Italian Journal of Pediatrics, 2019/04, 45. doi: 10.1186/s13052-019-0631-0, type of study: ,rev,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

Full text    (https://ijponline.biomedcentral.com/articles/10.1186/s13052-019-0631-0)

Keywords:

cystic fibrosis [13]
manual therapy [169]
osteopathic manipulative treatment [3945]
OMT [3924]
musculoskeletal pain [46]
chiropractic [126]
breathing [50]
review [753]

Abstract:

Background: Pain is a common complication in patients with cystic fibrosis (CF), negatively associated with pulmonary exacerbations, quality of life and treatment adherence. Moreover, with the increased life expectancy the prevalence of musculoskeletal complications is growing, and the use of physiotherapy techniques to minimise these problems has increased. The aim of this study is to review the efficacy of physiotherapeutic manual techniques to manage musculoskeletal pain in patients with CF.
Materials and methods: MEDLINE, CINAHL, PsycINFO, Scopus, CFDB and trials registries via WHO Portal were searched since 2000 up to September 14t 2018. Search terms included (cystic fibrosis) AND (musculoskeletal pain) AND (manual therapy) AND (sham therapy OR rest OR exercise OR drug OR surgery). Results: 364 studies were identified, of which 4 (190 participants) met the inclusion criteria: 3 randomised controlled studies (85 participants) and one non-randomized study (105 participants). The study size ranged from 20 to 105 participants (age 18 or older). Duration of treatment in the included studies ranged from one day to six months. Due to data heterogeneity no meta-analysis could be performed. Manual therapy (in the form of osteopathic manipulative treatment, spinal joint and intercostal mobilization, soft tissue therapy, massage or chiropractic) was compared with sham therapy or conventional care (no manual therapy). Three RCT compared manual therapy with sham therapy or no treatment (usual care). Primary endpoints were FEV1 and a composite outcome reflecting the intensity of pain and the number of painful days over the previous month. Secondary end-points were self-assessment of breathing, pain and anxiety level measured with a questionnaire, quality of life (Cystic Fibrosis Questionnaire), need for analgesics. The studies showed no statistically significant difference between the treatment groups and the control groups, it is however interesting to note that in one study 26 patients (81%) indicated in a questionnaire that they had been interested in the study and 15 of 16 patients (94%) in the treatment arm were very satisfied with the treatment received. One nonrandomized trial studied the effect of a combination of musculoskeletal physiotherapy techniques and massage therapy (a single treatment session) on musculoskeletal pain and ease of breathing (VAS) showing a significant reduction in both outcomes, irrespective of clinical status (acute versus stable patients). Conclusions Larger and more powerful studies are needed to determine whether manual therapy techniques could be a valuable therapeutic option in the management of musculoskeletal pain for patients with cystic fibrosis. Patients interest and satisfaction also encourage further research.