Cost of manual therapy for musculoskeletal disorders: a systematic review of systematic reviews with methodological and reporting quality

Objective : The purpose of this systematic review of systematic reviews was to determine the cost-effectiveness of manual therapy in the management of patients with musculoskeletal disorders, with an assessment of methodological and reporting quality. Methods: To be included, publications needed to be systematic reviews including studies with participants with musculoskeletal conditions > 18 years old; the experimental intervention was manual therapy; assessed the cost of manual therapy; and were published in English. Literature, narrative, and scoping reviews were excluded. An electronic search was conducted in May 2024 using CINAHL (EBSCO Host), Ovid MEDLINE (R) ALL, the Cochrane Library, and Embase. The methodological and reporting quality of systematic reviews was assessed using A MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020). Cost data was reported narratively. AMSTAR 2 and PRISMA compliancewas summarized narratively and graphically. Results: Eleven systematic reviews were included. Approximately half of the reviews on spine pain concluded that manual therapy and acupuncture were cost-effective compared to usual care. A limited number of systematic reviews on peripheral joint pain concluded that manual therapy was cost-effective for shoulder pain, but was inconclusive for ankle fractures and knee osteoarthritis. Confidence in the results of the included reviews was low to critically low. Compliance with PRISMA guidelines was highly variable. Conclusion: Overall low to critically low methodological quality, variability in reporting quality, and heterogeneity of cost data makes it difficult to draw summative conclusions about the cost-effectiveness of manual therapy for patients with musculoskeletal conditions.