Osteopathic Research Articles

The effect of osteopathic manipulative medicine and other manual manipulation techniques on dysmenorrhea

Introduction Worldwide, menstrual pain affects up to 90% of reproductive-age women. Dysmenorrhea can cause significant disruption to the daily lives of menstruating persons and absenteeism from work or school. The combination of first line treatment ineffectiveness and significant prevalence calls for further investigation into alternative treatments such as Osteopathic Manipulative Treatment (OMT). Methods This meta-analysis aims to aggregate the evidence supporting the use of OMT as a successful treatment option to reduce pain symptoms due to dysmenorrhea. The criteria for accepted articles in our analysis included the studies that mentioned primary dysmenorrhea, the use of a quantitative pain scale, and the inclusion of only patients with regular cycle lengths. Results A total of four studies were compiled to compare the relative improvement that manual manipulative treatments had on reported pain intensity of primary dysmenorrhea, using the Numeric Rating Scale (NRS). Total number of subjects in the experimental group was 88. The mean numeric pain rating scale amongst the studies was 5.4 before treatment and 2.6 after. The p-value of 0.023 is <0.05 and therefore statistically significant. Conclusion The meta-analysis combining data from four studies showed significant improvement of dysmenorrhea when treated with manual manipulative treatments. Findings warrant further investigation with a larger sample size with utilization of standardized OMM regimen.

The Touch Taboo: Origins for the Prohibition of Touch in Psychiatry and a Rational Osteopathic Approach

Abstract The prohibition of touch in psychiatry has multiple origins. The most prominent advocate for an interdiction on touch has been Sigmund Freud and the legacy of psychoanalysis. Scientism, dualism, and medicolegal concerns have also promoted a touch taboo in psychiatry. However, it is evident that non-sexual physical touch is vital for human health; studies of touch in children and adults have shown numerous health benefits physically and psychologically. A discussion of ethical principles in light of the use of touch in psychiatry is provided. Several theoretical paradigms do utilize touch in treating patients and are reviewed including the medical model, body-psychotherapies, and osteopathic medicine. The osteopathic philosophy provides a lens through which the osteopathic physician both assesses and provides rational treatment to the patient. In addition to this philosophy, osteopathic physicians are extensively trained in osteopathic manipulative treatment (OMT). Osteopathic physicians have treated patients with psychiatric disorders with OMT and other treatments for nearly 150 years. The unique osteopathic model of care contrasts with the long-standing prohibition of touch with psychiatric patients and thereby provides a rational approach to the use of touch in psychiatry. The reasoned recommendations for osteopathic psychiatrists using touch clinically include consent, context, and competency considerations.

The Role of Osteopathic Manipulative Medicine in the Rehabilitation of a Competitive Dancer after a Major Abdominal Surgery

Abstract Transmural inflammation in Crohn’s disease can lead to stricturing of the bowel which may result in an obstruction and perforation of the intestines. Emergent surgery is indicated to amend a perforation but complications, such as edema, can limit a surgeon’s ability to close the abdominal wall. In such a case, the open wounds may heal by secondary intent where new tissue is laid down from the base upwards. This case report describes a 23-year-old woman completing her Bachelor of Arts in dance with a past medical history of stricturing and inflammatory ileocolonic Crohn’s disease who presented to the osteopathic manipulative medicine (OMM)/Physical Medicine and Rehabilitation (PM&R) clinic for multiple open abdominal wounds and weakness. To the authors’ knowledge, this is the first case report detailing the benefits of osteopathic manipulative treatment (OMT) to healing open abdominal wounds, increasing flexibility and physical fitness, and improving the mental health of an individual who required prompt rehabilitation to return to the high-level of fitness required to pursue a career as a professional dancer.

Understanding and preference toward DOs and OMT before and after an osteopathic principles and practice fellow lecture series.

