Efficacy and safety of osteopathic manipulative treatment

The aim of the study by Bagagiolo et al. (2022) is to examine available clinical evidence on the efficacy and safety of osteopathic manipulative therapy (OMT) for various conditions, and an electronic search was conducted in seven databases: PubMed, EMBASE, CINAHL, Scopus, JBI, Prospero and Cochrane Library from inception to November 2021.Inclusion criteria for study selection were systematic reviews and meta-analyses of randomized controlled trials evaluating the efficacy and safety of OMT for all conditions.Data extraction and synthesis Data were extracted independently by two authors. The AMSTAR-2 tool was used to assess the methodological quality of the RCTs and AMs. The review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and the literature search identified 9 SRs or MAs conducted between 2013 and 2020, with 55 primary studies involving 3740 participants. The reviews covered a wide range of conditions, including acute and chronic non-specific low back pain (NSLBP, four reviews), chronic non-specific neck pain (CNSNP, one review), chronic non-cancer pain (CNCP, one review), pediatric (one review), neurological (primary headache, one review), and irritable bowel syndrome (IBS, one review). Although the effect sizes and quality of evidence varied, the investigators reported that OMT was more effective than comparator medications in relieving pain and improving functional status in acute/chronic NSLBP, CNSNP and CNCP. Due to small sample size, conflicting results and high heterogeneity, the evidence for the effectiveness of OMT in pediatric conditions, primary headache and irritable bowel syndrome was questionable and adverse events were not reported in most studies. The methodological quality of the included studies was rated as low or critically low according to AMSTAR-2.Conclusion:Based on currently available recommendations and pivotal trials, there is promising evidence of potential efficacy of OMT for musculoskeletal conditions, a 2022 systematic review showed. Limited and inconclusive evidence is available for pediatric conditions, primary headache and IBS. Further well-conducted systematic reviews and meta-analyses are needed to confirm and extend the efficacy and safety of OMT.Strengths of this study:The review was conducted in accordance with the Cochrane Handbook for the Systematic Review of Interventions and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Inclusion criteria were limited to systematic reviews and meta-analyses of randomized controlled trials that included patients with any condition.Weaknesses of this study:As only randomized controlled trials in which OMT was performed by osteopathic physicians or osteopaths were included, some relevant systematic reviews may have been missed. Bagagiolo D, Rosa D, Borrelli F. Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews. BMJ Open. 2022 Apr 12;12(4):e053468. doi: 10.1136/bmjopen-2021-053468. PMID: 35414546; PMCID: PMC9021775.