Patient Factors Associated With Treatment Effect of Manual Therapy: A Scoping Review

Abstract

OBJECTIVES: To identify the association between pain phenotypic variables and manual therapy (MT) pain outcomes. DESIGN: Scoping review. LITERATURE SEARCH: The databases MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Physiotherapy Evidence Database (PEDro) were searched on November 3, 2022. STUDY SELECTION CRITERIA: Studies investigating the strength of association between patient variables and MT pain outcomes. Variables included psychosocial factors (depression, anxiety, kinesiophobia/fear, catastrophizing, patient expectations), sleep factors (sleep and fatigue), initial pain qualities (intensity, symptoms duration, variability, sensitivity, irritability), endogenously driven modifications in pain sensitivity or presentation (quantitative sensory testing, temporal summation, conditioned pain modulation), and clinical response to analgesic challenge. RESULTS: Fifty studies were included for review. We identified no to moderate associations between variables and pain outcomes, and significant variability in the number of studies performed for each variable. Baseline pain characteristics and analgesic response to MT challenge had the strongest association with MT pain outcomes. CONCLUSIONS: We found associations between patient psychological status, sleep/fatigue characteristics, baseline pain characteristics, and ability to achieve early clinical analgesia with MT pain outcomes. We propose the strength of this association may increase with clustering these variables into patient subgroups (phenotyping). Clinicians should appreciate the moderating effect of these factors on MT pain outcomes. Future studies should record phenotypic factors at baseline, and develop patient subgroups for more precise application of MT toward those who are likely to benefit from it. JOSPT Open 2024;2(2):82-98. Epub 14 February 2024. doi:10.2519/josptopen.2024.1128