Osteopathic Manipulative Treatment In Patients Research Articles

The effect of osteopathic manipulative treatment on quality of life in patients with cardiac implantable electronic devices.

Osteopathic manipulative treatment (OMT) has been demonstrated to have an effect on the autonomic nervous system, which may have antiarrhythmic effects. The effects of OMT in patients with cardiac implantable electronic devices (CIEDs) have not previously been reported. This study investigated the impact of OMT on quality of life (QOL) in this patient population. The purpose of this study is to investigate the effects of OMT on QOL in CIED patients. Subjects with CIEDs were recruited into a double-blind randomized controlled institutional review board (IRB)-approved clinical trial (ClinicalTrials.gov ID: NCT04004741) and randomized to OMT or light touch (control) groups. Subjects received a one-time intervention, performed by board-certified neuromusculoskeletal medicine (NMM) and osteopathic manipulative medicine (OMM) physicians. The OMT protocol utilized techniques including myofascial release, rib raising, facilitated positional release (FPR), and osteopathic cranial manipulative medicine. Subjects' QOL was assessed immediately preceding intervention and one-month postintervention utilizing the Research ANd Development (RAND) 36-Item Short Form Health Survey (SF-36, eight parameters). Groups were compared utilizing unpaired t tests; α=0.05. Forty-two subjects were enrolled, with four lost to follow-up, which resulted in 19 OMT and 19 control subjects for analysis. Of the eight QOL parameters, two showed significant improvement with OMT: role limitations due to physical health (p=0.001) and pain (p=0.003). This study demonstrates the potential for QOL improvement in CIED patients. Specifically, subjects in the OMT group reported an improvement in activities of daily living as well as a decrease in overall pain, including pain interfering with work. Additional research is necessary to further understand the physiologic effects of OMT, including its effects on arrhythmias, in CIED patients.

Osteopathic manipulative treatment for chronic inflammatory diseases.

Chronic inflammatory diseases (CIDs) are debilitating and potentially lethal illnesses that affect a large proportion of the global population. Osteopathic manipulative treatment (OMT) is a manual therapy technique developed and performed by osteopathic physicians that facilitates the body's innate healing processes. Therefore, OMT may prove a beneficial anti-inflammatory modality useful in the management and treatment of CIDs. This work aims to objectively evaluate the therapeutic benefits of OMT in patients with various CIDs. In this review, a structured literature search was performed. The included studies involving asthma, chronic obstructive pulmonary disease, irritable bowel syndrome, ankylosing spondylitis, and peripheral arterial disease were selected for this work. Various OMT modalities, including lymphatic, still, counterstain, and muscle energy techniques, were utilized. Control treatments included sham techniques, routine care, or no treatment. OMT utilization led to variable patient outcomes in individuals with pathologies linked to CID.

Osteopathic Manipulative Treatment in Patients with Anxiety and Depression: A Pilot Study, Part 2

Abstract Background & Aims This is part 2 of an original study with a focus on pain. The role of touch in psychiatry is debatable; the purpose of this pilot study was to determine the effectiveness of osteopathic manipulative treatment (OMT) in treating pain in patients with comorbid anxiety and/or depression. Methods The study was an 8-week prospective, experimental, randomized, controlled pilot study to examine the effects of OMT as an adjunctive treatment of chronic anxiety and depression and pain. The study compared a treatment group to a control group, each consisting of 10 randomly-assigned adult participants with anxiety and/or depression on psychotropics, with a focus on pain. All patients were assessed and evaluated weekly using a musculoskeletal screening assessment which included the Numeric Rating Scale (NRS-11) to grade the level of pain or discomfort. From the initial cohort (n=20), a complete database was achieved for 16 of the patients. Statistical analysis was performed using RStudio. Results Of the 16 patients who successfully participated in the study, 6 received OMT, and 10 were part of the control group. Statistical analysis of pain treatment group data revealed a week one mean of 7.0 ± 2.4 (n=6) with a paired t-test showing significance as early as week three 5.7 ± 2.1 (n=6), P = 0.025* and thereafter. Analysis of pain control group data revealed a week 1 mean of 6.4 ± 1.8 (n=10) with paired t-test significant at weeks 6 through 8. All patients in the treatment group showed significant improvements in their pain levels in half the time compared to those in the control group. Conclusions Findings in this study indicate that OMT may be an effective adjunctive treatment modality for alleviating pain in patients with comorbid depression and anxiety.

