American Osteopathic Association guidelines for osteopathic manipulative treatment (OMT) for patients with low back pain

• Published in: The Journal of the American Osteopathic Association 2010-11, Vol.110 (11), p.653-666
• Main Authors: American Osteopathic Association, Clinical Guideline Subcommittee on Low Back Pain
• Format: Article
• Language: English
• Subjects: Confidence Intervals; Evidence-Based Medicine; Humans; Low Back Pain - rehabilitation; Low Back Pain - therapy; Manipulation, Osteopathic - methods; Manipulation, Osteopathic - standards; Osteopathic Medicine - standards; Osteopathic Physicians - standards; Societies, Medical - standards; Statistics as Topic; Treatment Outcome; United States
• ISSN: 1945-1997

Osteopathic manipulative treatment (OMT) is a distinctive modality commonly used by osteopathic physicians to complement conventional treatment of musculoskeletal disorders, including those that cause low back pain. Osteopathic manipulative treatment is defined in the Glossary of Osteopathic Terminology as: "The therapeutic application of manually guided forces by an osteopathic physician (US Usage) to improve physiologic function and/or support homeostasis that has been altered by somatic dysfunction. OMT employs a variety of techniques." Somatic dysfunction is defined as: "Impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial and myofascial structures, and their related vascular, lymphatic, and neural elements. Somatic dysfunction is treatable using osteopathic manipulative treatment." Previous published guidelines have been based on literature reviews and meta-analyses of spinal manipulation for low back pain. They have not specifically addressed OMT and generally have focused on spinal manipulation as an alternative to conventional treatment. The purpose of this study was to assess the efficacy of OMT for somatic dysfunction associated with low back pain by osteopathic physicians and osteopathic practitioners trained in osteopathic palpatory diagnosis and manipulative treatment. Computerized bibliographic searches of MEDLINE, OLDMEDLINE, EMBASE, AMED, MANTIS, OSTMED (OSTMED.DR), and the Cochrane Central Register of Controlled Trials were supplemented with additional database and manual searches of the literature. Six trials, involving eight OMT vs control treatment comparisons, were included because they were randomized controlled trials of OMT that involved blinded assessment of low back pain in ambulatory settings. Data on trial methodology, OMT and control treatments, and low back pain outcomes were abstracted by two independent reviewers. Effect sizes were computed using Cohen d statistic, and meta-analysis results were weighted by the inverse variance of individual comparisons. In addition to the overall meta-analysis, subgroup meta-analyses were performed according to control treatment, country where the trial was conducted, and duration of follow-up. Sensitivity analyses were performed for both the overall and subgroup meta-analyses. Osteopathic manipulative treatment significantly reduced low back pain (effect size, -0.30; 95% confidence interval, -0.47 to -0.13; P=.001). Subgroup analys