Effects Of Osteopathic Manipulative Treatment Research Articles

Effects of osteopathic manipulative treatment and concentric and eccentric maximal-effort exercise on women with multiple sclerosis: a pilot study.

The research objectives of this study were to evaluate the effects of osteopathic manipulative treatment (OMT) combined with maximal-effort exercise (MEE) on strength, coordination, endurance, and fatigue in female patients with multiple sclerosis (MS). Seven female subjects with MS participated in the 12-week study, which included intervention with OMT and MEE twice per week. Standardized tests for progression of MS and fatigue were used. Strength (maximal effort and impulse) was measured with the IsoPump exercise machine (IsoPump USA, Cleveland, Miss) during the three phases of the exercise protocol. Significant changes occurred in all but one measure of strength and on the 25-foot walk (P < .05), but not on the block-and-box test. The change in fatigue scores was not significantly different. Findings indicate that OMT combined with MEE significantly increases strength and ambulatory levels while not increasing fatigue in female patients with MS who have low to medium impairment. Qualitative data show that this intervention also produces beneficial effects in activities of daily living.

Effectiveness of osteopathic manipulative treatment for carpal tunnel syndrome: a pilot project.

Osteopathic manipulative treatment (OMT) has been recognized as a management option for carpal tunnel syndrome (CTS), although limited research exists to substantiate its effectiveness. To evaluate the effectiveness of OMT in the management of CTS. This single-blinded quasi-controlled trial was conducted at an academic institution. Participants with CTS underwent weekly OMT sessions for 6 consecutive weeks. The main outcome measures were the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), a sensory symptom diagram (SSD), patient estimate of overall change, electrophysiologic testing of the median nerve (trans-carpal tunnel motor and sensory nerve conduction velocity and amplitude ratio), and carpal tunnel ultrasound imaging of the cross-sectional area of the median nerve and transverse carpal ligament length and bowing. All outcome measures were administered to participants before the first OMT session. Immediately after the first session, electrophysiologic testing of the median nerve and ultrasound imaging of the carpal tunnel were repeated. After 6 weeks of OMT, all outcome measures were readministered. Results of the BCTQ revealed statistically significant improvements in symptoms and function after 6 weeks of OMT (F=11.0; P=.004), and the improvements tended to be more pronounced on the treated side. The drop in SSD scores after 6 weeks of treatment was statistically significant (F=4.19; P=.0002). Patient estimate of overall improvement of symptoms was statistically significant for the treated side. No statistically significant changes in electrophysiologic function of the median nerve, cross-sectional area of the median nerve, or transverse carpal ligament bowing were observed. After treatment, the increase in transverse carpal ligament length was statistically significant, but no side-to-side difference was detected. Osteopathic manipulative treatment resulted in patient-perceived improvement in symptoms and function associated with CTS. However, median nerve function and morphology at the carpal tunnel did not change, possibly indicating a different mechanism by which OMT acted, such as central nervous system processes.

Osteopathic manipulative treatment for self-reported fatigue, stress, and depression in first-year osteopathic medical students.

During medical education, many students experience psychological distress, including symptoms such as fatigue, stress, and depression. To evaluate the effect of osteopathic manipulative treatment (OMT) on self-perceived fatigue, stress, and depression in first-year osteopathic medical students. This randomized controlled pilot study with repeated measures was conducted at the Lake Erie College of Osteopathic Medicine-Bradenton in Florida during the fall 2012 semester. First-year osteopathic medical students voluntarily enrolled in the study and were randomly assigned to directed OMT (D-OMT), nondirected OMT (ND-OMT), or control groups. The D-OMT and ND-OMT groups received treatment by osteopathic physicians weekly for 4 weeks. The control group received no treatment. All groups completed the Epworth Sleepiness Scale (ESS), the Self-Perceived Stress Scale (SPSS), and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire 9 (PHQ-9) depression scale before treatment (pretest), after 2 treatments (midtest), and after 4 treatments (posttest). All participants self-reported as white and single, with both sexes equally represented, and had an mean age of 24 years. Analysis of ESS scores revealed a statistically significant decrease in the D-OMT group from pretest and posttest scores and a statistically significant increase in the ND-OMT group from pretest to midtest but not from pretest to posttest scores. No statistically significant differences were noted in the control group scores on this measure. No statistically significant differences were seen in the SPSS or PHQ-9 scores from pretest to midtest or pretest to posttest in any of the 3 groups. The D-OMT regimen used in the current study produced a statistically significant decrease in self-perceived fatigue in first-year osteopathic medical students. Osteopathic manipulative treatment represents a potential modality to reduce self-perceived distress in medical students. Further research is warranted.