Efficacy of osteopathic manipulative treatment in patients with Parkinson’s disease: a narrative review

Parkinson's disease (PD) is a neurodegenerative disease that leads to impaired motor and non-motor function in patients. PD is non-curative and gradually reduces quality of life, leading patients to seek treatment for symptom management. Osteopathic manipulative treatment (OMT) applies the biomechanical, neurologic, circulatory, metabolic, and psychosocial models in approaching and treating the major symptomatology of PD patients. This article evaluates the literature published in the past 10 years analyzing evidence on OMT and its functional application on gait, balance, motor function, bradykinesia, and autonomic dysfunctions, and to identify promising avenues for further investigation. The authors obtained studies from the research databases MEDLINE/PubMed, ScienceDaily, and EBSCO, as well as the Journal of American Osteopathic Association's published archives. Searches were conducted in December 2020 utilizing the search phrases "OMM" (osteopathic manipulative medicine), "OMT," "osteopathic," "Parkinson Disease," "manual therapy," "physical therapy," "training," "autonomics," "gait," and "balance." Articles published between 2010 and 2021 including subjects with Parkinson's disease and the use of OMT or any other form of manual therapy were included. Five authors independently performed literature searches and methodically resolved any disagreements over article selection together. There were a total of 10,064 hits, from which 53 articles were considered, and five articles were selected based on the criteria. The progressive nature of PD places symptom management on the forefront of maintaining patients' quality of life. OMT has demonstrated the greatest efficacy on managing motor-related and neurologic symptoms and assists in treating the greater prevalence of somatic dysfunctions that arise from the disease. Research in this field remains limited and should be the target of future research.

Osteopathic Manipulative Treatment in Patients with Anxiety and Depression: A Pilot Study

Abstract Background & Aims: The role of touch in managing psychiatric patients is controversial. The purpose of this pilot study was to determine the effectiveness of osteopathic manipulative treatment (OMT) in patients with anxiety and or depression. Methods: This was an 8-week pilot study comparing a treatment to a control group, each consisting of 10 randomly assigned adult participants with anxiety and or depression on psychotropics. No significant difference existed between groups for age or severity of disease. Participant responses for anxiety and depression were recorded weekly via a modified Generalized Anxiety Disorder 7 item (GAD-7) and Harvard National Depression Screening Day (HANDS) scales. From the initial cohort (n=20) a complete database was achieved for 16 of the patients. Statistical analysis was performed using RStudio. Results: Of the 16 patients who successfully participated in the study, 6 received OMT, and 10 were part of the control group. For statistical purposes, the data gathered from both groups were subdivided into two categories: depression and anxiety subgroups. The depression treatment group had a week 1 mean of 24.4 ± 11.2 (n=5) with a paired t-test showing significance at week 7 of 18.0 ± 10.9 (n=5), P = .00767 and week 8 of 15.2 ± 12.5 (n=5), P = .041.The anxiety treatment group had a week 1 mean of 26.0 ± 8.7 (n=5) with paired t-test significant at week 7 of 20.2 ± 10.7 (n=5), P = .019 and week 8 of 19.2 ± 11.1 (n=5), P = .00815.All patients in the treatment group showed significant improvements in their anxiety and depression levels compared to those in the control group, which worsened by week 8. Conclusions: Findings in this study indicate that OMT may be an effective adjunctive treatment modality for depression and anxiety.

Cost comparison of osteopathic manipulative treatment for patients with chronic low back pain.

