Context is Complex: Challenges and opportunities addressing contextual factors in manual therapy mechanisms research.

Damian L Keter, Jorge E Esteves, M Terry Loghmani, Giacomo Rossettini, Chad E Cook

Abstract read

In one paragraph

Article in International journal of osteopathic medicine : IJOM, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it

0cells of the map it votes in

1citing papers in PubMed

–field-weighted citation impact

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

Manual therapy treatment mechanisms are complex: Challenges and a call to action.Complementary therapies in medicine · 2026
Article

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Damian L KeterPhysical Medicine and Rehabilitation Department, United States Department of Veterans Affairs, Cleveland, OH, USA.

Jorge E EstevesClinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy.

M Terry LoghmaniDepartment of Physical Therapy, School of Health & Human Sciences, Indiana University, Indianapolis, IN, USA.

Giacomo RossettiniDepartment of Physiotherapy, Faculty of Sport Sciences, Musculoskeletal Pain and Motor Control Research Group, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain.

Chad E CookDepartment of Orthopaedics, Duke University, Durham, NC, USA.

Funding

Intramural VA VA999999

6 · The paper itself

Abstract

Mechanistic studies on manual therapy (MT) have potential to allow better understanding of 'why' and 'how' MT interventions provide an effect. Contextual factors (CF) include the multitude of intrinsic and extrinsic inputs outside of the specific intervention which influence response. CFs must be accounted for within both clinical and mechanistic trials. The influence of CFs provides several challenges and opportunities which are outlined within this commentary. Researchers should consider the specific purpose of their research when developing mechanistic trials to establish if controlling versus recording CF is warranted based on their aim(s).

Indexed as

Contextual FactorsMechanisms ResearchMusculoskeletal ManipulationsPainPhysiotherapy

Identifiers

PMID42267145

DOI10.1016/j.ijosm.2025.100750

PMCPMC13245580

What Socratic holds

Textmetadata

LicenceTDM

Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.