Use of real-time physiologic parameter assessment to augment osteopathic manipulative treatment training for first-year osteopathic medical students.

The first 2 years of osteopathic medical school involve training in osteopathic principles and practice, including understanding the tenets of osteopathic medicine and developing palpatory skills for clinical application. Although this training emphasizes the link between somatic dysfunction and physiologic function, it does not include the opportunity for students to quantitatively assess the physiologic effect of osteopathic manipulative treatment (OMT) using physiologic measurements. To evaluate an approach for integrated OMT training coupled with physiologic measurements of relevant parameters, whereby first-year osteopathic medical students assess the quantitative, real-time changes in specific physiologic signals during instruction. During mandatory musculoskeletal and cardiovascular demonstration laboratories at a single osteopathic medical school, students were divided into small groups and performed OMT on each other while recording real-time measurements of physiologic functions such as maximum clench force, time to fatigue for the forearm flexor muscles, heart rate, and peripheral vascular flow. After data were collected, students analyzed pre- and post-OMT measurements and discussed underlying physiologic principles in a large group format. At the end of the sessions, students completed a brief survey on the usefulness of the integrated laboratories. Overall, 13 of 28 student groups (46.4%) measured a pre- to post-OMT increase in maximum clench force, and 16 (57.1%) observed an increase in time to fatigue for the forearm flexor muscles. Twenty-three of 27 student groups (85.2%) observed a reduction in heart rate and 19 (70.4%) measured an increase in peripheral vascular flow after OMT. Student satisfaction was generally favorable, with overall mean (SD) ratings of 6.38 (1.86) for the musculoskeletal laboratory and 7.81 (1.69) for the cardiovascular laboratory out of a maximum of 10 points. In open-ended comments, students deemed the combined laboratories as clinically applicable but desired more time for completing the laboratories. Measurement of specific physiologic musculoskeletal and cardiovascular parameters before and after OMT enabled quantification of physiologic responses to OMT. Students' favorable feedback indicated that the quality of learning in the laboratories was enhanced by the addition of physiologic measurements.

The effect of osteopathic manipulative treatment on length of stay in posterolateral postthoracotomy patients: A retrospective case note study

ObjectiveThis study retrospectively evaluated the effect of OMT on length of stay (LOS) in hospitalized posterolateral postthoracotomy patients. MethodsInpatient medical records of patients who received posterolateral thoracotomies with lung resection between 1998 and 2011 were reviewed for demographic data, LOS, thoracotomy surgery data, consultation data excluding osteopathic manipulative medicine, discharge data, and osteopathic manipulative medicine consultation data. ResultsThirty-eight patients received posterolateral thoracotomies with lung resection; 23 patients received OMT and 15 did not. The mean (standard deviation) LOS was 11.0 (6.8) days (range, 5–29 days) for those who received OMT and 10.4 (5.5) days (range, 3–22 days) for those who did not (P = .90). Five patients developed postoperative ileus, and all had received OMT. Patients receiving 2 surgical procedures had a longer LOS than those receiving 1 surgical procedure (P = .002). Having a decortication performed during the thoracotomy increased LOS by a mean of 6.4 days (P = .005). Patients admitted directly to the intensive care unit were more likely to receive OMT than those who were not (P = .03). ConclusionWhile there was no difference in LOS, severity of illness was different between patients who received OMT and those who did not. Patients who developed postoperative ileus and most of those admitted directly to the intensive care unit received OMT, suggesting that severity of illness was greater for those who received OMT. Future studies should include a higher subject number in order to stratify for illness severity and also assess the effect of OMT on postoperative pain.

Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis.

BackgroundNonspecific back pain is common, disabling, and costly. Therefore, we assessed effectiveness of osteopathic manipulative treatment (OMT) in the management of nonspecific low back pain (LBP) regarding pain and functional status.MethodsA systematic literature search unrestricted by language was performed in October 2013 in electronic and ongoing trials databases. Searches of reference lists and personal communications identified additional studies. Only randomized clinical trials were included; specific back pain or single treatment techniques studies were excluded. Outcomes were pain and functional status. Studies were independently reviewed using a standardized form. The mean difference (MD) or standard mean difference (SMD) with 95% confidence intervals (CIs) and overall effect size were calculated at 3 months posttreatment. GRADE was used to assess quality of evidence.ResultsWe identified 307 studies. Thirty-one were evaluated and 16 excluded. Of the 15 studies reviewed, 10 investigated effectiveness of OMT for nonspecific LBP, 3 effect of OMT for LBP in pregnant women, and 2 effect of OMT for LBP in postpartum women. Twelve had a low risk of bias. Moderate-quality evidence suggested OMT had a significant effect on pain relief (MD, -12.91; 95% CI, -20.00 to -5.82) and functional status (SMD, -0.36; 95% CI, -0.58 to -0.14) in acute and chronic nonspecific LBP. In chronic nonspecific LBP, moderate-quality evidence suggested a significant difference in favour of OMT regarding pain (MD, -14.93; 95% CI, -25.18 to -4.68) and functional status (SMD, -0.32; 95% CI, -0.58 to -0.07). For nonspecific LBP in pregnancy, low-quality evidence suggested a significant difference in favour of OMT for pain (MD, -23.01; 95% CI, -44.13 to -1.88) and functional status (SMD, -0.80; 95% CI, -1.36 to -0.23), whereas moderate-quality evidence suggested a significant difference in favour of OMT for pain (MD, -41.85; 95% CI, -49.43 to -34.27) and functional status (SMD, -1.78; 95% CI, -2.21 to -1.35) in nonspecific LBP postpartum.ConclusionClinically relevant effects of OMT were found for reducing pain and improving functional status in patients with acute and chronic nonspecific LBP and for LBP in pregnant and postpartum women at 3 months posttreatment. However, larger, high-quality randomized controlled trials with robust comparison groups are recommended.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-286) contains supplementary material, which is available to authorized users.

Effect of osteopathic manipulative treatment on middle ear effusion following acute otitis media in young children: a pilot study.

Childhood acute otitis media (AOM) is highly prevalent. Its usual sequela of middle ear effusion (MEE) can lead to conductive hearing loss, for which surgery is commonly used. To evaluate the efficacy of an osteopathic manipulative treatment (OMT) protocol on MEE resolution following an episode of AOM. The authors hypothesized that OMT provided adjunctively to standard care for young children with AOM would reduce the duration of MEE following the onset of AOM. We compared standard care only (SCO) and standard care plus OMT (SC+OMT) for the duration of MEE following AOM. Patients were aged 6 months to 2 years. The SC+OMT group received OMT during 3 weekly visits. Weekly tympanometric and acoustic reflectometer (AR) readings were obtained from all patients. There were 52 patients enrolled, with 43 completing the study and 9 dropping out. No demographic differences were noted. Only ears from each patient with abnormal tympanograms at entry were included. There were 76 ears in the tympanogram analysis (38 from SCO; 38 from SC+OMT) and 61 ears in the AR data analysis (31 from SCO; 30 from SC+OMT). Dependence of bilateral ear disease noted in AR readings was accounted for in statistical analysis. Tympanogram data demonstrated a statistically significant improvement in MEE at visit 3 in patients in the SC+OMT group (odds ratio, 2.98; 95% confidence interval, 1.16, 7.62; χ(2) test for independence, P=.02). The AR data analysis showed statistically significant improvement at visit 3 for the SC+OMT group (z=2.05; P=.02). There was no statistically significant change in MEE before or immediately after the OMT protocol. A standardized OMT protocol administered adjunctively with standard care for patients with AOM may result in faster resolution of MEE following AOM than standard treatment alone. (ClinicalTrials.gov number NCT00520039.).