Chronic low back pain (cLBP) is the second leading cause of disability in the United States, with significant physical and financial implications. Development of a multifaceted treatment plan that is cost effective and optimizes patients' ability to function on a daily basis is critical. To date, there have been no published prospective studies comparing the cost of osteopathic manipulative treatment to that of standard care for patients with cLBP. To contrast the cost for standard of care treatment (SCT) for cLBP with standard of care plus osteopathic manipulative treatment (SCT+OMT). This prospective, observational study was conducted over the course of 4months with two groups of patients with a diagnosis of cLBP. Once consent was obtained, patients were assigned to the SCT or the SCT+OMT group based on the specialty practice of theirphysician. At enrollment and after 4 months of treatment, all patients in both groups completed two questionnaires: the 11 point pain intensity numerical scale (PI-NRS) and the Roland Morris Disability Questionnaire (RMDQ). Cost data was collected from the electronic medical record of each patient enrolled in the study. Chi-square (χ2Yates) tests for independence using Yates' correction for continuity were performed to compare the results for each group. There was a total of 146 patients: 71 (48.6%) in the SCT+OMT group and 75 (51.4%) in the SCT group. The results showed no significant differences between themean total costs for the SCT+OMT ($831.48±$553.59) and SCT ($997.90±$1,053.22) groups. However, the utilization of interventional therapies (2; 2.8%) and radiology (4;5.6%) services were significantly less for the SCT+OMT group than the utilization of interventional (31; 41.3%) and radiology (17; 22.7%) therapies were for the SCT group (p<0.001). Additionally, the patients in the SCT+OMT group were prescribed fewer opioid medications (15; 21.1) than the SCT (37; 49.3%) patients (p.001). Patients in the SCT group were approximately 14.7 times more likely to have received interventional therapies than patients in the SCT+OMT group. Likewise, the patients in the SCT group were approximately four times more likely to have received radiological services. Paired t tests comparing the mean pre- and 4 month self reported pain severity scores on the RMDQ for 68 SCT+OMT patients (9.91±5.88 vs. 6.40±5.24) and 66 SCT patients (11.44±6.10 vs. 8.52±6.14) found highly significant decreases in pain for both group (<0.001). The mean total costs for the SCT and SCT+OMT patients were statistically comparable across 4 months of treatment. SCT+OMT was comparable to SCT alone in reducing pain and improving function in patients with chronic low back pain; however, there was less utilization of opioid analgesics, physical therapy, interventional therapies, radiologic, and diagnostic services for patients in the SCT+OMT group.

Ultrasound Shear Wave Elastography to Assess Osteopathic Manipulative Treatment on the Iliocostalis Lumborum Muscle: A Feasibility Study.

To investigate the feasibility of ultrasound shear wave elastography (SWE) in assessing iliocostalis lumborum muscle changes after osteopathic manipulative treatment (OMT). Using a linear array ultrasound transducer (4-9 MHz), we prospectively measured the shear wave velocity (SWV) of bilateral iliocostalis lumborum muscles in 20 patients with low back somatic dysfunction and in 9 age-matched healthy volunteers. The SWV was measured in muscle relaxation and contraction in all participants and immediately before and after OMT in patients. We developed a muscle SWV rate [SWVcontraction - SWVrelaxation )/SWVrelaxation ] and an SWV improvement index [(SWVpre-OMT - SWVpost-OMT )/SWVpre-OMT ] for quantifying muscle contractibility and changes in muscle stiffness after OMT. Statistical analyses included an unpaired t test to analyze the difference in the muscle SWV between muscle relaxation and contraction and between somatic dysfunction and nonsomatic dysfunction in patients and healthy volunteers, a paired t test to examine the difference in the SWV and SWV rate before and after OMT, the intraclass correlation coefficient to test intraobserver and interobserver reliability, and Spearman rank correlation to analyze the correlation of changes in the SWV with manual osteopathic assessments. The mean ages of the patients with low back somatic dysfunction and the healthy volunteers were 28 and 26 years, respectively. The muscle SWV significantly differed between somatic dysfunction and nonsomatic dysfunction in patients and healthy volunteers, between muscle relaxation and contraction, and before and after OMT (P < .001). The SWV improvement index moderately correlated with manual osteopathic assessments (r = 0.68). The interobserver and intraobserver reliability for performing SWE was good (intraclass correlation coefficient, >0.8). Our results suggest that SWE is feasible for quantifying the change in muscle stiffness and contractibility after OMT.