One of the two major pathways to become a physician in the United States is the Doctor of Osteopathic Medicine (DO) degree. A major distinctive feature is often perceived as the addition of manual training in osteopathic manipulative treatment (OMT) in the DO education. However, the profession also has a distinct philosophy imbedded in the curriculum of all osteopathic medical schools. Many medical schools offer professional degrees with graduates who may choose to continue their education in medicine, such as the Master of Science in Biomedical Sciences (MSBS). At our institution, there is no formal exposure to the differences between osteopathic and allopathic medicine in the MSBS curriculum, and most of this understanding is gained through out-of-classroom conversations. During the SARS-CoV-2 pandemic, virtual learning prohibited the usual gathering and discourse that occurs when students are learning on campus. The objective of this study is to create a curriculum in the form of a seminar series to assist premedical students in making an informed choice about which profession is the best fit for their own education and to gain an appreciation for osteopathic medicine. This appreciation could also aid in the future collaboration of premedical students with osteopathic providers, recommendations to patients, and potentially their own medical care. Questionnaires were utilized to determine if our osteopathic seminar series was effective at changing the preferences and understanding of MSBS students. We also sought to determine the effectiveness of virtual vs. in-person delivery of our curriculum. A seminar series with pre-established objectives was developed and presented to MSBS students at an osteopathic institution during the Fall of 2020 and 2021. The 2020 seminar was delivered through a virtual conference platform, and the 2021 seminar was delivered in-person. An eight question pre-and postquestionnaire was given to participants to evaluate their preferences and understanding. Internal validity and differences between delivery formats were assessed. Both seminar series produced equally effective, significant changes in the preferences and perceptions of osteopathic medicine in both virtual and in-person delivery formats. Differences in pre-vs. post understanding across both seminar series were not consistently significant and were smaller than those observed in preferences and perceptions. Positive changes included an increased willingness to see a DO and to recommend a loved one see a DO as their personal physician. Preference changes between the in-person vs. virtual delivery platforms did not show significant differences; however, understanding did show some inconsistent differences. This study demonstrates the utility of a virtual or in-person seminar to improve the preferences and perceptions of the osteopathic profession in MSBS students. The seminar series was successful in its goal of offering formal exposure to the osteopathic profession. The improved preferences and perceptions will have potential substantial benefits to the field of osteopathic medicine in the future. Further research is warranted to determine the most effective way to increase understanding of the osteopathic profession.

Variation in medical humanities program mission statements in United States and Canadian Medical Schools

Purpose In 2019, the American Association of Medical Colleges (AAMC) identified the discipline of medical humanities as a priority in medical education. Although medical humanities programs have existed in medical and osteopathic schools in the U.S. and Canada since the late 1960’s, this interdisciplinary field remains difficult to define. We studied the mission statements of medical humanities programs to identify core themes and priorities. Materials and methods We conducted a content analysis of U.S. and Canada medical humanities MD and DO mission statements and associated descriptions (n = 56). We compared themes across programs whose directors had a clinical degree versus a terminal research degree, conducted comparisons between medical humanities programs housed in medical schools ranked in Top 20 U.S. News and World Report for Research or Primary Care, and conducted a word frequency analysis. Results Content analysis revealed five themes: improving patient care, improving the provider experience, generating scholarship, cultivating community relationships, and promoting diversity/sociocultural awareness. 70% of programs emphasized patient care and provider experience. Only 34% included the promotion of diversity/sociocultural awareness as a theme. Word frequency analysis corroborated our findings. Conclusions U.S. and Canada medical humanities programs focus primarily on improving patient care and provider wellness.

Model-Base Estimation of Non-Invasive Ventilation Weaning of Preterm Infants Exposed to Osteopathic Manipulative Treatment: A Propensity-Score-Matched Cohort Study.

Ventilation weaning is a key intensive care event influencing preterm infants' discharge from a neonatal intensive care unit (NICU). Osteopathic manipulative treatment (OMT) has been recently introduced in some Italian NICUs. This retrospective cohort study tested if OMT is associated with faster non-invasive ventilation (NIV) weaning. The time to NIV weaning was assessed in very preterm and very low birth weight infants who either received or did not receive OMT. The propensity score model included gender, antenatal steroids, gestational age (GA), birth weight (BW), and Apgar score 5'. Out of 93 infants, 40 were included in the multilevel survival analysis, showing a reduction of time to NIV weaning for GA (HR: 2.58, 95%CI: 3.91 to 1.71, p < 0.001) and OMT (HR: 3.62, 95%CI: 8.13 to 1.61, p = 0.002). Time to independent ventilation (TIV) was modeled with GA and BW as dependent variables and OMT as the factor. A negative linear effect of GA and BW on TIV was shown. OMT exposure studied as the factor of GA had effects on TIV in infants born up to the 32nd gestational week. Preterm infants exposed to OMT were associated with earlier achievement of NIV weaning. This result, together with the demonstrated OMT safety, suggests the conduct of clinical trials in preterm infants younger than 32 weeks of GA.

Preliminary Effects of Osteopathic Manipulative Medicine on Reactive Oxygen Species in Parkinson's Disease: A Randomized Controlled Pilot Study.