Introducing an osteopathic approach into neonatology ward: the NE-O model.

BackgroundSeveral studies showed the effect of osteopathic manipulative treatment on neonatal care in reducing length of stay in hospital, gastrointestinal problems, clubfoot complications and improving cranial asymmetry of infants affected by plagiocephaly. Despite several results obtained, there is still a lack of standardized osteopathic evaluation and treatment procedures for newborns recovered in neonatal intensive care unit (NICU). The aim of this paper is to suggest a protocol on osteopathic approach (NE-O model) in treating hospitalized newborns.MethodsThe NE-O model is composed by specific evaluation tests and treatments to tailor osteopathic method according to preterm and term infants’ needs, NICU environment, medical and paramedical assistance. This model was developed to maximize the effectiveness and the clinical use of osteopathy into NICU.ResultsThe NE-O model was adopted in 2006 to evaluate the efficacy of OMT in neonatology. Results from research showed the effectiveness of this osteopathic model in reducing preterms’ length of stay and hospital costs. Additionally the present model was demonstrated to be safe.ConclusionThe present paper defines the key steps for a rigorous and effective osteopathic approach into NICU setting, providing a scientific and methodological example of integrated medicine and complex intervention.

Somatic dysfunction and effect of OMT on pulmonary function in healthy adult male subjects (871.7)

The effects of osteopathic manipulative treatment (OMT) on pulmonary function have been equivocal. Our long‐term goal is to design hypothesis driven research to determine the efficacy of OMT. We hypothesize that treatment of somatic dysfunction with OMT will increase chest compliance and vital capacity. IRB approval was obtained and healthy adult males were randomly divided into a control group (n=17) or OMT group (n=20). Pulmonary function was measured at baseline, ~10min post‐OMT or quiet reading (control), and repeated at 24hrs. Somatic dysfunction was assessed and treated with OMT. There were no statistical differences between the control and OMT groups at baseline, or changes in pulmonary function in controls acutely or 24hrs. Of the OMT group, 75% of the subjects had somatic dysfunction in the C2‐C7, T5‐T9, ribs, and L1‐L5 regions. After OMT, upper thoracic excursion increased from 5.7±0.5 to 6.3±0.5cm (p = 0.03), and forced vital capacity (FVC) increased from 5.13±0.20 to 5.24±0.19L (p = 0.02) at 24hrs. Of note, OMT treatment of subjects with rib dysfunction significantly improved FVC at 24hrs (p = 0.02). Our data demonstrate significant somatic dysfunction in otherwise healthy adult males and suggest OMT can increase upper thoracic excursion and lung volumes. These data support the possibility that OMT can improve pulmonary function in patients with extrinsic restrictive lung disease.Grant Funding Source: Supported by: AHA 10SDG2640219

The Effect of Optimally Timed Osteopathic Manipulative Treatment on Length of Hospital Stay in Moderate and Late Preterm Infants: Results from a RCT.

Introduction. Little research has been conducted looking at the effects of osteopathic manipulative treatment (OMT) on preterm infants. Aim of the Study. This study hypothesized that osteopathic care is effective in reducing length of hospital stay and that early OMT produces the most pronounced benefit, compared to moderately early and late OMT. A secondary outcome was to estimate hospital cost savings by the use of OMT. Methods. 110 newborns ranging from 32- to 37-week gestation were randomized to receive either OMT or usual pediatric care. Early, moderately early, and late OMT were defined as <4, <9, and <14 days from birth, respectively. Result. Hospital stay was shorter in infants receiving late OMT (−2.03; 95% CI −3.15, −0.91; P < 0.01) than controls. Subgroup analysis of infants receiving early and moderately early OMT resulted in shorter LOS (early OMT: −4.16; −6.05, −2.27; P < 0.001; moderately early OMT: −3.12; −4.36, −1.89; P < 0.001). Costs analysis showed that OMT significantly produced a net saving of €740 (−1309.54, −170.33; P = 0.01) per newborn per LOS. Conclusions. This study shows evidence that the sooner OMT is provided, the shorter their hospital stay is. There is also a positive association of OMT with overall reduction in cost of care.

