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

BMC Musculoskeletal Disorders

Gary Fryer²  Jan-David Franke¹  Helge Franke¹ 

[1]INIOST-Institute for Osteopathic Studies, Siegen, Germany

[2]A.T. Still Research Institute, A.T. Still University of Health Sciences, Kirksville, Missouri, USA

关键词: Systematic review;    Osteopathic manipulative treatment;    Spinal manipulation;    Low back pain;   

Others  :  1122171
DOI  :  10.1186/1471-2474-15-286

 received in 2014-03-03, accepted in 2014-08-25,  发布年份 2014

【 摘 要 】

Background

Nonspecific 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.

Methods

A 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.

Results

We 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.

Conclusion

Clinically 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.

【 授权许可】

   
2014 Franke et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]van Tulder M, Becker A, Bekkering T, Breen A, del Real MT, Hutchinson A, Koes B, Laerum E, Malmivaara A, Care CBWGoGftMoALBPiP: Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2006, 15(Suppl 2):S169-S191.
• [2]Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G: Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006, 15(Suppl 2):S192-S300.
• [3]Deyo RA, Weinstein JN: Low back pain. N Engl J Med 2001, 344:363-370.
• [4]National Collaborating Centre for Primary Care: Low Back Pain: Early Management of Persistent Non-specific Low Back Pain. NICE Clinical Guideline 88. London: National Institute for Health and Clinical Excellence; 2009. http://www.nice.org.uk/nicemedia/pdf/CG88NICEGuideline.pdf webcite
• [5]Burton AK, Balague F, Cardon G, Eriksen HR, Henrotin Y, Lahad A, Leclerc A, Muller G, van der Beek AJ: Chapter 2. European guidelines for prevention in low back pain. Eur Spine J 2006, 15(Suppl 2):S136-S168.
• [6]Dagenais S, Caro J, Haldeman S: A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J 2008, 8:8-20.
• [7]Croft P, Papageorgiou A: Low back pain in the community and in hospitals. A report to the Clinical Standards Advisory Group of the Department of Health, Arthritis and Rheumatism Council. Manchester: Epidemiology Research Unit University of Manchester; 1994.
• [8]Vermani E, Mittal R, Weeks A: Pelvic girdle pain and low back pain in pregnancy: a review. Pain Pract 2010, 10:60-71.
• [9]Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B: European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J 2008, 17:794-819.
• [10]Gutke A, Ostgaard HC, Oberg B: Predicting persistent pregnancy-related low back pain. Spine 2008, 33:E386-E393.
• [11]Ostgaard HC, Zetherstrom G, Roos-Hansson E, Svanberg B: Reduction of back and posterior pelvic pain in pregnancy. Spine 1994, 19:894-900.
• [12]Sabino J, Grauer JN: Pregnancy and low back pain. Curr Rev Musculoskelet Med 2008, 1:137-141.
• [13]Majchrzycki M, Mrozikiewicz PM, Kocur P, Bartkowiak-Wieczorek J, Hoffmann M, Stryla W, Seremak-Mrozikiewicz A, Grzeskowiak E: Low back pain in pregnant women. Ginekol Pol 2010, 81:851-855.
• [14]Gutke A, Ostgaard HC, Oberg B: Association between muscle function and low back pain in relation to pregnancy. J Rehabil Med 2008, 40:304-311.
• [15]Brown S, Lumley J: Maternal health after childbirth: results of an Australian population based survey. Br J Obstet Gynaecol 1998, 105:156-161.
• [16]MacArthur C, Lewis M, Knox EG: Health after childbirth. Br J Obstet Gynaecol 1991, 98:1193-1195.
• [17]Patel RR, Peters TJ, Murphy DJ: Is operative delivery associated with postnatal back pain at eight weeks and eight months? a cohort study. Acta Obstet Gynecol Scand 2007, 86:1322-1327.
• [18]Saurel-Cubizolles MJ, Romito P, Lelong N, Ancel PY: Women's health after childbirth: a longitudinal study in France and Italy. BJOG 2000, 107:1202-1209.
• [19]DiGiovanna EL, Schiowitz S, Dowling DJ: An Osteopathic Approach to Diagnosis & Treatment. 3rd edition. Philadelphia: Lippincott William & Wilkins; 2005.
• [20]Vaughan B, Morrison T, Buttigieg D, Macfarlane C, Fryer G: Approach to low back pain - osteopathy. Aust Fam Physician 2014, 43:197-198.
• [21]Greenman PE: Principles of Manual Medicine. 3rd edition. Philadelphia: Lippincott William & Wilkins; 2003.
• [22]Maniadakis N, Gray A: The economic burden of back pain in the UK. Pain 2000, 84:95-103.
• [23]Fawkes CA, Leach CM, Mathias S, Moore AP: A profile of osteopathic care in private practices in the United Kingdom: a national pilot using standardised data collection. Man Therin press
• [24]General Osteopathic Council: Snapshot Survey. London, UK: General Osteopathic Council; 2001. http://www.osteopathy.org.uk/uploads/survey2snapshot_survery_results_2001.pdf webcite
