Place of manual therapy in patients with endometriosis: Review of the scope - Material and method

The aim of this study is to review the current state of knowledge on the evolution of chronic or cyclical pelvic pain in patients with endometriosis and their quality of life using manual therapy.

A scoping review has proved to be the most appropriate way of addressing this issue, enabling us to compare the various studies carried out to date. A scoping review enables us to take stock of the current state of knowledge, not to mention the quality of the studies selected. It is a broader approach than the systematic review, as it does not assess the methodological quality of the selected studies. This scoping review takes into account observational, experimental and literary studies.

The searches used in this literature review were carried out between December 2021 and December 2022. The articles are scientific and medical publications found in various white and grey literature databases as follows:

• Databases :
  • Pubmed;
  • ScienceDirect ;
  • Cochrane.
• Grey literature: magazine articles:
  • International Journal of Osteopathic Medicine ;
  • European journal of obstetrics, gynecology, and reproductive biology ;
  • American journal of obstetrics and gynecology.

In addition, the author of the dissertation is interested in the references of the selected articles in order to find additional articles that are sometimes not present from the first searches.

Various keywords in English, chosen by the author in advance, were used. For greater relevance, the keywords chosen have been verified and are part of MeSH (Medical Subject Headings). The "manual therapy" terms chosen were: manual therapy, physical therapy, manipulate, touch and ostopathy. For endometriosis, the term chosen and seen in the MeSH is: endometriosis. To enrich research on this pathology, pelvic pain, abdominal pain and adenomyosis were also used.

During the study, the articles searched for had to have the keywords used in their title or abstract, otherwise the title of the article had to evoke the subject of the search. To make the search as thorough as possible, the keywords were linked by the Boolean operators "AND", "OR" or "*".

The research was carried out as follows:

• PubMed → (("manual therap*") OR ("physical therap*") OR (manipulat*) OR (touch*) OR (osteopath*)) AND (endometriosis) ;
• ScienceDirect → ((manual therap$) OR (physical therap$) OR (manipulat*) OR(touch*) OR (osteopath*)) AND ((endometrios) OR (pelvic pain) OR (abdominal pain) OR (adenomyosis)) ;
• Cochrane → ((manual therapy) OR (physical therapy) OR (manipulation) OR (touch) OR (osteopathy)) AND ((endometriosis) OR (pelvic pain) OR (abdominal pain) OR (adenomyosis)).

For the study, inclusion, non-inclusion and exclusion criteria were chosen prior to the search for the articles we selected. They are as follows

• Inclusion criteria:
  • articles in English or French ;
  • major women diagnosed with endometriosis;
  • manual therapies included: osteopathy; chiropractic; physiotherapy; massage; acupuncture.
• Non-inclusion criteria :
  • articles not available in full version ;
  • articles in languages other than French and English;
  • studies involving underage women or women not diagnosed with endometriosis.
• Exclusion criteria :
  • articles that don't provide any answers to the problem; - duplicates.

To select the articles for the study, the protocol from the Guide d'analyse de la littérature et gradations des recommandations (17) was used, as shown in figure 1. It was published by ANAES in 2000 and proceeds as follows:

1. discard articles whose title does not refer to the research topic;

2. read the summary to check that it contains the key words or evokes the subject of the

   the search ;

3. read the entire article to assess the relevance of the information

   on the subject ;

4. Remove duplicates.

Figure 1: Selection of articles using the Guide to literature analysis protocol and

gradations of recommendations

Firstly, the thesis will analyze the evolution of chronic or cyclical pelvic pain in patients with endometriosis and the change in their quality of life thanks to manual therapy.

In a second phase, the study will look at the evolution of other symptoms of the disease using manual therapies:

• dyspareunia;

• dysmenorrhea;

• digestive damage;

• neurological damage;

• asthenia;

• infertility;

• ... (6)(7).

Lastly, we analyze the type of treatment used: standardized, massage, non-specific touch, etc.

Before starting the research, the author of the dissertation created a computer table with different information to be selected for each article. So, once an article has been selected, it is entered directly into this table. The data, selected by the author of the brief, are :

• title, author, year of article ;

• purpose of the study ;

• study population ;

• techniques/manual therapy used;

• changes in pain and quality of life (primary data) ;

• evolution of other endometriosis symptoms (secondary data);

• conclusion.

The author of the brief carried out the research, selected and analyzed the articles, then extracted the information to fill in the summary table directly.