Osteopathic evaluation and manipulative treatment in reducing the morbidity of otitis media: a pilot study.

To study the effects of osteopathic manipulative treatment in routine pediatric care for children with recurrent acute otitis media. Pilot cohort study with 1-year posttreatment follow-up. At follow-up, subjects' parents or legal guardians and their referring and/or family physicians were contacted to determine recurrence of otitis media since intervention. A referred and volunteer sample of pediatric patients ranging in age from 7 months to 35 months with a history of recurrent otitis media (N=8). For 3 weeks, all subjects received weekly osteopathic structural examinations and osteopathic manipulative treatment. This intervention was performed concurrently with traditional medical management. Five (62.5%) subjects had no recurrence of symptoms. Of the three remaining subjects in this cohort, one had a bulging tympanic membrane, another had four episodes of otitis media, and the last underwent surgery after recurrence at 6 weeks posttreatment. Closer analysis of the posttreatment course of the last two subjects indicates that there may have been a clinically significant decrease in morbidity for a period of time after intervention. The present study indicates that osteopathic manipulative treatment may change the progression of recurrent otitis media, a finding that supports the need for additional research in this area.

Clinical effectiveness of osteopathic manipulative treatment versus sham therapy and usual care in chronic migraine: 3 armed RCT

Migraine is a common disorder with population prevalence in Europe of 6% in men and 18% in women. Recent studies documented controversy results in relation to the benefit of the application of OMT in migraine and those are even more unclear if CAM are considered.

Use of the SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness.

Dizziness is the third most common complaint among outpatients and the most common complaint in patients aged 75 years or older. It can be incapacitating for patients, affecting both productivity and quality of life. To evaluate the effect of osteopathic manipulative treatment (OMT) for spinal somatic dysfunction in patients with dizziness lasting longer than 3 months. A prospective clinical cohort study that took place in 2011. Department of Physical Therapy laboratory at the Western University of Health Sciences College of Osteopathic Medicine in Pomona, California. Sixteen participants (2 male, 14 female; mean [range] age, 49 [13-75] years) with dizziness lasting at least 3 months (mean duration of symptoms, 84 months) and spinal somatic dysfunction, but no history of known stroke or brain disease, were recruited from the local community and evaluated for postural balance control before, immediately after, and 1 week after OMT. Four osteopathic physicians board certified in neuromusculoskeletal medicine/osteopathic manipulative medicine provided OMT, including muscle energy; high-velocity, low-amplitude; counterstrain; myofascial release; balanced ligamentous release; and cranial OMT techniques. Outcomes were assessed with the SMART Balance Master (NeuroCom), a validated instrument that provides graphic and quantitative analyses of sway and balance, and the Dizziness Handicap Inventory (DHI), a self-assessment inventory designed to assess precipitating physical factors associated with dizziness and functional and emotional consequences of vestibular disease. Paired t tests, performed to assess changes in mean composite scores for all challenge tests, revealed that balance was significantly improved both immediately and 1 week after OMT (both P<.001), with no significant difference between immediate and 1-week post-OMT scores (P=.20). The DHI scores, both total and subscale, improved significantly after OMT (P<.001), and changes in composite and DHI scores were correlated with each other (P=.047). Osteopathic manipulative treatment for spinal somatic dysfunction improved balance in patients with dizziness lasting at least 3 months.

The effect of osteopathic manipulative treatment on postoperative medical and functional recovery of coronary artery bypass graft patients.

