Efficacy of non-surgical, non-pharmacological treatments for congenital muscular torticollis: a systematic review and meta-analysis
Abstract Background Congenital Muscular Torticollis (CMT) is the third most common musculoskeletal condition in infancy, and if untreated can lead to significant disability. While a range of conservative treatments are commonly used in the management of CMT, an understanding of their efficacy and sa...
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2025-02-01
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| Online Access: | https://doi.org/10.1186/s12891-025-08407-3 |
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| author | Joyaa B. Antares Mark A. Jones Nga Ting Natalie Chak Yuan Chi Hong Li Mingdi Li Eva Y. W. Chan Tracy Mui Kwan Chen Crystal Man Ying Lee Donna M. Urquhart |
| author_facet | Joyaa B. Antares Mark A. Jones Nga Ting Natalie Chak Yuan Chi Hong Li Mingdi Li Eva Y. W. Chan Tracy Mui Kwan Chen Crystal Man Ying Lee Donna M. Urquhart |
| author_sort | Joyaa B. Antares |
| collection | DOAJ |
| description | Abstract Background Congenital Muscular Torticollis (CMT) is the third most common musculoskeletal condition in infancy, and if untreated can lead to significant disability. While a range of conservative treatments are commonly used in the management of CMT, an understanding of their efficacy and safety is limited. This systematic review and meta-analysis, without language or discipline restriction, was conducted to address this knowledge gap. Methods Electronic searches of CENTRAL, PubMed, 22 other electronic databases, three trials registers and Google Scholar, were conducted for randomised controlled trials, which examined any non-surgical, non-pharmacological interventions, including but not limited to manual treatments, movement therapy, acupuncture, adjunctive therapies and physical support, in children aged 0 to 5 years with CMT. Two reviewers independently assessed the risk of bias of the included studies using the Cochrane Risk of bias 1 tool, rated their certainty of evidence using grading of recommendations assessment, development and evaluation (GRADE) framework, and performed random-effects meta-analyses. Results One hundred studies (80 from China) involving 8125 participants published between 1990 and 2023 were included. Adding manual therapy to an active control resulted in short-term improvements in passive cervical rotation (odds ratio (OR) 9.79, 95%CI 4.26,22.50), passive cervical lateroflexion (OR 2.66, 95%CI 1.17,6.04), active cervical rotation (OR 3.94, 95%CI 1.08,14.35), symmetric head posture (OR 4.55, 95%CI 2.57,8.05), sternocleidomastoid tumour thickness (mean difference (MD) -2.12 mm, 95%CI -2.98,-1.26) and development of symmetrical movement (standardised MD -0.70, 95%CI -0.95,-0.45). The addition of an electrophysical agent to an active control reduced sternocleidomastoid tumour thickness (MD -2.03 mm, 95%CI -2.67,-1.39) and optimised Tuina reduced tumour thickness more than traditional Tuina (MD -1.20 mm, 95%CI -1.80,-0.59). Adverse events were uncommon but poorly reported, with 71 (71%) of studies providing no data. Study heterogeneity limited pooling of data for meta-analysis, and there was very low to low certainty evidence for all results, due to high risk of bias, small sample sizes and study heterogeneity. Conclusions This review found that non-surgical, non-pharmacological treatments may be effective for CMT, but the certainty of evidence is very low to low. These findings are important in informing clinical guidelines and management for CMT and highlight an urgent need for large definitive trials that address the limitations of current studies. Protocol registration Cochrane Database of Systematic Reviews (No.: CD012987). |
| format | Article |
| id | doaj-art-6e0aa9a69d0d4047bf7d5c087ff6ae11 |
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| publishDate | 2025-02-01 |
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| spelling | doaj-art-6e0aa9a69d0d4047bf7d5c087ff6ae112025-08-20T02:15:17ZengBMCBMC Musculoskeletal Disorders1471-24742025-02-0126111610.1186/s12891-025-08407-3Efficacy of non-surgical, non-pharmacological treatments for congenital muscular torticollis: a systematic review and meta-analysisJoyaa B. Antares0Mark A. Jones1Nga Ting Natalie Chak2Yuan Chi3Hong Li4Mingdi Li5Eva Y. W. Chan6Tracy Mui Kwan Chen7Crystal Man Ying Lee8Donna M. Urquhart9GC OsteopathyInstitute for Evidence-Based Healthcare, Bond UniversityUnited Christian Hospital, Kwun TongDepartment of Health Research Methods, Evidence and Impact, McMaster UniversitySchool of Traditional Chinese Medicine, Southern Medical UniversityDepartment of Preventive Health Care, Qingdao