• [25]Walker BF, Muller R, Grant WD: Low back pain in Australian Adults. health provider utilization and care seeking. J Manipulative Physiol Ther 2004, 27:327-335.
• [26]Orrock P: Profile of members of the Australian Osteopathic Association: part 2 - the patients. Int J Osteopath Med 2009, 12:128-139.
• [27]Licciardone JC: The epidemiology and medical management of low back pain during ambulatory medical care visits in the United States. Osteopath Med Prim Care 2008, 2:11. BioMed Central Full Text
• [28]Licciardone JC, Brimhall AK, King LN: Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord 2005, 6:43. BioMed Central Full Text
• [29]Franke H: Why reservations remain: a critical reflection about the systematic review and meta-analysis "Osteopathic manipulative treatment for low back pain" by Licciardone et al. J Bodyw Mov Ther 2012, 16:411-415.
• [30]Orrock PJ, Myers SP: Osteopathic intervention in chronic non-specific low back pain: a systematic review. BMC Musculoskelet Disord 2013, 14:129. BioMed Central Full Text
• [31]Higgins JPT, Green S: Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. Cochrane Collaboration; 2011. http://www.cochrane-handbook.org webcite
• [32]Rubinstein SM, Terwee CB, Assendelft WJ, de Boer MR, van Tulder MW: Spinal manipulative therapy for acute low back pain: an update of the cochrane review. Spine 2013, 38:E158-E177.
• [33]Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW: Spinal manipulative therapy for chronic low-back pain: an update of a Cochrane review. Spine 2011, 36:E825-E846.
• [34]Johnson SM, Kurtz ME: Osteopathic manipulative treatment techniques preferred by contemporary osteopathic physicians. J Am Osteopath Assoc 2003, 103:219-224.
• [35]Orrock P: Profile of members of the Australian Osteopathic Association: part 1 - the practitioners. Int J Osteopath Med 2009, 12:14-24.
• [36]Fryer G, Johnson JC, Fossum C: The use of spinal and sacroiliac joint procedures within the British osteopathic profession. part 2: treatment. Int J Osteopath Med 2010, 13:152-159.
• [37]Hozo SP, Djulbegovic B, Hozo I: Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005, 5:13. BioMed Central Full Text
• [38]Furlan AD, Pennick V, Bombardier C, van Tulder M: 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine (Phila Pa 1976) 2009, 34:1929-1941.
• [39]Cruser dA, Maurer D, Hensel K, Brown S, White K, Stoll S: A randomized, controlled trial of osteopathic manipulative treatment for acute low back pain in active duty military personnel. J Man Manip Ther 2012, 20:5-15.
• [40]Andersson GB, Lucente T, Davis AM, Kappler RE, Lipton JA, Leurgans S: A comparison of osteopathic spinal manipulation with standard care for patients with low back pain. N Engl J Med 1999, 341:1426-1431.
• [41]Gibson T, Grahame R, Harkness J, Woo P, Blagrave P, Hills R: Controlled comparison of short-wave diathermy treatment with osteopathic treatment in non-specific low back pain. Lancet 1985, 1:1258-1261.
• [42]Heinze G: The Effectiveness of a Holistic Osteopathic Treatment in Subacute Low Back Pain. A Randomized Controlled Trial. Akademie für Osteopathie; 2006. [Unpublished D.O. Thesis] http://www.osteopathic-research.com/index.php?option=com_jresearch&view=publication&task=show&id=13797&lang=en webcite
• [43]Kunz R, Djulbegovic B, Schunemann HJ, Stanulla M, Muti P, Guyatt G: Misconceptions, challenges, uncertainty, and progress in guideline recommendations. Semin Hematol 2008, 45:167-175.
• [44]Guyatt GH, Oxman AD, Schunemann HJ, Tugwell P, Knottnerus A: GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology. J Clin Epidemiol 2011, 64:380-382.
• [45]Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009, 339:b2700.
• [46]Adorjàn-Schaumann K, Höhrhan G, Wille H, Wolff A: Osteopathic Treatment of Chronic Low Back Pain. A Randomized Controlled Trial. Akademie für Osteopathie; 1999. [Unpublished D.O. Thesis] http://www.osteopathic-research.com/index.php?option=com_jresearch&view=publication&task=show&id=13311&lang=en webcite
• [47]Chown M, Whittamore L, Rush M, Allan S, Scott D, Archer M: A prospective study of patients with chronic back pain randomised to group exercise, physiotherapy or osteopathy. Physiother 2008, 94:21-28.
• [48]Gundermann S: Effectiveness of Osteopathic Treatment in Pregnant Women Suffering From Low Back Pain. A Randomized Controlled Trial. Akademie für Osteopathie; 2013. [Unpublished D.O. Thesis] http://www.osteopathic-research.com/index.php?option=com_jresearch&view=publication&task=show&id=15363&lang=en webcite