Several studies have investigated the use of osteopathic manipulative treatment (OMT) after coronary artery bypass graft (CABG) operations; however, there is little information regarding the effect of OMT in the postoperative recovery of patients undergoing CABG operations. Patients scheduled to undergo a CABG operation were voluntarily enrolled and randomly assigned to receive 1 of 3 treatment protocols after their surgical procedure: standardized daily OMT and conventional postoperative care (the OMT group), daily time-matched placebo OMT and conventional postoperative care (the placebo group), or conventional postoperative care only (the control group). Specific OMT techniques used were thoracic inlet myofascial release, standard rib raising (with paraspinal muscle stretch to the L2 vertebral level), and soft tissue cervical paraspinal muscle stretch (with suboccipital muscle release). Primary outcome measures included time to discharge, time to postoperative bowel movement, and FIM functional assessment scores. Fifty-three patients completed the study protocol: 17 in the OMT group, 18 in the placebo group, and 18 in the control group. After surgical procedures, patients were discharged to home at a mean (standard deviation [SD]) rate of 6.1 (1.4), 6.3 (1.5), and 6.7 (3.0) days for the OMT group, placebo group, and control group, respectively. Patients in the OMT group were discharged 0.55 days earlier than those in the control group and 0.16 days earlier than those in the placebo group. The mean (SD) number of days to first postoperative bowel movement was 3.5 (0.9), 4.0 (0.8), and 4.0 (0.9) for the OMT group, the placebo group, and the control group, respectively. On day 3 after surgery, the mean (SD) total score on the FIM was 19.3 (6.7), 15.4 (7.3), and 18.6 (6.5) for the OMT, the placebo, and the control group, respectively; total score for the OMT group was 0.81 greater than that of the control group and 3.87 greater than that of the placebo group. None of the differences achieved statistical significance (P<.05) A daily postoperative OMT protocol improved functional recovery of patients who underwent a CABG operation.

Effect of osteopathic manipulative treatment on length of stay in a population of preterm infants: a randomized controlled trial

BackgroundThe use of osteopathic manipulative treatment (OMT) in preterm infants has been documented and results from previous studies suggest the association between OMT and length of stay (LOS) reduction, as well as significant improvements in several clinical outcomes. The aim of the present study is to investigate the effect of OMT on LOS in premature infants.MethodsA randomized controlled trial was conducted on preterm newborns admitted to a single NICU between 2008-2009. N=110 subjects free of medical complications and with gestational age >28 and < 38 weeks were enrolled and randomized in two groups: study group (N=55) and control group (N=55). All subjects received routine pediatric care and OMT was performed to the study group for the entire period of hospitalization. Endpoints of the study included differences in LOS and daily weight gain.ResultsResults showed a significant association between OMT and LOS reduction (mean difference between treated and control group: -5.906; 95% C.I. -7.944, -3.869; p<0.001). OMT was not associated to any change in daily weight gain.ConclusionsThe present study suggests that OMT may have an important role in the management of preterm infants hospitalization.Trial registrationClinicalTrials.gov, NCT01544257.

Effectiveness of osteopathic manipulative treatment in neonatal intensive care units: protocol for a multicentre randomised clinical trial

IntroductionNeonatal care has been considered as one of the first priorities for improving quality of life in children. In 2010, 10% of babies were born prematurely influencing national healthcare policies,...

971 Neonatology-Osteopathy (Ne-O) Study: RCT on the Effect of Osteopathic Manipulative Treatment on Los

Background and AimsThe use of osteopathic manipulative treatment (OMT) in preterm infants has been documented and results from previous studies suggest the association between OMT and length of stay (LOS)...

A randomised control trial on the effectiveness of osteopathic manipulative treatment in reducing pain and improving the quality of life in elderly patients affected by osteoporosis

A randomised control trial on the effectiveness of osteopathic manipulative treatment in reducing pain and improving the quality of life in elderly patients affected by osteoporosis

Effect of osteopathic manipulative treatment on gastrointestinal function and length of stay of preterm infants: an exploratory study

