Efficacy of Manual Physiotherapy Techniques for Improving Cervical Range of Motion in Infants With Congenital Muscular Torticollis: A Systematic Review and Meta-Analysis.
Paul S Sung, Zebulon Murray, Mersadie Malott et al.
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In 30 seconds
This systematic review and meta-analysis assessed therapist-directed manual physiotherapy techniques for cervical range of motion (ROM) in infants with congenital muscular torticollis. Five randomized controlled trials involving 143 infants were included. Manual techniques were associated with a statistically significant pooled improvement in cervical ROM compared with the study comparators (Cohen's d = 0.90, 95% CI: 0.54 to 1.27, p < 0.001), with low between-study heterogeneity (I 2 = 9%). The authors characterize the benefit as potentially clinically meaningful in the short term, while noting that the evidence base is limited.
Key findings
- Across five trials (n = 143 infants), the pooled effect favored manual therapy for cervical ROM: Cohen's d = 0.90, 95% CI: 0.54 to 1.27, p < 0.001.
- Between-study heterogeneity was low (I 2 = 9%; τ 2 = 0.02; H 2 = 1.10).
- PEDro scores ranged from 4 to 7 out of 10, with a mean score of 6.2 and a median score of 7.
Why it matters
Restricted cervical ROM is a defining concern in congenital muscular torticollis. This synthesis suggests manual physiotherapy may improve ROM in the short term, giving clinicians evidence to consider when evaluating physiotherapy approaches. The pooled result should be interpreted alongside the small evidence base and limited information on longer-term outcomes.
What to keep in mind
Only five trials were included; intervention protocols varied, and long-term data were limited. Methodological quality ranged from 4 to 7 on the PEDro scale.