Effectiveness of Osteopathic Interventions in Chronic Non Specific Low Back Pain: a Systematic Review and Meta-Analysis

Fulvio Dal Farra PT DO, MSc1, Roberta Giulia Risio DO1, Luca Vismara DO MSc PhDs1,2,3 , Andrea Bergna PT DO1

1 SOMA – Istituto Osteopatia Milano, Viale Sarca 336 F, 20126 Milan, Italy.
2 Division of Neurology and Neurorehabilitation, IRCCS Institute Auxologico Italiano 28824, Piancavallo-Verbania, Italy.
3 Department of Neurosciences “Rita Levi Montalcini”, University of Torino, 10126 Torino, Italy

Complementary Therapies in Medicine, 12 Novembre 2020
DOI

articolo in pubblicazione


Complementary Therapies in Medicine SOMA Osteopatia Milano

Abstract

BACKGROUND

Chronic low back pain (CLBP) is a frequent cause of disability and it represents a medical, social and economic burden globally. Therefore, we assessed effectiveness of osteopathic interventions in the management of CLBP for pain and functional status.

METHODS

A systematic review and meta-analysis were conducted. Findings were reported following the PRISMA statement. Six databases were searched for RCTs. Studies were independently assessed using a standardized form. Each article was assessed using the Cochrane risk of bias (RoB) tool. Effect size (ES) were calculated at post-treatment and at 12 weeks’ follow up. We used GRADE to assess quality of evidence.

RESULTS

10 articles were included. Studies investigated osteopathic manipulative treatment (OMT, n=6), myofascial release (MFR, n=2), craniosacral treatment (CST, n=1) and osteopathic visceral manipulation (OVM, n=1). None of the study was completely judged at low RoB. Osteopathy revealed to be more effective than control interventions in pain reduction (ES: -0.59; 95% CI: -0.81, -0.36; P<0.00001) and in improving functional status (ES: -0.42; 95% 95% CI: -0.68, -0.15; P=0.002). Moderate-quality evidence suggested that MFR is more effective than control treatments in pain reduction (ES: -0.69; 95% CI: -1.05, -0.33; P=0.0002), even at follow-up (ES: -0.73; 95% CI: -1.09, -0.37; P<0.0001). Low-quality evidence suggested superiority of OMT in pain reduction (ES: -0.57; 95% CI: -0.90, -0.25; P=0.001) and in changing functional status (ES: -0.34; 95% CI: -0.65, -0.03; P=0.001). Very low-quality evidence suggested that MFR is more effective than control interventions in functional improvements (ES: -0.73; 95% CI: -1.25, -0.21; P=0.006).

CONCLUSION

Results strengthen evidence that osteopathy is effective in pain levels and functional status improvements in CLBP patients. MFR reported better level of evidence for pain reduction if compared to other interventions. Further high-quality RCTs, comparing different osteopathic modalities, are recommended to produce better-quality evidence.

Keywords: Chronic low back pain, Osteopathic manipulative treatment, Manipulation, Myofascial release, Systematic review