BackgroundOrganizational improvement of neonatal intensive care units requires strict monitoring of preterm infants, including routine assessment of physiological functions of the gastrointestinal system and optimized procedures for the definition of appropriate discharge timing.MethodsWe conducted a prospective study on the effect of osteopathic manipulative treatment in a cohort of N = 350 consecutive premature infants admitted to a neonatal intensive care unit without any major complication between 2005 and 2008. In addition to ordinary care, N = 162 subjects received osteopathic treatment. Endpoints of the study were differences between study and control groups in terms of excessive length of stay and gastrointestinal symptoms, defined as the upper quartiles in the distribution of the overall population. Statistical analysis was based on crude and adjusted odds ratios from multivariate logistic regression.ResultsBaseline characteristics were evenly distributed across treated/control groups, except for the rate of infants unable to be oral fed at admission, significantly higher among those undergoing osteopathic care (p = .03). Osteopathic treatment was significantly associated with a reduced risk of an average daily occurrence of gut symptoms per subject above .44 (OR = 0.45; 0.26-0.74). Gestational age lower or equal to 32 weeks, birth weight lower or equal to 1700 grams and no milk consumption at admission were associated with higher rates of length of stay in the unit of at least 28 days, while osteopathic treatment significantly reduced such risk (OR = 0.22;0.09-0.51).ConclusionsIn a population of premature infants, osteopathic manipulative treatment showed to reduce a high occurrence of gastrointestinal symptoms and an excessive length of stay in the NICU. Randomized control studies are needed to generalize these results to a broad population of high risk newborns.

Osteopathic manipulative treatment in patients with low back pain

To the Editor: I read with interest the systematic review of Posadzki and Ernst regarding randomized controlled trials of osteopathy for musculoskeletal pain (MSP) patients [1]. The authors are correct in asserting that there is no compelling evidence for the effectiveness of osteopathic manipulative treatment (OMT) in managing musculoskeletal pain generally. However, a valid assessment of OMT in the management of patients with low back pain (LBP) was precluded by several methodological shortcomings of their review. Consequently, their results were discrepant from those of our previous systematic review and meta-analysis (SRMA) [2]. Posadzki and Ernst claim that our SRMA is burdened with a high risk of bias for two reasons: (1) four of the six included studies showed no difference between OMT and control treatments, and (2) it lacked a critical assessment of the methodology and validity of the included studies. With regard to the first criticism, the North Texas trial found significant differences between OMT and the nointervention control treatment at all three reported followup intervals [(Fig. 3) 3]. Other studies in our SRMA also found significant differences between OMT and the control treatments at one or more time intervals [4, 5]. Thus, the complexity of such clinical trials is too great to be adequately captured with a simple binary measure. For this reason, the vote-counting method invoked in this criticism has been largely abandoned since the earliest days of metaanalysis because it yields an unacceptably large risk of drawing erroneous conclusions [6]. Alternatively, metaanalysis is most useful in summarizing research studies that are too small to yield valid conclusions individually [7]. The second criticism, regarding the methodology and validity of included studies in our SRMA, can be dismissed by simply accepting the Jadad scores reported by Posadzki and Ernst in Table 1. Four of our six SRMA studies (references 9, 13, 22, and 24 in Table 1) were assigned Jadad scores of 3, 4, 4, and 2, respectively (mean Jadad score, 3.25). By contrast, the 16 included studies in Table 1 of the Posadzki and Ernst review achieved a mean Jadad score of only 2.63. Another shortcoming of their review was that they did not include the two remaining studies of OMT for LBP, which were previously identified in our SRMA [4, 8]. Even under adverse assumptions regarding the quality of these two additional studies [4, 8], the resulting mean Jadad score for our six SRMA studies would be comparable or superior to the mean Jadad score for the 16 included studies in Table 1 of the Posadzki and Ernst review. Finally, their review states, “to date no definitive conclusions about the effectiveness of osteopathy in the management ofMSP has [sic] been drawn, and the usefulness of OMT in treating MSP is unclear.” However, our SRMA [2] is now the basis for an evidence-based clinical practice guideline that promotes the use of OMT in patients with LBP [9]. Further, this guideline has been accepted by the National Guideline Clearinghouse (NCG:007504), which is sponsored by the Agency for Healthcare Research and Quality. J. C. Licciardone The Osteopathic Research Center, University of North Texas Health Science Center, Fort Worth, TX, USA