What effect can manual therapy have on a patient's pain experience?

Manual therapy (MT) is a passive, skilled movement applied by clinicians that directly or indirectly targets a variety of anatomical structures or systems, which is utilized with the intent to create beneficial changes in some aspect of the patient pain experience. Collectively, the process of MT is grounded on clinical reasoning to enhance patient management for musculoskeletal pain by influencing factors from a multidimensional perspective that have potential to positively impact clinical outcomes. The influence of biomechanical, neurophysiological, psychological and nonspecific patient factors as treatment mediators and/or moderators provides additional information related to the process and potential mechanisms by which MT may be effective. As healthcare delivery advances toward personalized approaches there is a crucial need to advance our understanding of the underlying mechanisms associated with MT effectiveness.

The state of personalized treatment for anxiety disorders: A systematic review of treatment moderators.

INTRODUCTION: The aim of this review was to synthesize findings for moderators of treatment outcome across adult anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder. METHODS: Twenty-four papers that compared two or more active treatments (at least one of which was a form of cognitive behavioral therapy [CBT]) were identified and organized into five treatment comparison categories (distinct psychotherapy combinations, CBT full package vs. single components, CBT vs. augmented CBT, CBT delivery methods, and CBT vs. pharmacotherapy). Sixty-three distinct baseline moderators were tested across seven categories (symptom severity, comorbid emotional disorders or emotional reactivity, cognitive maintenance factors, behavioral maintenance factors, personality traits and disorders, sociodemographic factors, and biological factors). RESULTS: Few consistent treatment moderators were identified. All studies testing quadratic effects found at least one significant non-linear moderator or predictor effect. In addition, the majority of studies had methodological problems and limitations, demonstrating the need for future methodological improvements. CONCLUSION: Limited conclusions can be drawn about how to match anxiety disorder patients to treatment. A strong need to improve the methodological consistency and rigor of treatment moderator studies was identified. A series of recommendations for moderation analyses are proposed in order to strengthen future studies and facilitate replication efforts.