports Phys Ther. 2004 Nov;34(11):701-12
references.pmid: 15609490
references.citation: Ann Intern Med. 2004 Dec 21;141(12):920-8
references.pmid: 15611489
references.citation: Chiropr Osteopat. 2010 Jun 02;18:16
references.pmid: 20525200
references.citation: J Manipulative Physiol Ther. 2004 Oct;27(8):493-502
references.pmid: 15510092
references.citation: Pediatrics. 2007 Jan;119(1):e275-83
references.pmid: 17178922
references.citation: J Manipulative Physiol Ther. 2000 Oct;23(8):557-63
references.pmid: 11050613
references.citation: J Orthop Sports Phys Ther. 2006 Apr;36(4):209-14
references.pmid: 16676870
references.citation: Spine (Phila Pa 1976). 2008 Sep 15;33(20):E721-7
references.pmid: 18794746
references.citation: J Manipulative Physiol Ther. 2003 Jan;26(1):1-8
references.pmid: 12532132
references.citation: BMJ. 2004 Jun 19;328(7454):1490
references.pmid: 15205295
references.citation: Chiropr Osteopat. 2010 Jun 02;18:15
references.pmid: 20525199
references.citation: Headache. 2010 Feb;50(2):224-30
references.pmid: 19845788
references.citation: J Manipulative Physiol Ther. 2001 Sep;24(7):457-66
references.pmid: 11562654
references.citation: J Orthop Sports Phys Ther. 2007 Jun;37(6):290-302
references.pmid: 17612355
references.citation: Pain. 2005 Dec 15;119(1-3):150-158
references.pmid: 16298064