Effects of osteopathic manipulative treatment on patients with multiple sclerosis: A pilot study

ObjectivesTo describe the effects of osteopathic manipulative treatment in patients affected by Multiple Sclerosis (MS). Design and settingThis is a pilot study involving 20 MS patients attending the IRCCS Neurolesi “Bonino-Pulejo”, Messina, Italy. InterventionThe clinical evaluation was performed before starting rehabilitation treatment (T0) and after 8 weeks of treatment (T1). The CG sample undergo a conventional rehabilitation training (CRT), 5 times/week for 60 min (for a total of 40 sessions), the EG performed the same CRT (but with a different frequency, i.e. 3 times/week, for a total of 24 sessions) and a specific OMT 2 times/week for 60 min (for a total of 16 sessions). Main outcome measuresWe analyzed the scores recorded in the following main scales: Expanded Disability Status Scale (EDSS), 10 m walking test (10mWT), Hamilton anxiety rating scale (HRS-A), and the Fatigue severity scale (FSS). ResultsOur data showed a reduction in the FSS score for the EG (40 ± 1,41 at T0 vs 37 ± 2,32 at T1; p = 0.04) but not in the CG (41 ± 2,41 at TO vs 39 ± 2,6 at T1) with an intergroup difference p < 0.00. An improvement of HRS-A and 10mWT was also detected in the EG. ConclusionsOur data raise idea that OMT might be useful in rehabilitative setting in MS patients, with particular regard to anxiety and fatigue.

Osteopathy for primary headache patients: a systematic review

ObjectiveThis systematic review aimed to assess the efficacy, effectiveness, safety, and tolerability of osteopathic manipulative treatment (OMT) in patients with headache.BackgroundMigraine is one of the most common and disabling medical conditions. It affects more than 15% of the general population, causing high global socioeconomic costs, and the currently available treatment options are inadequate.MethodsWe systematically reviewed all available studies investigating the use of OMT in patients with migraine and other forms of headache.ResultsThe search of literature produced six studies, five of which were eligible for review. The reviewed papers collectively support the notion that patients with migraine can benefit from OMT. OMT could most likely reduce the number of episodes per month as well as drug use. None of the included studies, however, was classified as low risk of bias according to the Cochrane Collaboration’s tool for assessing risk of bias.ConclusionThe results from this systematic review show a preliminary low level of evidence that OMT is effective in the management of headache. However, studies with more rigorous designs and methodology are needed to strengthen this evidence. Moreover, this review suggests that new manual interventions for the treatment of acute migraine are available and developing.

Osteopathic manipulative treatment for inpatients with pulmonary exacerbations of cystic fibrosis: effects on spirometry findings and patient assessments of breathing, anxiety, and pain.

Osteopathic manipulative treatment (OMT) has been studied in patients with various respiratory diseases. However, to the authors' knowledge, no studies have assessed the efficacy of OMT in patients with cystic fibrosis (CF). To evaluate pulmonary function and perceptions of breathing, anxiety, and pain of CF patients who receive OMT in addition to standard inpatient management of pulmonary exacerbation. In a single-blind randomized controlled trial, we assessed adult patients with a history of CF who were admitted to the hospital because of pulmonary exacerbation. Participants were randomly assigned to receive a daily standardized protocol of OMT or sham therapy. Both groups also received standard treatment for CF. Spirometry and questionnaire data (self-assessment of breathing, pain, and anxiety level) were collected before the first OMT or sham therapy session and after the final session. A total of 33 patients were included in the study: 16 in the OMT group and 17 in the sham therapy group. Improvements in spirometric parameters were observed in both the OMT and the sham therapy groups, with no statistically significant differences found between the groups. More patients in the OMT group than in the sham therapy group had questionnaire response patterns that indicated their breathing had improved during the study period (15 of 16 vs 8 of 16, respectively). No differences were found between groups for perceived improvement of pain and anxiety. In the current study, CF patients who received OMT did not demonstrate statistically significant differences in pre- and posttreatment spirometry findings compared with CF patients who received sham therapy. Questionnaire findings suggest that OMT may affect CF patients' perception of overall quality of breathing. Additional studies are needed to assess the clinical use of OMT in patients with CF.

