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

Abstract

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.

Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States

“…125–133 Conclusions from these systematic reviews for practitioner approaches (acupuncture, chiropractic, massage therapy) 125–131 and dietary supplements 132 were generally consistent with our findings. For instance, in a comprehensive reviews of both pharmacological and non-pharmacological approaches to manage back pain, Chou et al (20016) 125 found that acupuncture and yoga appear to be effective for improving pain and/or function in back pain.…”

“…The authors of the systematic reviews concluded that yoga appears to be a viable option for relieving pain and discomfort associated with arthritis, but that larger, better designed trials were needed. A recent systematic review 131 that included international trials found that “clinically relevant effects of OMT were found for reducing pain and improving functional status” for those with back pain. Although this is a stronger conclusion than we reached, the authors’ identified deficiencies in trial methodology and called for larger, better quality RCT’s to provide firm conclusions.…”

The risk associated with spinal manipulation: an overview of reviews

“…Some of these reviews further specified SMT as cervical, thoracic or lumbar SMT (21 reviews [46, 47, 49, 54, 57, 65, 91, 96, 103, 105, 114, 115, 119, 121, 123, 125–127, 134, 136, 150]). Other reviews did not further specify than ‘manipulation’ (10 reviews [36, 66, 70–73, 79, 93, 101, 107]), ‘osteopathic manipulative treatment/therapy’ (8 reviews [38, 52, 56, 64, 81, 82, 116, 139]), and ‘chiropractic care/interventions’ (5 reviews [67, 98–100, 137]).…”

Comparative Effectiveness of Chuna Manipulative Therapy for Non-Acute Lower Back Pain: A Multi-Center, Pragmatic, Randomized Controlled Trial

“…Some limitations of our study are attributable to the fact that CMT entails contact with patients when treating, rendering it impossible to blind patients due to its method of treatment. Potential bias is a possible liability in this study design, but is difficult to control due to unblinding [3,48]. Experts considered sham control in meetings, but as CMT would generally be provided for an average of 15 min per patient, it was concluded that a sham-controlled trial would be unrealistic in Korean clinical settings.…”