Article

Osteopathic manipulative treatment for low back pain: A systematic review and meta-analysis of randomized controlled trials

Osteopathic Research Center, University of North Texas Health Science Center, Fort Worth, TX 76107, USA.
BMC Musculoskeletal Disorders (Impact Factor: 1.72). 02/2005; 6(1):43. DOI: 10.1186/1471-2474-6-43
Source: PubMed

ABSTRACT

Osteopathic manipulative treatment (OMT) is a distinctive modality commonly used by osteopathic physicians to complement their conventional treatment of musculoskeletal disorders. Previous reviews and meta-analyses of spinal manipulation for low back pain have not specifically addressed OMT and generally have focused on spinal manipulation as an alternative to conventional treatment. The purpose of this study was to assess the efficacy of OMT as a complementary treatment for low back pain.
Computerized bibliographic searches of MEDLINE, EMBASE, MANTIS, OSTMED, and the Cochrane Central Register of Controlled Trials were supplemented with additional database and manual searches of the literature. Six trials, involving eight OMT vs control treatment comparisons, were included because they were randomized controlled trials of OMT that involved blinded assessment of low back pain in ambulatory settings. Data on trial methodology, OMT and control treatments, and low back pain outcomes were abstracted by two independent reviewers. Effect sizes were computed using Cohen's d statistic and meta-analysis results were weighted by the inverse variance of individual comparisons. In addition to the overall meta-analysis, stratified meta-analyses were performed according to control treatment, country where the trial was conducted, and duration of follow-up. Sensitivity analyses were performed for both the overall and stratified meta-analyses.
Overall, OMT significantly reduced low back pain (effect size, -0.30; 95% confidence interval, -0.47 - -0.13; P = .001). Stratified analyses demonstrated significant pain reductions in trials of OMT vs active treatment or placebo control and OMT vs no treatment control. There were significant pain reductions with OMT regardless of whether trials were performed in the United Kingdom or the United States. Significant pain reductions were also observed during short-, intermediate-, and long-term follow-up.
OMT significantly reduces low back pain. The level of pain reduction is greater than expected from placebo effects alone and persists for at least three months. Additional research is warranted to elucidate mechanistically how OMT exerts its effects, to determine if OMT benefits are long lasting, and to assess the cost-effectiveness of OMT as a complementary treatment for low back pain.