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.

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

Osteopathic manipulative treatment is effective on pain control associated to spinal cord injury

This study was designed as an experimental study (trial). To verify the effects of the association between conventional pharmacological treatment and osteopathic manipulative treatment (OMT) for chronic pain management in spinal cord injury (SCI). This study was carried out at Spinal Unit, Ospedale Niguarda Ca' Granda, Milan, Italy. Istituto Superiore di Osteopatia, Milan, Italy. We enrolled 47 patients with SCI, 26 with pain of both nociceptive and neuropathic origin, and 21 with pure neuropathic pain. In all, 33 patients had a complete spinal cord lesion (ASIA level A) and 14 had incomplete lesion (ASIA level B, C and D). The patients were subdivided in a pharmacological group (Ph), a pharmacological osteopathic (PhO) group and a osteopathic (Os) group. The verbal numeric scale (VNS) was used at various time intervals to evaluate treatment outcomes. Ph patients reached a 24% improvement in their pain perception, assessed by the VNS scale after 3 weeks of treatment, whereas Os patients reached a 16% improvement in their pain perception for the same weeks. Both treatments per se failed to induce further improvements at later time points. In contrast, the combination of the two approaches yielded a significantly better pain relief both in patients with nociceptive or pure neuropathic pain in the PhO group. Our results suggest the OMT is a feasible approach in patients in whom available drugs cannot be used. Moreover, a benefit can be expected by the association of OMT in patients treated according to existing pharmacological protocols.

Osteopathic Manipulative Treatment and Vertigo: A Pilot Study

To assess the safety and feasibility of studying osteopathic manipulative treatment and its potential effectiveness for patients with vertigo. A nonrandomized pilot study. Outpatient clinic affiliated with a teaching hospital and osteopathic medical school. The subjects were older than 18 years of age, with the diagnosis of vertigo for longer than 3 months. The patients were treated with osteopathic manipulative treatment (OMT). Treatment effectiveness was measured with the use of the Dizziness Handicap Inventory (DHI), a validated symptom inventory. Intensity and duration of adverse effects after OMT were used to measure study safety. Of the 18 patients who were recruited all 18 (100%) met the inclusion criteria and were enrolled in the study. Sixteen patients (88.9%) completed the treatment course with OMT, and data with respect to the DHI were obtained from all 16 (100%). Significant improvement (P<.001) in total and subcomponent DHI scores was observed after completion of treatment. Of the 8 patients with moderate pretest scores, 7 (87.5%) had mild post-test scores after undergoing OMT, and of the 8 patients with severe pretest scores, 4 (50%) had mild post-test scores. Of the 18 enrolled patients, 3 (16.7%) experienced an exacerbation of their vertigo, and 5 (27.8%) experienced muscle soreness after OMT. These adverse effects were mild and transient, not lasting longer than 24 hours. This study showed that OMT is generally well tolerated in patients with vertigo. It also demonstrated that it is feasible to recruit a population of patients with vertigo who can complete a course of OMT and collect data by using the DHI. A randomized control trial that examines the efficacy of OMT in patients with vertigo is warranted, given that OMT may be a reasonable treatment for vertigo and the functional impairment associated with it.

Effects of osteopathic manipulative treatment in patients with cervicothoracic pain: Pilot study using thermography

To provide information on how cervicothoracic pain responds to osteopathic manipulative treatment, five subjects with acute or chronic pain received appropriate medication and three osteopathic manipulative treatments by the principal investigator using thrust and nonthrust techniques. The mean number of findings by both investigators on structural examination decreased considerably immediately after each of the three treatments. The number of findings increased in week 2 and decreased in week 3. The principal investigator observed a further decrease by the final session, but the coinvestigator reported an increase. The pain scale score improved an average of nearly 30%. Thermography showed cooling of the cervicothoracic region in all subjects and conversion to a normal pattern in four. Osteopathic manipulative treatment should be considered for patients with acute or chronic cervicothoracic pain. The use of thermographic analysis in clinical osteopathic research seems warranted.