Why reservations remain: A critical reflection about the systematic review and meta-analysis “Osteopathic manipulative treatment for low back pain” by Licciardone et al.

Franke, Helge

doi:10.1016/j.jbmt.2012.05.002

Cited by 3 publications

(2 citation statements)

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“…In 2005, Licciardone et al[28] published the first systematic review of OMT for LBP and concluded that OMT significantly reduced LBP. This review had a number of limitations and was criticized because it did not differentiate between OMT and single manual techniques[29] and because single techniques do not reflect osteopathic clinical practice. Further, it combined dichotomous and continuous outcomes, combined studies with specific and nonspecific back pain, lacked a risk of bias evaluation, and contained a unit of analysis error.…”

Section: Introductionmentioning

confidence: 99%

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

Franke¹,

Franke²,

Fryer

2014

BMC Musculoskelet Disord

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202

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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.

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Section: Introductionmentioning

confidence: 99%

“…Further, it combined dichotomous and continuous outcomes, combined studies with specific and nonspecific back pain, lacked a risk of bias evaluation, and contained a unit of analysis error. Given these shortcomings, reservations remain concerning the authors’ conclusions[29]. …”

Section: Introductionmentioning

confidence: 99%

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

Franke¹,

Franke²,

Fryer

2014

BMC Musculoskelet Disord

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202

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Systematic review and meta-analysis conclusions relating to osteopathic manipulative treatment for low back pain remain valid and well accepted

Licciardone

2013

Journal of Bodywork and Movement Therapies

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Osteopathic Manipulative Treatment Is Effective for Nonspecific Low Back Pain

2015

Journal of Osteopathic Medicine

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German integrative medicine researchers at the University of Duisburg-Essen assessed the applicability of a sham-controlled intervention of craniosacral therapy (CST) in the treatment of patients with chronic neck pain. The data reported were secondary findings of a randomized controlled trial on neck treatment (the primary outcome measures have not yet been reported). Fifty-four patients were randomly assigned to either a CST group or a sham-CST group. The CST protocol included cranial manual techniques well known to osteopathic physicians who use osteopathic cranial manipulative medicine (OCMM). The sham-CST was light touch "without therapeutic intention" for the same amounts of time and applied to the same regions of the body as the CST. Each patient was seen at 8 weekly 45-minute sessions. The patients all had chronic neck pain lasting at least 3 months with moderate intensity of at least 45 on a 100-mm visual analog scale. Four different therapists provided the interventions. Outcome measures were the Credibility/ Expectancy Questionnaire and the Helping Alliance Questionnaire obtained at the end of the eighth session. The results for adjusted ORs showed no difference between groups for the following Credibility/Expectancy Questionnaire items: (1) How confident are you that CST will be successful in reducing your neck pain symptoms? (2) How logical does CST seem to you for treating your limitations due to neck pain? and (3) How confident would you be in recommending CST to a friend with the same problem? Likewise, there was no difference between groups for the Helping Alliance Questionnaire variables of relation to therapist and satisfaction with treatment. Per-protocol analysis by regression coefficient revealed a significant difference between the groups for satisfaction with treatment, but findings were not significant in the intent-to-treat analysis. Previous osteopathic research using "light touch" found light touch to have a treatment effect. 1 As a treatment provider in that study, I can say that had there been a more concerted effort to mentally avoid "therapeutic intent," results might have been different. However, in a study 2 that "The Somatic Connection" highlights and summarizes important contributions to the growing body of literature on the musculoskeletal system's role in health and disease. This section of The Journal of the American Osteopathic Association (JAOA) strives to chronicle the significant increase in published research on manipulative methods and treatments in the United States and the renewed interest in manual medicine internationally, especially in Europe. To submit scientific reports for possible inclusion in "The Somatic Connection," readers are encouraged to contact JAOA Associate Editor Michael A. Seffinger, DO

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Why reservations remain: A critical reflection about the systematic review and meta-analysis “Osteopathic manipulative treatment for low back pain” by Licciardone et al.

Cited by 3 publications

References 15 publications

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

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

Systematic review and meta-analysis conclusions relating to osteopathic manipulative treatment for low back pain remain valid and well accepted

Osteopathic Manipulative Treatment Is Effective for Nonspecific Low Back Pain

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