Osteopathy and Evidence Based Medicine. Analysis of Studies Investigating Benefits of Osteopathy as Treatment of Back Pain

Item

Title
Osteopathy and Evidence Based Medicine. Analysis of Studies Investigating Benefits of Osteopathy as Treatment of Back Pain
Author(s)
Richter Anja
Abstract
Study Design
The first chapter explains historical development and the basics of “Evidence based Medicine”. The randomized placebo controlled study and other types of clinical studies for evaluation of efficacy and effectiveness of therapies are introduced. The second chapter discusses some limitations and weaknesses of EbM. The third chapter discusses some problems of osteopathy to provide high graded studies with strong evidence for its application. The last chapter summarizes the results of the most important publications of clinical studies on OMT and spinal manipulation of patients with back pain over the last 15 years.
Outline/Problem Definition
There is little evidence from clinical studies as yet that osteopathic manipulation is effective for the treatment of any medical condition. Clinical research in osteopathy mainly focuses on patient-oriented observational studies including case reports and case series, which are ranking low in the evidence pyramid.
Research Question & Objective
Randomized control trials (RCTs) have been considered as the gold standard in establishing the efficacy of treatment or prevention of a disease. Over the past 15-20 years, several randomized control trials of osteopathic manipulation for treatment of back pain, have been reported. Thus, back pain is the best studied disease with regard to efficacy and effectiveness of OMT. Here, I will discuss the most recognized and cited reports over the past 15 years on studies, systematic reviews, and meta-analysis investigating efficacy and cost-effectiveness of osteopathy in treatment of back pain.
Hypothesis
Osteopathic manipulation (OM) has been thought to be specifically effective for treatment of musculoskeletal pain conditions such as back and shoulder pain, especially when these conditions are chronic. Therefore, prima facie evidence for the benefits of osteopathic manipulation may be provided in rigorous high quality clinical trials that unequivocally demonstrate efficacy and effectiveness in treatment of these conditions.
Relevance for the Patients
Back pain is one of the commonest causes of disability, work loss, and for consultation of physicians and practitioners of complementary medicine in industrialized countries. As such it is both a burden for the individual patient and a major economic problem. Back pain is a multifaceted disease and, conversely, there are multifaceted therapies for treatment of this condition. Dissatisfied with ineffective conventional methods, the patient is looking for alternative care including different manual therapies such as chiropractics, Alexander Technique, and Osteopathy. Therefore, it is important for the patient, the clinician, and the health care policymakers to identify adequate and effective treatments.
Relevance for Osteopathy
Acceptance of osteopathy amongst many patients, health policymakers, and physicians goes hand in hand with proving a benefit of OM in the Evidence based Medicine movement.
Methodology
Literature Study. Analysis of studies and meta-analyses investigating efficacy of (osteopathic) spinal manipulation as treatment of low back pain.
Results
Two of the best-designed studies enrolling 178 and 199 patients with back pain over 3 and 6 months, respectively, failed to provide evidence for a benefit of osteopathic manipulation. OM proved not more effective than standard treatment or fake OM. The second study that also included a no-treatment group showed that real and fake OM provided a greater improvement than no treatment suggesting that the effect was placebo-mediated. Follow up studies indicate a better cost effectiveness of OM. However these studies fall short of optimum design.
Critical Reflection/Perspectives/Conclusions
Osteopathy has fundamental methodological weaknesses that curtail expectations for ascertainment of its benefits in randomized clinical trials. More basic research including latest technologies of molecular medicine (i.e. proteomics, genomics, and systems biology) and imaging methods appear mandatory to demonstrate physiological changes at the molecular level after OM and thus overcome its current limitations.
Additional Information
presented at
Wiener Schule für Osteopathie
Date Accepted
2010
Date Submitted
1.12.2009 00:00:00
Type
osteo_thesis
Language
English
Number of pages
56
Submitted by:
62
Pub-Identifier
14687
Inst-Identifier
781
Keywords
Evidence,Back Pain,Evidenz,Rückenschmerzen
Recommended
0
Medium
RichterAnja_2009engl.pdf
Item sets
Thesis
Media
RichterAnja_2009engl.pdf

Richter Anja, “Osteopathy and Evidence Based Medicine. Analysis of Studies Investigating Benefits of Osteopathy as Treatment of Back Pain”, Osteopathic Research Web, accessed May 4, 2025, https://www.osteopathicresearch.com/s/orw/item/2859