Patients' experiences and perceived outcomes of manual therapy: a qualitative systematic review with framework synthesis.

OBJECTIVE: To systematically synthesize qualitative evidence on patient-reported experiences of manual therapies (including massage therapy, osteopathic manipulation, and craniosacral therapy) across biological, psychological, and social dimensions. We aimed to identify patient-perceived outcomes, contextual factors influencing the therapeutic process, and hypothesized mechanisms underlying patient experiences, thereby constructing an integrated conceptual framework centered on patient narratives. METHODS: A systematic search of Chinese and English databases was conducted from inception to March 2024 for qualitative studies exploring patient experiences of manual therapies. Methodological quality was assessed using the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist and the CASP (Critical Appraisal Skills Programme) Qualitative Checklist. Best-fit framework synthesis was employed to integrate patient-reported outcomes within the COMET (Core Outcome Measures in Effectiveness Trials) framework. Contextual factors influencing patient experiences were organized under the contextual factors framework proposed by Marco Testa for physical therapy. A diagnostic and therapeutic model of "assessment-intervention-feedback" was constructed based on the mechanisms of dynamic adaptation and multisensory integration. RESULTS: Fifteen studies were included. Manual therapies were found to significantly improve clinical symptoms, physical function, affective function, and quality of life. Simultaneously, background factors-including therapist characteristics and patient characteristics-were revealed as multidimensional regulatory mechanisms of therapeutic efficacy. A diagnostic-treatment system was constructed using tactile input as the nexus, dynamic regulation as the foundation, and multisystem synergy as the distinctive feature. Its four technical dimensions synergistically functioned throughout the diagnostic-treatment cycle, achieving integrated regulation of physiological-psychological-social systems. CONCLUSION: Manual therapy achieves multidimensional synergistic therapeutic effects through a dynamic coupling mechanism mediated by touch, integrating mechanical, neurological, and social dimensions. Its diagnostic and therapeutic system provides an innovative paradigm for the management of chronic diseases and the promotion of psychosomatic health. Future research should focus on optimizing personalized interventions by integrating artificial intelligence and wearable technologies, thereby facilitating the transition from empirical medicine to a precision science paradigm.