OBJECTIVE: The aims of this work are to evaluate the validity and reliability of manual assessment and treatment, and the effectiveness of manual therapy for non-specific adult thoracic pain. DATA SOURCES: Review of the literature. DATABASES CONSULTED: PubMed, Embase, CINAHL, PEDro, and the Cochrane Library. STUDY SELECTION: Articles were selected if they concerned the thoracic spine and rib cage, and outcome measures were within the scope of manual therapy practice. DATA EXTRACTION: Studies about diagnostic tests were excluded if the study population was less than 10 subjects, and Cohen's Kappa scores or Pearson's Correlation Coefficients or Intraclass Correlation Coefficients were not calculated. Studies about treatment were excluded if the PEDro score was less than 4/10. DATA SYNTHESIS: Studies concerning physical examination procedures have shown a good intrarater, but poor interrater reliability. Studies of the mechanical effects of manipulation have given discordant results, while those on the clinical effects of manipulation have given positive results. CONCLUSIONS: Procedures of physical examination did not show sufficient interexaminer reliability. Manipulative treatment seems to be clinically effective, but whether manual treatment is more effective than non-treatment, other treatments or placebo, cannot be established.

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