title: Assessment of skin blood flow following spinal manual therapy: a systematic review.
abstract: Skin blood flow (SBF) indexes have been used to describe physiological mechanisms associated with spinal manual therapy (SMT). The aims of the current review were to assess methods for data collection, assess how investigators interpreted SBF changes, and formulate recommendations to advance manual medicine research. A database search was performed in PubMed, Cochrane Library, the Physiotherapy Evidence Database, and the Cumulative Index to Nursing and Allied Health Literature through April 2014. Articles were included if at least 1 outcome measure was changes in 1 SBF index following SMT. The database search yielded 344 records. Two independent authors applied the inclusion criteria. Twenty studies met the inclusion criteria. Selected studies used heterogeneous methods to assess short-term post-SMT changes in SBF, usually vasoconstriction, which was interpreted as a general sympathoexcitatory effect through central mechanisms. However, this conclusion might be challenged by the current understanding of skin sympathetic nervous activity over local endothelial mechanisms that are specifically controlling SBF. Evaluation of SBF measurements in peripheral tissues following SMT may document physiological responses that are beyond peripheral sympathetic function. Based on the current use of SBF indexes in clinical and physiological research, 14 recommendations for advancing manual medicine research using laser Doppler flowmetry are presented.
authors.affiliation: A.T. Still Research Institute, A.T. Still University, Kirksville, MO, USA. Electronic address: rzegarraparodi@atsu.edu.
authors.forename: Rafael
authors.initials: R
authors.lastname: Zegarra-Parodi
authors.affiliation: A.T. Still University, Kirksville College of Osteopathic Medicine, Kirksville, MO, USA.
authors.forename: Peter Yong Soo
authors.initials: PY
authors.lastname: Park
authors.affiliation: A.T. Still University, School of Osteopathic Medicine, Mesa, AZ, USA.
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Heath
authors.affiliation: A.T. Still University, School of Osteopathic Medicine, Mesa, AZ, USA.
authors.forename: Inder Raj S
authors.initials: IR
authors.lastname: Makin
authors.affiliation: A.T. Still Research Institute, A.T. Still University, Kirksville, MO, USA.
authors.forename: Brian F
authors.initials: BF
authors.lastname: Degenhardt
authors.affiliation: Clinical Pharmacology Unit, Inserm CIC1406, Grenoble University Hospital, Grenoble, France; UMR 1042 - HP2, Inserm and University of Grenoble-Alpes, Grenoble, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Roustit
mesh_terms: D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D010147:Pain Measurement; D012039:Regional Blood Flow / Q000502:physiology*; D012720:Severity of Illness Index; D013131:Spine / Q000098:blood supply; D016896:Treatment Outcome
keywords: Skin blood flow index; Skin microcirculation; Spinal manual therapy; Systematic review