Agreement or disagreement with GAPS in force-based mechanisms research.

	Composite Score (Range: −16 to 16)	Consensus Status
Gaps in neurological mechanisms research (fMRI etc.)
Developing a model that uses (EEG, central reflexes, etc) to identify both spinal and supraspinal mechanisms associated with pain modulation.	11	CM
Studies investigating by fMRI how people with different pain types (nociceptive, nociplastic, neuropathic etc) respond to FBM	6	CM
Neuroimaging studies investigating the effects of FBM on the ANS, nociceptive and interoceptive systems in both healthy individuals and chronic pain patients (e.g. musculoskeletal related, visceral)	5	CNM
Studies describing the cellular and molecular responses to different types and dosages of FBM	4	CNM
Gaps in neuroimmune mechanisms research (inflammatory/anti-inflammatory mediators etc.)
Studies investigating how various FBMs impact the inflammatory process and how putative inflammatory mediators affect pain pathways.	9	CM
Studies investigating differences in inflammatory parameters and other mechanisms of FBM including long term follow up studies with characteristics of applied force being considered.	6	CM
Studies investigating the effects of FBM on neurogenic inflammation	1	CNM
Studies (human) investigating different FBM and their effects in formation of fibrosis post inflammation and in tissue repair (scar tissue formation post-surgery)	1	CNM
Gaps in biomechanical/kinematic mechanisms research (tissue movement, fluid loading, etc)
Studies that link biomechanical and neurophysiological responses (both segmentally/regionally and globally)	10	CM
Studies that evaluate the effects of FBM on regional and global neuromechanical function	5	CNM
Studies that investigate the potential of FBM to create tissue damage and injury	4	CNM
Studies that use in silico approaches (e.g. FEM) to identify structures loaded as a result of FBM.	3	CNM
Studies that determine how FBM changes regional and global movement – optimally linking this with direct measurements	3	CNM
Studies that explore the ‘plausibility’ of FBM to cause reported adverse events; trying to replicate AEs in the lab. e.g. can we ‘cause’ a stroke in a lab using FBM?	1	CNM
Studies investigating the effects of FBM on passive physiological and accessory motion	0	CNM
Gaps in neurovascular mechanisms research (sympathetic response etc.)
Studies exploring the interaction of ANS effects and descending pain modulatory effects of FBM	11	CM
Studies exploring direct evidence for the action of FBM on the ANS, specifically in terms of demonstration of neurotransmitter levels and microneurographic studies	4	CNM
Gaps in neurotransmitters mechanisms research (serotonin, B endorphin, etc.)
Studies investigating how meaningful neuroendocrine effects may be for pain, inflammation, or movement	5	CM
Gaps in translational mechanisms research (Correlating mechanisms to clinical outcomes)
Studies that Determine if and how much contextual factors can change mechanisms of FBM	13	CM
Studies clarifying direct versus behavioral assessment. (ie. Do findings in animal studies have relevance to humans.)	10	CM
Studies that investigate whether a change in any mechanisms have an impact on clinical outcomes.	7	CM
Gaps in contextual factors influence on mechanisms (contextual factors effect on mechanisms)
Studies that explore improved sham for different types of FBM interventions	10	CM
Studies investigating the role of top-down processes on the effects of FBM (language, imagery, context, etc)	9	CM
Studies that can measure contextual effects differences between different types of FBM (do contextual effects have a different influence for different FBM) ie. how do contextual effects influence dynamic prolonged touch vs massage vs SMT	9	CM
Studies that investigate how contextual factors are used when performing FBM in practice	8	CM
Studies that identify the critical components of different types of FBM that affect the mechanistic response	9	CM
Studies that systematically vary the context while keeping treatment parameters consistent.	6	CM
In studies of FBM and inflammatory parameters, tighter control of contextual as well as technical factors are needed.	4	CNM
Studies that map force input through to biochemical responses	2	CNM
Studies investigating the physiological effects of gentle FBM on pre-terms and newborns (with little top-down/expectations etc)	−3	CNM
Gaps in other areas
Studies that define the dose response of FBM on mechanistic physiological and behavioral outcomes	16	CM
Studies that define key parameters of dose of different types of FBM	15	CM
Studies investigating if different patient phenotypes (based on experimental measurements) respond differently to different FBM	11	CM
Studies that identify aberrant pain mechanisms and investigate the effects of FBM on these mechanisms (Example: Determine the modulatory effects of soft tissue FBM on TRPV1 receptors activation)	8	CM
Studies investigating how transduction of FBM interventions occur at the cellular molecular level? (Precise mechanisms from the activation of cellular components in tissues, to peripheral and central neuronal activation)	6	CM
Studies investigating the effects of FBM on neuropathic pain mechanisms	6	CM
Studies investigating the effects of deep slow dynamic touch vs other FBM on interoception	3	CM

FBM = Force Based Manipulation;
EEG = Electroencephalogram;
fMRI = Functional Magnetic Resonance Imaging;
ANS = Autonomic Nervous System;
FEM = Finite element method;
SMT = Spinal Manipulative Therapy;
CM = Consensus Met (>75% Agreement);
CNM = Consensus Not Met (<75% Agreement)

Table 3.