Context Parkinson's disease (PD) is the second most common neurodegenerative disorder and causes many clinical manifestations including bradykinesia, tremor, postural instability, and musculoskeletal stiffness. Neurodegeneration is commonly associated with oxidative stress. Oxidative stress has not been measured in PD in relation to the manual techniques used in Osteopathic Manipulative Treatment (OMT). Objective To investigate the effect of OMT on oxidative stress biomarkers in PD. Methods In this randomized non-blinded study, 32 PD subjects were separated by block randomization into counseling and OMT groups, receiving respective interventions twice a week for six weeks. The counseling arm received informative sessions while the OMT arm received a set treatment protocol. Biomarkers of oxidative stress, malondialdehyde (MDA), dityrosine (DT), 3-nitrotyrosine (3-NT), 8-hydroxy-2-deoxyguanosine (8-OHdG), and 8-isoprostane were measured before and after the first session and at weeks three, six, and 10 (four weeks after conclusion of intervention). Results No significant changes were found in blood plasma levels of MDA, DT, 3-NT, or 8-OHdG during or after intervention compared to controls (p > 0.05). No significant changes were found in urine 8-OHdG or 8-isoprostane during or after intervention compared to controls (p > 0.05). Conclusion OMT used in this study did not significantly affect the chosen oxidative stress biomarkers, however many limitations of the study may have impeded possible findings.

Opportunities to Incorporate Osteopathic Manipulative Treatment Within Cancer Rehabilitation and the Current State of the Evidence

Opportunities to Incorporate Osteopathic Manipulative Treatment Within Cancer Rehabilitation and the Current State of the Evidence

The Florida Clinical Skills Collaborative: A New Regional Consortium for the Assessment of Clinical Skills.

Discontinuation of the United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS)exam and Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 2 Performance Evaluation (2-PE) raised questions about the ability of medical schools to ensure the clinical skills competence of graduating students. In February 2021, representatives from all Florida, United States, allopathic and osteopathic schools initiated a collaboration to address this critically important issue in the evolving landscape of medical education.A 5-point Likert scale survey of all members (n=18/20 individuals representing 10/10 institutions) reveals that initial interest in joining the collaboration was high among both individuals (mean 4.78, SD 0.43) and institutions (mean 4.69, SD 0.48).Most individuals (mean 4.78, SD 0.55) and institutions (mean 4.53, SD 0.72) are highly satisfied with their decision to join. Members most commonly cited a "desire to establish a shared assessment in place of Step 2 CS/2-PE" as their most important reason for joining.Experienced benefits of membership were ranked as the following: 1) Networking, 2) Shared resources for curriculum implementation, 3) Scholarship, and 4) Work towards a shared assessment in place of Step 2 CS/2-PE.Challenges of membership were ranked as the following: 1) Logistics such as scheduling and technology, 2) Agreement on common goals, 3) Total time commitment, and 4) Large group size.Members cited the "administration of a joint assessment pilot" as the highest priority for the coming year. Florida has successfully launched a regional consortium for the assessment of clinical skills competency with high levels of member satisfaction which may serve as a model for future regional consortia.

Physiotherapists and Osteopaths' Attitudes: Training in Management of Temporomandibular Disorders.

Temporomandibular disorders (TMDs) are a condition which has multifactorial etiology. The most acknowledged method to classify TMDs is the diagnostic criteria (DC) introduced firstly by Dworkin. This protocol considers different aspects that are not only biological, but even psychosocial. Diagnosis is often based on anamnesis, physical examination and instrumental diagnosis. TMDs are classified as intra-articular and/or extra-articular disorders. Common signs and symptoms include jaw pain and dysfunction, earache, headache, facial pain, limitation to opening the mouth, ear pain and temporomandibular joint (TMJ) noises. This study regards two kind of clinicians that started in the last years to be more involved in the treatment of TMDs: osteopaths (OOs) and physiotherapists (PTs). The purpose is to analyze their attitude and clinical approach on patients affected by TMDs. Four hundred therapists answered an anonymous questionnaire regarding TMJ and TMDs. OOs showed greater knowledges on TMDs and TMJ and, the therapists with both qualifications seemed to be most confident in treating patients with TMDs. In conclusion this study highlights OOs and all the clinicians with this qualification, have a higher confidence in treating patients with TMD than the others. Dentists and orthodontists, according to this study, should co-work with OOs and PTs, because they are the specialists more requested by them than other kinds of specialists.

