Understanding factors related to application of traditional Chinese medicine tuina for congenital muscular torticollis in children: a qualitative study based on traditional Chinese medicine tuina practitioners

Background: Congenital muscular torticollis (CMT) is a common pediatric congenital musculoskeletal abnormality that may impact children’s development even quality of life if not managed appropriately. Traditional Chinese Medicine (TCM) tuina is a manual therapy derived from the theoretical foundations of TCM, has become an important non-invasive intervention in pediatric clinical practice, particularly for the management of CMT. However, the factors influencing its application remain insufficiently explored. Understanding these factors from the perspective of TCM tuina practitioners is crucial for optimizing treatment strategies and promoting broader integration of TCM tuina in pediatric care. This study aims to explore key factors related to the clinical application of TCM tuina for children with CMT, in order to inform clinical practice and support the more effective implementation of tuina therapy in pediatric care, based on qualitative insights from experienced TCM tuina practitioners. Method: A qualitative research design was employed, with data collected from a purposive sample of 15 practitioners, each with over three years of experience in TCM tuina at three different public hospitals. Individual interviews were conducted using a semi-structured interview guide. The data were processed using template analysis, facilitated by MS Word software. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist guided this study’s reporting. Results: Two main themes included: (1) existed problems, (2) optimized approaches. The theme of existed problems included the subthemes of: (a) Variability in clinical practice, (b) Barriers to parental involvement, (c) Importance of strong parental participation in TCM tuina. The theme of optimized approaches included the subthemes of: (a) Promotion of public awareness, (b) Improvement of treatment protocols, (c) Enhancement of practitioner–parent communication. Conclusion: This study highlights key factors influencing the clinical application of TCM tuina for children with CMT, as identified by experienced practitioners. Challenges such as inconsistent treatment practices, limited parental awareness, and inadequate family involvement were commonly reported. Practitioners emphasized the importance of early intervention, individualized tuina techniques, standardized protocols, and active parent-practitioner collaboration. These findings provide valuable insights for optimizing treatment strategies and promoting the effective integration of TCM tuina into pediatric care for CMT.