Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia: a randomized controlled trial

Abstract

BackgroundThe Multicenter Osteopathic Pneumonia Study in the Elderly (MOPSE) is a registered, double-blinded, randomized, controlled trial designed to assess the efficacy of osteopathic manipulative treatment (OMT) as an adjunctive treatment in elderly patients with pneumonia.Methods406 subjects aged ≥ 50 years hospitalized with pneumonia at 7 community hospitals were randomized using concealed allocation to conventional care only (CCO), light-touch treatment (LT), or OMT groups. All subjects received conventional treatment for pneumonia. OMT and LT groups received group-specific protocols for 15 minutes, twice daily until discharge, cessation of antibiotics, respiratory failure, death, or withdrawal from the study. The primary outcomes were hospital length of stay (LOS), time to clinical stability, and a symptomatic and functional recovery score.ResultsIntention-to-treat (ITT) analysis (n = 387) found no significant differences between groups. Per-protocol (PP) analysis (n = 318) found a significant difference between groups (P = 0.01) in LOS. Multiple comparisons indicated a reduction in median LOS (95% confidence interval) for the OMT group (3.5 [3.2-4.0] days) versus the CCO group (4.5 [3.9-4.9] days), but not versus the LT group (3.9 [3.5-4.8] days). Secondary outcomes of duration of intravenous antibiotics and treatment endpoint were also significantly different between groups (P = 0.05 and 0.006, respectively). Duration of intravenous antibiotics and death or respiratory failure were lower for the OMT group versus the CCO group, but not versus the LT group.ConclusionsITT analysis found no differences between groups. PP analysis found significant reductions in LOS, duration of intravenous antibiotics, and respiratory failure or death when OMT was compared to CCO. Given the prevalence of pneumonia, adjunctive OMT merits further study.

Medium term effects of including manual therapy in a pulmonary rehabilitation program for chronic obstructive pulmonary disease (COPD): a randomized controlled pilot trial.

“…30 There is some evidence to show that direct application of MT to the chest wall benefits patients with chronic respiratory disease. Soft tissue-focused techniques have been used with mixed success in the management of COPD 31,32 and pneumonia in the elderly, [33][34][35] 39,40 Measuring the effect of combining these two types of MT with exercise raises the question: are both types of MT required in order to achieve the improvements in lung function and exercise capacity? Reports that some soft-tissue techniques produce a worsening in pulmonary function immediately postintervention when applied on their own 31,32 suggest that this form of MT may need to be administered in conjunction with joint-focused MT in order to produce improvements in lung function in people with COPD.…”

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

“…For example, a lymphatic technique was only documented in 4 patients who received OMT even though lymphatic techniques have been shown to be beneficial in the inpatient setting. 7,13,14 However, most lymphatic techniques such as thoracic inlet release were likely documented as myofascial release, leaving only techniques such as effleurage and lymphatic pumps to be documented as lymphatic. In studies looking at the effect of OMT on pneumonia patients, 13e15 a specific protocol was used.…”

Thoracic and Abdominal Lymphatic Pump Techniques Inhibit the Growth ofS. pneumoniaeBacteria in the Lungs of Rats

“…7,8 Clinical studies report that LPT enhances antibody responses to bacterial vaccines, 9,10 shortens duration of cough in patients with respiratory disease, 11 and shortens the duration of intravenous antibiotic therapy and hospital stay in patients with pneumonia. 12 While there are no published reports measuring the effect of LPT on the lymphatic system of humans, studies in animals demonstrate that LPT promotes the uptake of interstitial antigens into the lymphatic system, 13 enhances lymph flow, 14,15 increases the lymphatic concentration of leukocytes 16,17 enhances the lymphatic flux of inflammatory cytokines, chemokines, and reactive oxygen and nitrogen species, 18 and reduces bacterial burden in the lungs of rats. 19 Collectively, these studies suggest that LPT enhances the lymphatic and immune systems and can protect against respiratory disease; however, the mechanism by which LPT protects against pneumonia has not been quantitatively defined.…”