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Meta-Analysis
. 2018 Jan 24;8(1):e019040.
doi: 10.1136/bmjopen-2017-019040.

Manual therapy for unsettled, distressed and excessively crying infants: a systematic review and meta-analyses

Dawn Carnes  1   2   3 , Austin Plunkett  1   3 , Julie Ellwood  3 , Clare Miles  1
Affiliations
Meta-Analysis

Manual therapy for unsettled, distressed and excessively crying infants: a systematic review and meta-analyses

Dawn Carnes et al. BMJ Open. .

Abstract

Objective: To conduct a systematic review and meta-analyses to assess the effect of manual therapy interventions for healthy but unsettled, distressed and excessively crying infants and to provide information to help clinicians and parents inform decisions about care.

Methods: We reviewed published peer-reviewed primary research articles in the last 26 years from nine databases (Medline Ovid, Embase, Web of Science, Physiotherapy Evidence Database, Osteopathic Medicine Digital Repository , Cochrane (all databases), Index of Chiropractic Literature, Open Access Theses and Dissertations and Cumulative Index to Nursing and Allied Health Literature). Our inclusion criteria were: manual therapy (by regulated or registered professionals) of unsettled, distressed and excessively crying infants who were otherwise healthy and treated in a primary care setting. Outcomes of interest were: crying, feeding, sleep, parent-child relations, parent experience/satisfaction and parent-reported global change.

Results: Nineteen studies were selected for full review: seven randomised controlled trials, seven case series, three cohort studies, one service evaluation study and one qualitative study.We found moderate strength evidence for the effectiveness of manual therapy on: reduction in crying time (favourable: -1.27 hours per day (95% CI -2.19 to -0.36)), sleep (inconclusive), parent-child relations (inconclusive) and global improvement (no effect). The risk of reported adverse events was low: seven non-serious events per 1000 infants exposed to manual therapy (n=1308) and 110 per 1000 in those not exposed.

Conclusions: Some small benefits were found, but whether these are meaningful to parents remains unclear as does the mechanisms of action. Manual therapy appears relatively safe.

Prospero registration number: CRD42016037353.

Keywords: Excessive Crying; Infants; Manual Therapy; Paediatrics; ’colic'.

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Conflict of interest statement

Competing interests: CM had financial support from the National Council for Osteopathic Research from crowd-funded donations.

Figures

Figure 1
Figure 1
Flow chart of search process for the review. RCTs, randomised controlled trials.
Figure 2
Figure 2
Reduction in crying: RCTs mean difference. *Like Dobson et al, we were unable to determine the SD for the Olafsdottir et al data. The Dobson review assigned the SD of change scores based on the correlation coefficient of other, similar studies, because personal correspondence was not successful with the author. We used the data from the Dobson et al review. **Miller is the same study labelled Miller in the Dobson review, which was a conference report in advance of the 2012 publication.
Figure 3
Figure 3
Adverse events meta-analysis: RCTs relative risk. RCTs, randomised conrolled trials.
See this image and copyright information in PMC

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