• [49]Licciardone JC, Buchanan S, Hensel KL, King HH, Fulda KG, Stoll ST: Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: a randomized controlled trial. Am J Obstet Gynecol 2009, 202:43-48.
• [50]Licciardone JC, Minotti DE, Gatchel RJ, Kearns CM, Singh KP: Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial. Ann Fam Med 2013, 11:122-129.
• [51]Licciardone JC, Stoll ST, Fulda KG, Russo DP, Siu J, Winn W, Swift J Jr: Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial. Spine (Phila Pa 1976) 2003, 28:1355-1362.
• [52]Mandara A, Fusaro A, Musicco M, Bado F: A randomised controlled trial on the effectiveness of osteopathic manipulative treatment of chronic low back pain (abstract). Int J Osteopath Med 2008, 11:156.
• [53]Peters R, Van Der Linde M: Osteopathic Treatment of Women with Low Back Pain during Pregnancy. A Randomized Controlled Trial. Akademie für Osteopathie; 2006. [Unpublished D.O. Thesis] http://www.osteopathic-research.com/index.php?option=com_jresearch&view=publication&task=show&id=13801&lang=en webcite
• [54]Recknagel C, Roá J: Study on the Effectiveness of Osteopathic Treatment for Women with Persistent Post Partum Back Pain. A Randomized Controlled Trial. Akademie für Osteopathie; 2007. [Unpublished D.O. Thesis] http://www.osteopathic-research.com/index.php?option=com_jresearch&view=publication&task=show&id=13395&lang=en webcite
• [55]Schwerla F, Rother K, Rother D, Ruetz M: Osteopathic treatment of women with persistent low back/pelvic girdle pain postpartum. In Vol Proceedings of the 9th International Symposium of Osteopathy 2012. Nantes, France: Akademie für Osteopathie; 2012. http://www.osteopathic-research.com/index.php?option=com_jresearch&view=publication&task=show&id=15181&lang=en webcite
• [56]Vismara L, Cimolin V, Menegoni F, Zaina F, Galli M, Negrini S, Villa V, Capodaglio P: Osteopathic manipulative treatment in obese patients with chronic low back pain: a pilot study. Man Ther 2012, 17:451-455.
• [57]Boesler D, Warner M, Alpers A, Finnerty EP, Kilmore MA: Efficacy of high-velocity low-amplitude manipulative technique in subjects with low-back pain during menstrual cramping. J Am Osteopath Assoc 1993, 93:203-204.
• [58]Cleary C, Fox JP: Menopausal symptoms: an osteopathic investigation. Complement Ther Med 1994, 2:181-186.
• [59]Hoehler FK, Tobis JS, Buerger AA: Spinal manipulation for low back pain. JAMA 1981, 245:1835-1838.
• [60]Tozzi P, Bongiorno D, Vitturini C: Low back pain and kidney mobility: local osteopathic fascial manipulation decreases pain perception and improves renal mobility. J Bodyw Mov Ther 2012, 16:381-391.
• [61]Caragan C, Tang PY, Slack M, Leiber JD, Koskinen J, Zust D, Cragun T: Pilot clinical study of osteopathic manipulative treatment in pregnant patients with acute low back pain. Int J Osteopath Med 2008, 11:155.
• [62]Hoffman KS, Hoffman LL: Effects of adding sacral base leveling to osteopathic manipulative treatment of back pain: a pilot study. J Am Osteopath Assoc 1994, 94:216-217.
• [63]Parker J, Heinking KP, Kappler RE: Efficacy of osteopathic manipulative treatment for low back pain in euhydrated and hypohydrated conditions: a randomized crossover trial. J Am Osteopath Assoc 2012, 112:276-284.
• [64]Williams NH, Wilkinson C, Russell I, Edwards RT, Hibbs R, Linck P, Muntz R: Randomized osteopathic manipulation study (ROMANS): pragmatic trial for spinal pain in primary care. Fam Pract 2003, 20:662-669.
• [65]MacDonald RS, Bell CM: An open controlled assessment of osteopathic manipulation in nonspecific low-back pain. Spine (Phila Pa 1976) 1990, 15:364-370.
• [66]Williams NH, Edwards RT, Linck P, Muntz R, Hibbs R, Wilkinson C, Russell I, Russell D, Hounsome B: Cost-utility analysis of osteopathy in primary care: results from a pragmatic randomized controlled trial. Fam Pract 2004, 21:643-650.
• [67]Kirk L, Underwood M, Chappell L, Martins-Mendez M, Thomas P: The effect of osteopathy in the treatment of chronic low back pain. a feasibility study. Int J Osteopath Med 2005, 8:5-11.
• [68]Burton AK, Tillotson KM, Cleary J: Single-blind randomised controlled trial of chemonucleolysis and manipulation in the treatment of symptomatic lumbar disc herniation. Eur Spine J 2000, 9:202-207.
• [69]Posadzki P, Ernst E: Osteopathy for musculoskeletal pain patients: a systematic review of randomized controlled trials. Clin Rheumatol 2011, 30:285-291.
• [70]Walker BF, French SD, Grant W, Green S: A Cochrane review of combined chiropractic interventions for low-back pain. Spine 2011, 36:230-242.