COVID-19 in Patients with Asthma: Review and Implications for Care of Adult Patients with an Osteopathic Component

Patients with asthma who have COVID-19 typically present with rhinitis, rhinosinusitis, cough, and shortness of breath and rarely with wheezing. Family physicians should consider a patient’s asthma subtype, pertinent medical history, and medications. Maintenance medications, including inhaled corticosteroids (ICS), should be continued for most patients. Whether to start ICS in patients with asthma who have COVID-19 should be considered, as the risks and benefits are unclear, and systemic corticosteroids should be avoided in patients with asthma who have COVID-19 if alternatives exist. Pregnant patients with both asthma and COVID-19 should be comanaged by an obstetrician, with consideration for early induction of labor. Behavioral health topics and osteopathic principles and manipulative techniques should be considered in patients with COVID-19 and asthma. Generalities are challenging to make, but patients with asthma do not seem to have worse outcomes with COVID-19 than patients without asthma.

CERVICOTHORACIC THRUST MANIPULATION IN AN ACUTE PAINFUL SHOULDER - A CASE REPORT

Purpose: The purpose of this case study was to determine whether cervicothoracic osteopathic thrust manipulation can improve a patient with shoulder pain and restriction. Case: This is a case of 35-year autorickshaw driver who complained an acute onset of shoulder pain and restriction. The therapist had several differential diagnoses according to the patients findings, however, since the cervical spine accessory movement findings were significantly associated with the patients complaints, wet ried a cervicothoracic-directed thrust manipulation. And we noticed an immediate improvement in the patients symptoms following the manipulation procedure. Outcomes: The pain perception improved 4 point in10-point Numeric pain rating scale. Similarly, there were 60 degrees and 90-degree improvements in the active flexion and abduction range respectively immediately following the intervention. Conclusion: This case study concludes that a spinal thrust manipulation targeted at the cervicothoracic region can immediately alleviate shoulder pain and discomfort.

Assessing the Impact of Diverse Approaches of Promoting Virtual Radiation Oncology Educational Content to Medical Students

Assessing the Impact of Diverse Approaches of Promoting Virtual Radiation Oncology Educational Content to Medical Students

Impact of osteopathic manipulative techniques onthe management of dizziness caused by neuro-otologic disorders: systematic review andmeta-analysis.

Osteopathic manipulative treatment (OMT) has been utilized by osteopathic clinicians as primary or adjunctive management for dizziness caused by neuro-otologic disorders. To our knowledge, no current systematic reviews provide pooled estimates that evaluate the impact of OMT on dizziness. We aimed to systematically evaluate the effectiveness and safety of OMT and analogous techniques in the treatment of dizziness. We performed a literature search in CINAHL, Embase, MEDLINE, Allied and Complementary Medicine Database (AMED), EMCare, Physiotherapy Evidence Database (PEDro), PubMed, PsycINFO, Osteopathic Medicine Digital Library (OSTMED.DR), and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to March 2021 for randomized controlled trials (RCTs) and prospective or retrospective observational studies of adult patients experiencing dizziness from neuro-otological disorders. Eligible studies compared the effectiveness of OMT or OMT analogous techniques with a comparator intervention, such as a sham manipulation, a different manual technique, standard of care, or a nonpharmacological intervention like exercise or behavioral therapy. Assessed outcomes included disability associated with dizziness, dizziness severity, dizziness frequency, risk of fall, improvement in quality oflife (QOL), and return to work (RTW). Assessed harm outcomes included all-cause dropout (ACD) rates, dropouts due to inefficacy, and adverse events. The meta-analysis was based on the similarities between the OMT or OMT analogous technique and the comparator interventions. The risk of bias (ROB) was assessed utilizing a modified version of the Cochrane Risk of Bias Tool for RCTs and the Cochrane Risk of Bias in Non-randomized Studies- of Interventions (ROBINS-I) for observational studies. The quality of evidence was determined utilizing the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. There were 3,375 studies identified and screened, and the full text of 47 of them were reviewed. Among those, 12 (11 RCTs, 1 observational study, n=367 participants) met the inclusion criteria for data extraction. Moderate-quality evidence showed that articular OMT techniques were associated with decreases (all p<0.01) in disability associated with dizziness (n=141, mean difference [MD]=-11, 95% confidence interval [CI]=-16.2 to-5.9), dizziness severity (n=158, MD=-1.6, 95% CI=-2.4 to-0.7), and dizziness frequency (n=136, MD=-0.6, 95% CI=-1.1 to-0.2). Low-quality evidence showed that articular OMT was not associated with ACD rates (odds ratio [OR]=2.2, 95% CI=0.5 to 10.2, p=0.31). When data were pooled for any type of OMT technique, findings were similar; however, disability associated with dizziness and ACD rates had high heterogeneity (I2=59 and 46%). No studies metall of the criteria for ROB. The current review found moderate-quality evidence that treatment with articular OMT techniques was significantly associated with decreased disability associated with dizziness, dizziness severity, and dizziness frequency. However, our findings should be interpreted cautiously because of the high ROB and small sample sizes in the eligible studies.

