Responding to the challenge of clinically relevant osteopathic research: Efficacy and beyond

Abstract

The osteopathic profession has been challenged over the past decade to provide clinically relevant research. The conduct of evidence-based osteopathic research is imperative not only for scientific, economic, and professional reasons, but also to drive health care policy and clinical practice guidelines. This paper summarizes recent studies in response to the osteopathic research challenge, including clinical trials registered with ClinicalTrials.gov and a systematic review and meta-analysis of osteopathic manipulative treatment (OMT) for low back pain. The concept of the OMT responder is introduced and supported with preliminary data. Within the context of a pain processing model, consideration is given to genomic (e.g., the catechol-O-methyltransferase gene) and psychological (e.g., depression and somatization) factors that are associated with pain sensitivity and pain progression, and to the role that such factors may play in screening for OMT responders. While substantial progress has been made in osteopathic research, much more needs to be done. Keywordsosteopathy; osteopathic medicine; osteopathic manipulative treatment (OMT); low back pain; genomics; catechol-O-methyltransferase (COMT); pain processing The osteopathic research challengeIn a recent Journal editorial, Lucas and Moran raised critical questions regarding the relevancy of contemporary osteopathy research in the evolving healthcare environment. 1 Their ultimate challenge to the osteopathic profession was to provide the "numbers" supporting the clinical effectiveness of osteopathy, or osteopathic manipulative treatment (OMT) as it is better known in the United States. They aptly identified important consumers of the numbers, including researchers, universities, health insurers, government agencies, and the media, with the latter noted to exert considerable influence over public opinion and, potentially, policy. The recent media attention afforded the Ernst and Canter 2 systematic review of systematic reviews of spinal manipulation and its conclusion that "data do not demonstrate that spinal manipulation is an effective intervention for any condition," illustrates their point.The osteopathic profession in the United States has been similarly challenged in the past decade. In 1997, Goldstein editorialized that the profession should foster evidence-based osteopathic medicine. 3 In 1999, following publication of a major randomized controlled trial of OMT in the New England Journal of Medicine ,4 Howell commented that "the long-term Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Ong...

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