Effects of mobilization or manipulation of the thoracic spine on autonomic nervous system markers in symptomatic and asymptomatic participants - a systematic review and meta-analysis.
Lars Hansen, Hartmut Goebel, Larissa Pagels, Kerstin Luedtke
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引用次数: 0
Abstract
Objectives: To identify the effects of thoracic mobilization/manipulation on autonomic nervous system responses.
Methods: Four electronic databases were searched for controlled trials published before February 2024. Studies on mobilization/manipulation of the thoracic spine were included evaluating effects on the autonomic nervous system (ANS). Risk of bias was assessed by two independent assessors using the Cochrane risk-of-bias tool 2, the RoB-2 tool for crossover studies or the ROBINS-I tool. Meta-analyses using random-effects models present the overall combined mean effects.
Results: 2139 articles were identified, 20 studies (863 participants) were included in the qualitative data analysis and 15 in meta-analyses. Four studies had a high risk of bias in one or more domains. Meta-analyses indicated no statistically significant effect of mobilization or manipulation on markers of the ANS. The ratio of low-frequency-to-high-frequency power did not significantly decrease after thoracic mobilization/manipulation compared to any type of control intervention (-0.28; 95% CI -0.59 to 0.04; p=0.09). Skin conductance and root mean square of successive RR interval differences as well as LFab (ms^2; absolute power of the low-frequency band) did not significantly increase after thoracic mobilization/manipulation. Subgroup and sensitivity-analyses indicated no significant effects.
Discussion: Methodological limitations and heterogeneity (I2=0-94%) in reported outcomes, reduce the level of evidence. Future studies with a rigorous methodological approach and studies on symptomatic participants with longer follow-ups are warranted.
Conclusion: No significant effects of mobilization/manipulation of the thoracic spine on ANS markers were found. The direction of changes towards increased or decreased sympathetic or parasympathetic nervous system activity was ambiguous.
期刊介绍：
The Journal of Manual & Manipulative Therapy is an international peer-reviewed journal dedicated to the publication of original research, case reports, and reviews of the literature that contribute to the advancement of knowledge in the field of manual therapy, clinical research, therapeutic practice, and academic training. In addition, each issue features an editorial written by the editor or a guest editor, media reviews, thesis reviews, and abstracts of current literature. Areas of interest include: •Thrust and non-thrust manipulation •Neurodynamic assessment and treatment •Diagnostic accuracy and classification •Manual therapy-related interventions •Clinical decision-making processes •Understanding clinimetrics for the clinician
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