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The Effectiveness of Instrument-Assisted Soft Tissue Mobilization in Athletes, Participants Without Extremity or Spinal Conditions, and Individuals with Upper Extremity, Lower Extremity, and Spinal Conditions: A Systematic Review

  • Goris Nazari
    Correspondence
    Corresponding author Goris Nazari, PT, MSc, PhD, School of Physical Therapy, University of Western Ontario Faculty of Health Sciences, Richmond Street, London, Ontario, N6A 3K7 Canada.
    Affiliations
    School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada

    Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, Ontario, Canada
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  • Pavlos Bobos
    Affiliations
    School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada

    Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, Ontario, Canada
    Search for articles by this author
  • Joy C. MacDermid
    Affiliations
    School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada

    Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, Ontario, Canada

    Roth McFarlane Hand and Upper Limb Centre, St. Joseph’s Hospital, London, Ontario, Canada
    Search for articles by this author
  • Trevor Birmingham
    Affiliations
    School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada

    Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, Ontario, Canada
    Search for articles by this author
Published:February 21, 2019DOI:https://doi.org/10.1016/j.apmr.2019.01.017

      Abstract

      Objective

      To assess the effectiveness of instrument-assisted soft tissue mobilization (IASTM) to other treatments or placebo in athletes or participants without extremity or spinal conditions and individuals with upper extremity, lower extremity, and spinal conditions.

      Data Sources

      The MEDLINE, EMBASE, CINAHL, and PEDro electronic databases were searched from January 1998 to March 2018.

      Study Selection

      Randomized controlled trials of participants without extremity or spinal conditions or athletes and people with upper extremity, lower extremity, or spinal conditions, who revived IASTM vs other active treatment, placebo, or control (no treatment), to improve outcome (function, pain, range of motion).

      Data Extraction

      Two independent review authors extracted data, assessed the trials for risk of bias using the Cochrane Risk of Bias tool in included studies, and performed the rating of quality of individual trials per outcome across trials was also performed using the Grading of Recommendations, Assessment, Development, and Evaluations guidelines.

      Data Synthesis

      Nine trials with 43 reported outcomes (function, pain, range of motion, grip strength), compared the addition of IASTM over other treatments vs other treatments. Six trials with 36 outcomes reported no clinically important differences in outcomes between the 2 groups. Two trials with 2 outcomes displayed clinically important differences favoring the other treatment (without IASTM) group. Six trials with 15 reported outcomes (pressure sensitivity, pain, range of motion, muscle performance), compared IASTM vs control (no treatment). Three trials with 5 outcomes reported no clinically important differences in outcomes between the 2 groups. Furthermore, in 1 trial with 5 outcomes, IASTM demonstrated small effects (standard mean difference range 0.03-0.24) in terms of improvement muscle performance in physically active individuals when compared to a no treatment group.

      Conclusion

      The current evidence does not support the use of IASTM to improve pain, function, or range of motion in individuals without extremity or spinal conditions or those with varied pathologies.

      Keywords

      List of abbreviations:

      CI (confidence interval), GRADE (Grading of Recommendations, Assessment, Development, and Evaluation), IASTM (instrument-assisted soft tissue mobilization), MCID (minimal clinically important difference), MD (mean difference), OIS (optimal information size), RCT (randomized controlled trial), SMD (standard mean difference)
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