Hiser Hospital Affiliated With Qingdao University (Qingdao Traditional Chinese Medicine Hospital)Department of Physiotherapy, School of Nursing and Health Sciences, Hong Kong Metropolitan UniversityAPA Physiotherapy ServicesSchool of Population Health, Curtin UniversitySchool of Public Health and Preventive Medicine, Monash UniversityAbstract Background Congenital Muscular Torticollis (CMT) is the third most common musculoskeletal condition in infancy, and if untreated can lead to significant disability. While a range of conservative treatments are commonly used in the management of CMT, an understanding of their efficacy and safety is limited. This systematic review and meta-analysis, without language or discipline restriction, was conducted to address this knowledge gap. Methods Electronic searches of CENTRAL, PubMed, 22 other electronic databases, three trials registers and Google Scholar, were conducted for randomised controlled trials, which examined any non-surgical, non-pharmacological interventions, including but not limited to manual treatments, movement therapy, acupuncture, adjunctive therapies and physical support, in children aged 0 to 5 years with CMT. Two reviewers independently assessed the risk of bias of the included studies using the Cochrane Risk of bias 1 tool, rated their certainty of evidence using grading of recommendations assessment, development and evaluation (GRADE) framework, and performed random-effects meta-analyses. Results One hundred studies (80 from China) involving 8125 participants published between 1990 and 2023 were included. Adding manual therapy to an active control resulted in short-term improvements in passive cervical rotation (odds ratio (OR) 9.79, 95%CI 4.26,22.50), passive cervical lateroflexion (OR 2.66, 95%CI 1.17,6.04), active cervical rotation (OR 3.94, 95%CI 1.08,14.35), symmetric head posture (OR 4.55, 95%CI 2.57,8.05), sternocleidomastoid tumour thickness (mean difference (MD) -2.12 mm, 95%CI -2.98,-1.26) and development of symmetrical movement (standardised MD -0.70, 95%CI -0.95,-0.45). The addition of an electrophysical agent to an active control reduced sternocleidomastoid tumour thickness (MD -2.03 mm, 95%CI -2.67,-1.39) and optimised Tuina reduced tumour thickness more than traditional Tuina (MD -1.20 mm, 95%CI -1.80,-0.59). Adverse events were uncommon but poorly reported, with 71 (71%) of studies providing no data. Study heterogeneity limited pooling of data for meta-analysis, and there was very low to low certainty evidence for all results, due to high risk of bias, small sample sizes and study heterogeneity. Conclusions This review found that non-surgical, non-pharmacological treatments may be effective for CMT, but the certainty of evidence is very low to low. These findings are important in informing clinical guidelines and management for CMT and highlight an urgent need for large definitive trials that address the limitations of current studies. Protocol registration Cochrane Database of Systematic Reviews (No.: CD012987).https://doi.org/10.1186/s12891-025-08407-3Conservative treatmentSafetyInfantManual therapyElectrophysical agentsTraditional Chinese Massage |
| spellingShingle | Joyaa B. Antares Mark A. Jones Nga Ting Natalie Chak Yuan Chi Hong Li Mingdi Li Eva Y. W. Chan Tracy Mui Kwan Chen Crystal Man Ying Lee Donna M. Urquhart Efficacy of non-surgical, non-pharmacological treatments for congenital muscular torticollis: a systematic review and meta-analysis BMC Musculoskeletal Disorders Conservative treatment Safety Infant Manual therapy Electrophysical agents Traditional Chinese Massage |
| title | Efficacy of non-surgical, non-pharmacological treatments for congenital muscular torticollis: a systematic review and meta-analysis |
| title_full | Efficacy of non-surgical, non-pharmacological treatments for congenital muscular torticollis: a systematic review and meta-analysis |
| title_fullStr | Efficacy of non-surgical, non-pharmacological treatments for congenital muscular torticollis: a systematic review and meta-analysis |
| title_full_unstemmed | Efficacy of non-surgical, non-pharmacological treatments for congenital muscular torticollis: a systematic review and meta-analysis |
| title_short | Efficacy of non-surgical, non-pharmacological treatments for congenital muscular torticollis: a systematic review and meta-analysis |
| title_sort | efficacy of non surgical non pharmacological treatments for congenital muscular torticollis a systematic review and meta analysis |
| topic | Conservative treatment Safety Infant Manual therapy Electrophysical agents Traditional Chinese Massage |
| url | https://doi.org/10.1186/s12891-025-08407-3 |
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