Effect of osteopathic techniques on human resting muscle tone in healthy subjects using myotonometry: a factorial randomized trial

Musculoskeletal disorders (MSDs) are highly prevalent, burdensome, and putatively associated with an altered human resting muscle tone (HRMT). Osteopathic manipulative treatment (OMT) is commonly and effectively applied to treat MSDs and reputedly influences the HRMT. Arguably, OMT may modulate alterations in HRMT underlying MSDs. However, there is sparse evidence even for the effect of OMT on HRMT in healthy subjects. A 3 × 3 factorial randomised trial was performed to investigate the effect of myofascial release (MRT), muscle energy (MET), and soft tissue techniques (STT) on the HRMT of the corrugator supercilii (CS), superficial masseter (SM), and upper trapezius muscles (UT) in healthy subjects in Hamburg, Germany. Participants were randomised into three groups (1:1:1 allocation ratio) receiving treatment, according to different muscle-technique pairings, over the course of three sessions with one-week washout periods. We assessed the effect of osteopathic techniques on muscle tone (F), biomechanical (S, D), and viscoelastic properties (R, C) from baseline to follow-up (primary objective) and tested if specific muscle-technique pairs modulate the effect pre- to post-intervention (secondary objective) using the MyotonPRO (at rest). Ancillary, we investigate if these putative effects may differ between the sexes. Data were analysed using descriptive (mean, standard deviation, and quantiles) and inductive statistics (Bayesian ANOVA). 59 healthy participants were randomised into three groups and two subjects dropped out from one group (n = 20; n = 20; n = 19–2). The CS produced frequent measurement errors and was excluded from analysis. OMT significantly changed F (−0.163 [0.060]; p = 0.008), S (−3.060 [1.563]; p = 0.048), R (0.594 [0.141]; p < 0.001), and C (0.038 [0.017]; p = 0.028) but not D (0.011 [0.017]; p = 0.527). The effect was not significantly modulated by muscle-technique pairings (p > 0.05). Subgroup analysis revealed a significant sex-specific difference for F from baseline to follow-up. No adverse events were reported. OMT modified the HRMT in healthy subjects which may inform future research on MSDs. In detail, MRT, MET, and STT reduced the muscle tone (F), decreased biomechanical (S not D), and increased viscoelastic properties (R and C) of the SM and UT (CS was not measurable). However, the effect on HRMT was not modulated by muscle–technique interaction and showed sex-specific differences only for F.Trial registration German Clinical Trial Register (DRKS00020393).

The Benefits of Integrative Medicine in the Management of Chronic Pain: A Review.

Chronic pain is a debilitating condition that affects many individuals throughout their daily lives. While it is common to treat chronic pain with pharmaceutical treatments, an approach that has also shown great benefits is the use of integrative medicine, such as massage therapy, osteopathic and spinal manipulation, acupuncture, and yoga. The keywords "integrative medicine," "pain," "chronic pain," and "pain management" with the use of the Boolean operators "AND," "OR," and "NOT" were used to identify relevant studies discussing the effectiveness of alternative medicine in the treatment of chronic pain. Massage therapy uses different forms of pressing, rubbing, and moving of muscles and other soft tissues, and has shown short-term benefits for chronic pain relief. Osteopathic and spinal manipulation is mainly used in treating muscles, tendons, and bone pain due to worn-out joints, torn ligaments, and more. Acupuncture involves penetrating the skin with thin needles which are activated through gentle and specific movements. According to our review, acupuncture and massage therapy are effective for short-term treatment, lasting three to five months for chronic pain. Yoga involves various physical, mental, and spiritual practices or disciplines that have shown beneficial results in the treatment of chronic pain. Combining yoga with physical therapy has shown significant benefits. This review aims to describe the benefits and uses of integrative medicine in the treatment of chronic pain.