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    • "Two previous systematic reviews examined the effect of OMT on LBP. In a 2005 review by Licciardone et al. [28], studies were included if they were performed by an osteopath or osteopathic physician, but the authors also included interventions based on single manual techniques. In the current review, we wanted to examine the effect of studies that used an authentic osteopathic intervention where the clinician was free to use clinical judgment for each patient, as occurs in clinical practice. "
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    ABSTRACT: Objectives: Nonspecific neck pain is common, disabling, and costly. The objective of the current review was to assess the effectiveness of osteopathic manipulative treatment (OMT) in the management of chronic nonspecific neck pain regarding pain, functional status, and adverse events. Study selection: A systematic literature search unrestricted by language was performed in March 2014 in several electronic databases and in databases of ongoing trials. A manual search of reference lists and personal communication with experts identified additional studies. Only randomized clinical trials were included, and studies of specific neck pain or single treatment techniques were excluded. Primary outcomes were pain and functional status, and secondary outcome was adverse events. Data extraction: Studies were independently reviewed using a standardized data extraction form. Mean difference (MD) or standard mean difference (SMD) with 95% confidence intervals (CIs) and overall effect size were calculated for primary outcomes. GRADE was used to assess quality of the evidence. Data synthesis: Of 299 identified studies, 18 were evaluated and 15 excluded. The 3 reviewed studies had low risk of bias. Moderate-quality evidence suggested OMT had a significant and clinically relevant effect on pain relief (MD: -13.04, 95% CI: -20.64 to -5.44) in chronic nonspecific neck pain, and moderate-quality evidence suggested a non-significant difference in favour of OMT for functional status (SMD: -0.38, 95% CI: -0.88 to 0.11). No serious adverse events were reported. Conclusion: Based on the 3 included studies, the review suggested clinically relevant effects of OMT for reducing pain in patients with chronic nonspecific neck pain. Given the small sample sizes, different comparison groups, and lack of long-term measurements in the few available studies, larger, high-quality randomized controlled trials with robust comparison groups are recommended.
    Full-text · Article · Aug 2014 · BMC Musculoskeletal Disorders
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    • "Much of the research into Osteopathic Manipulative Treatment (OMT) has focused on proving efficacy of the manual treatment components of osteopathic practice by conducting randomised controlled trials (RCT) [19]. The diversity of treatment approaches, as indicated by range of modalities used in any particular clinical encounter would indicate the translation of strictly controlled RCTs to clinical practice would be very difficult. "
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    ABSTRACT: There is limited evidence available to describe a profile of osteopathic practice in Australia. The purpose of this study was to describe the current activities of Australian osteopaths, using an internationally-developed standardised data collection tool. A voluntary national paper-based survey using a modified UK-developed standardised data collection tool was distributed to and completed by osteopaths across Australia between June 2010 and June 2011. Fifty four osteopaths participated in this study and returned a total of 799 patient records. Two thirds of patients were female, with a median age of 39 years and age range of 7 days - 89 years. Almost three quarters of people seeking osteopathic care were employed and the largest source of referral was by word-of-mouth.The majority of presenting complaints were acute musculoskeletal in nature. Approximately 38% of patients presented with a coexisting condition; the highest incidences were found in the cardiovascular and respiratory systems, along with mental health disorders.Main treatment approaches were soft tissue (22.3%), muscle energy technique (14.6%), articulation techniques (14.3%) and education/advice (11.9%). Improvement or resolution of the complaint was experienced by 96.2% of patients within a small number of treatments. Complications of treatment were minor and of low frequency. In this study, Australian osteopaths mainly see patients with acute or sub-acute musculoskeletal problems which are predominantly spinal conditions. A significant proportion of these patients have one or more co-existing condition, largely of the cardiovascular and respiratory systems, along with mental health disorders. The majority of patients have a significant improvement within few treatments, with infrequent and minor adverse events reported. These findings should be tested through multi-centred pragmatic trials of osteopathic practice.
    Full-text · Article · Aug 2013 · BMC Musculoskeletal Disorders
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    • "Osteopathic medicine is one of the registered professions legally allowed to use Spinal Manipulative Therapy (SMT), defined as manual loading of the spine using short or long leverage methods [2], and SMT as a single modality has been heavily researched [7,8]. John Licciardone, principal author of the only systematic review of OMT in chronic low back pain and a senior clinical academic, warns that OMT is not chiropractic or simple SMT, but a complex intervention based on a multi-factorial diagnostic work up [9]. "
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    ABSTRACT: Background Chronic Non Specific Low Back Pain (CNSLBP) is a common, complex and disabling condition that has been present for longer than three months and is not caused by a serious pathology. Osteopaths are health practitioners who commonly diagnose and treat CNSLBP patients using a complex set of interventions that includes manual therapy. The study aimed to complete a Systematic Review of clinical research into osteopathic intervention in CNSLBP using a rigorous assessment of study quality. Methods The literature was searched to August 2011 using the following databases: AMED, CINAHL Plus, Cochrane Central Register of Clinical Trials, MEDLINE Plus, EMBASE, MANTIS, OSTMED, PEDro, ScienceDirect. Multiple search terms were used in various combinations: osteopathy/osteopathic, osteopathic manipulative technique, OMT, Spinal Manipulative Therapy, SMT, clinical trial, back pain, chronic back pain. The inclusion criteria were papers that: reported clinical trials; had adult participants; tested the effectiveness and/or efficacy of osteopathic manual therapy intervention applied by osteopaths, and had a study condition of CNSLBP. The quality of the papers was assessed using the Cochrane Back Review Risk of Bias criteria. A meta-analysis would proceed if the studies had adequate clinical and methodological homogeneity. Results Initial searches revealed 809 papers, 772 of which were excluded on the basis of abstract alone. The remaining 37 trial papers were subjected to a more detailed analysis of the full text, which resulted in 35 being excluded. The two remaining trials had a lack of methodological and clinical homogeneity, precluding a meta-analysis. The trials used different comparators with regards to the primary outcomes, the number of treatments, the duration of treatment and the duration of follow-up. Conclusion There are only two studies assessing the effect of the manual therapy intervention applied by osteopathic clinicians in adults with CNSLBP. One trial concluded that the osteopathic intervention was similar in effect to a sham intervention, and the other suggests similarity of effect between osteopathic intervention, exercise and physiotherapy. Further clinical trials into this subject are required that have consistent and rigorous methods. These trials need to include an appropriate control and utilise an intervention that reflects actual practice.
    Full-text · Article · Apr 2013 · BMC Musculoskeletal Disorders
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