Current Manual Therapy Practices in Pediatric Neurological Physiotherapy: A Cross-Sectional Survey.

AIMS: To describe Manual Therapy (MT) practices, clinical reasoning, and perceived effectiveness among Greek physiotherapists working with children with neurological disorders. METHODS: A cross-sectional survey was conducted among 61 physiotherapists practicing in Greece, using a 34-item questionnaire assessing practice patterns, effectiveness, and safety. Data were analyzed using descriptive statistics and non-parametric tests. RESULTS: MT was used by 55.7% of participants, primarily as an adjunct intervention. It was rated most effective for joint mobility and range of motion. Formal MT training correlated with higher perceived effectiveness for pain reduction (p = .013) and sensory processing (p = .004). Conversely, specialized pediatric neurological training was negatively associated with perceived effectiveness for range of motion (p = .020) and joint mobility (p = .025). Frequent MT use was significantly associated with lower perceived safety (p <.001), indicating that clinical exposure increases risk awareness. No significant associations existed between years of experience and MT implementation. CONCLUSIONS: MT may have a role in managing selected biomechanical impairments when applied with clear clinical indications within a broader rehabilitation program. Training background, not years of experience, is the primary driver of clinical reasoning and risk perception. Findings emphasize the need for specialized pediatric education and longitudinal research.