Expanding the Scope of Manual Medicine Through Research, Academic Exchange, and Healthcare Coverage: A Summary of Two International Conferences

In Korea, Chuna was officially included in the Korean national health insurance (NHI) system in 2019. In the US, osteopathic manipulative treatment has been part of conventional healthcare since 1966. Since there are few countries that provide manual therapy in mainstream healthcare, academic exchange between experts in Chuna therapy on an international stage is essential; to date there has been a conference in 2018 and 2019, both of which were held in Korea. This review presents a summary of these conference proceedings. There were 13 keynote speakers including doctors of Korean medicine, osteopathic physicians, and policymakers. In the 1st conference, seven speakers shared their knowledge on the history of Chuna, policies, and the current body of evidence for using Chuna and osteopathic manipulative treatment of various conditions. In the following year, six speakers also included novel Chuna techniques, similarities and differences, and explored the possibilities for collaborations moving forward. Previous to these two international conferences, the last national conference was held in Korea in 2008. The timing of these two international conferences has proved significant due to the inclusion of Chuna in Korean national health insurance in 2019, and helped to provide guidance in expanding the scope of manual medicine.

Osteopathy in the Cranial Field as a Method to Enhance Brain Injury Recovery: A Preliminary Study.

The clinical burden of traumatic brain injury (TBI) continues to grow worldwide, with patients often developing chronic neurological, behavorial, and cognitive deficits. Treatment and management strategies remain a key challenge, given that they target the symptoms and not the underlying pathological response. To advance pre-clinical research and therapeutic developments, there is a need to study treatment strategies that improve brain injury recovery. Cranial osteopathic manipulative medicine (cOMM) is a non-invasive and non-pharmacological strategy that has been shown to improve quality of life for several medical conditions and injuries, and may be able to treat TBI and reduce subsequent symptoms. In this study, we aimed to evaluate the neurobiological effect of cOMM on the injury response and its potential to alleviate symptoms. We investigated the ability of cOMM to enhance fluid transport by quantifying fluorescent tracer clearance throughout the brain. Further, using an in vivo TBI model, male rats were exposed to a repeated blast overpressure that was followed by cOMM treatment 24 h later. Our findings indicated that cOMM treatment attenuated acute and subacute anxiety-like behaviors. Post-mortem pathological examination in the hippocampus, pre-frontal, and motor cortices indicated improvements in glial pathology in cOMM-treated animals compared to the untreated injury group. Overall, this is the first study to explore cOMM as a treatment option for brain injury, demonstrating its capability to improve TBI outcomes.

Model-base estimation of non-invasive ventilation weaning of preterm infants exposed to osteopathic manipulative treatment: a propensity score-matched cohort study.

Model-base estimation of non-invasive ventilation weaning of preterm infants exposed to osteopathic manipulative treatment: a propensity score-matched cohort study.

Correlation between diminished vagal tone and somatic dysfunction severity in very and extremely low birth weight preterm infants assessed with frequency spectrum heart rate variability and salivary cortisol.

Osteopathic manipulative treatment (OMT) is evolving in the neonatal intensive care unit (NICU) setting. Studies showed its efficacy in length of stay and hospitalization costs reduction. Moreover, it was suggested that OMT has a modulatory effect on the preterm infants’ autonomic nervous system (ANS), influencing saturation and heart rate. Even if OMT is based on the palpatory examination of the somatic dysfunctions (SD), there are controversies about its identification and clinical relevance. The objective of this study was to evaluate the inter-rater reliability, clinical characteristics, and functional correlation of the SD Grade score with the heart rate variability (HRV) and the salivary cortisol (sCor) using a multivariate linear model approach. To evaluate those features, we implemented an ad hoc SD examination for preterm infants that was performed by 2 trained osteopaths. It was based on the new variability model of SD that includes an SD Grade assessment procedure. The ANS features were assessed by frequency parameters of HRV studying high frequency (HF), low frequency (LF), and HF/LF, whereas sCor was tested with a radioimmunoassay. The ANS assessment was standardized and performed before SD testing. Sixty-nine premature infants were eligible. SD Grade showed excellent concordance between the blinded raters. Using SD Grade as a grouping variable, the infants presented differences in GA, Apgar, pathological findings, length of stay, and ventilatory assistance. In our multivariate model, HF, LF, and LF/HF resulted linearly correlated with SD Grade. Instead, sCor presented a linear correlation with 5’ Apgar and respiratory distress syndrome but not with SD Grade. SD Grade was in line with the natural history of the underdevelopment due to prematurity. Our models indicate that the cardiac vagal tone is linearly related with SD Grade. This finding may improve the multidisciplinary decision making inside NICU and the management of modifiable factors, like SD, for cardiac vagal tone regulation.