A systematic review of non-invasive manual therapies in the management of irritable bowel syndrome

Abstract

Background: Practitioners are increasingly required to practice within an evidence-based setting, with the demand being driven by patients as well as health management organisations. This is compounded by large volumes of literature that is available, making it difficult for the practitioner to synthesise and apply this knowledge. A systematic review provides an avenue for literature to be organized, critiqued and available in a condensed form for practitioners. The objective of this study was, therefore, to formulate such a review in order to provide practitioners with consolidated evidence of the efficacy of non-invasive manual interventions for patients with irritable bowel syndrome.

Method: A systematic search of the literature as well as a hand search were conducted with the following key terms: ”irritable bowel syndrome”, “conservative”, “manual”, “manipulation”, “manual manipulation”, “osteopathic manipulation”, “manual therapy”, “movement therapies”, “physical therapies”, “massage”, “exercise”, “kinesiology”, “reflexology”, “thermotherapy” and “yoga” (alone and in combination). The databases included: CINAHL Plus, Google Scholar, MEDLINE, Metalib, Pubmed, Science Direct, Springerlink and Summons. Once screened for inclusion and exclusion criteria, a final 18 articles earned inclusion status. The criteria included: Citation Inclusion- to be available in electronic format for purposes of accessing the citation; the title to include one or more of the following term(s): irritable bowel syndrome, conservative, manual, manipulation, manual manipulation, osteopathic manipulation, manual therapy, movement therapies, physical therapies, massage, exercise, kinesiology, reflexology, thermotherapy and yoga (alone and in combination). Full abstract / publication inclusion criteria -studies published in, or translated to, English; randomised controlled clinical trials, clinical trials, case reports or series and observational studies were included in the study; studies pertaining to the non-invasive manual therapy of IBS (as per the key terms above); studies pertaining to medicinal and non-surgical interventions. Exclusion criteria - non-English studies; studies inaccessible in full article format;

studies defined as a systematic review, review of literature or expert opinions. The articles were then individually rated by seven independent reviewers. Ratings were achieved via the application of published and validated scales. These include the Newcastle-Ottawa, PEDRO as well as Liddle rating scales, each specifically formulated to systematically evaluate the methodological rigour of articles as per their particular study type.

Data Collection and Analysis: The data obtained from the independent reviewers was then analysed and used to rank the articles, first individually according to the results achieved via aforementioned rating scales, and then collectively per intervention to determine the level of evidence in support of the non-invasive manual therapy interventions for irritable bowel syndrome.

Results: A total of 1542 potential citations were initially identified, with 15 articles enduring the screening process. A secondary hand-search added three additional articles, rendering a total of 18 articles for review. On analysis of the results, it was found that osteopathic care, yoga therapy and traditional Chinese spinal orthopedic manipulation interventions had the strongest and most consistent outcome for positive benefit for IBS patients. Chiropractic care and massage therapy presented with limited evidence, while no evidence was produced in support of reflexology in the treatment of patients with IBS.

Conclusion: It is evident that future research is required in all of the above fields in order to expand on the limited available evidence while addressing the limitations of previous studies, as highlighted in this systematic review. This would strengthen the literature and allow for improved clinical decision making based on available evidence that is of high quality and practical value.