Ricerca

Abstract

BACKGROUND:
The prolonged restrictions of ankle degrees-of-freedom when wearing ski-boots leads to prolonged mechanical compression of the athlete’s ankle and feet with alteration of the mechano-receptors in the skin of the sole of the foot. Our hypothesis was that prolonged repetitive use of ski boots may impair ankle function and, ultimately, postural control in skiers. This study conducted on elite alpine skiers was designed to verify if an osteopathic treatment aimed at improving ankle function may affect postural control on skiers.

METHODS:
Seven elite skiers were assessed using three-dimensional quantitative movement analysis of the spine and postural analysis before and after osteopathic manipulative treatment (OMT). OMT consisted of low-amplitude thrusts in the ankle and myofascial release of the interosseous membrane and shank.

RESULTS:
The range of motion of the shoulders in the frontal plane, of pelvic obliquity and lumbar curve increased significantly after OMT. No changes appeared in terms of posture.

CONCLUSIONS:
This study shows that a single OMT session targeted to the ankle seems to induce beneficial biomechanical effects in terms of spinal flexibility in elite alpine skiers. This may be beneficial for the athlete’s performance capacity and safety.

KEY WORDS: Skiing – Manipulation, osteopathic – Ankle

Abstract

Objective
To investigate the action of osteopathic manipulative treatment on the muscular activity of the stomatognathic apparatus by using surface electromyography (sEMG).
Material and Methods
Surface electromyography (sEMG) was performed on the masseter and anterior temporalis muscles of 120 subjects (73 F; 47 M), both at time T0 and T2. The sample was divided into three randomized groups of 40 subjects each: control, placebo, and osteopathic manipulative treatment (OMT). In the T1 interval between the two evaluations, the control group was not treated, the placebo group underwent a placebo treatment, and the OMT group underwent manipulative treatment. The mean value of each measurement and its coefficient of variation, between time T0 and T2, were calculated for both the intragroup (OMT, placebo, control) and the intergroup (OMT-placebo, OMT-control).
Outcomes
In 40% of the subjects, statistically significant improvements were highlighted in the OMT. Whereas, the statistically significant results of the placebo and control groups were 7.5% and 17.5%, respectively, of which more than 75% moved away from the physiological range, showing a worsening of the muscular activity. This analysis showed statistically significant variations (p ≤ 0.05) in the OMT group compared to the placebo and the control groups. Conclusions: OMT determines variations of the activity of masticatory muscles.

Keywords: osteopathic manipulative treatment; masticatory muscles; electromyography; occlusion; temporomandibular joint

Abstract

Background
Osteopathic manipulative treatment (OMT) has been successfully tested in the context of preterm infants. No studies, however, have been conducted to investigate the OMT immediate effects on physiological measurements, such as partial oxygen saturation (SpO2) and heart rate (HR). The purpose of the present study was to assess the effect of osteopathic treatment on SpO2 and HR values and to compare it with 10 min of static touch.

Materials and methods
Ninety-six preterm infants (41 male), aged 33.5 weeks (±4.3) with mean weight at birth of 2067gr (±929) were recruited from the neonatal intensive care unit (NICU) of the Buzzi Hospital in Milan, and randomly allocated to two groups: OMT and Static Touch. Each protocol session consisted of: a) 5-min Pre-touch baseline recording, b) 10-min touch procedure, c) 5-min post-touch recording. Primary and secondary outcomes were, respectively, the baseline changes of HR and SpO2.

Results
The 2 × 2 repeated measure ANOVA for HR showed a statistically significant effect (F (1,94) = 5.34; p 

Conclusion
Results from the present study suggest that a single osteopathic intervention may induce beneficial effects on preterm physiological parameters.

Trial registration
ClinicalTrials.gov identifier: NCT03833635 – Date: February 7, 2019

Keywords:

Autonomic nervous system, Heart rate, Osteopathic manipulative treatment, Oxygen saturation, Preterm, Touch

Abstract

Constipation is frequent amongst infants who have undergone surgery for anorectal malformation (ARM). Faecal retention, due to a dysfunctional enteric reflex of defaecation, can cause abdominal cramps, pseudoincontinence and, in the worst cases, megacolon. Prokinetic protocols are used to stimulate at least 1 bowel movement per day, including laxatives, enema, stools softeners and dietary schedules.
While osteopathic manipulative treatment is adopted in adults for functional constipation, it has not been described for infants. Herein, we report the case of an infant undergoing anorectoplasty for a low ARM who was referred to the osteopath 2 years after the onset of severe constipation associated with pseudoincontinence and abdominal cramps and was refractory to the prokinetic protocol. In a child with a good ARM prognosis, autonomous daily bowel movements should be achieved. In this child, the imbalanced tension of the pelvic floor and immaturity of the parasympathetic plexus led to a functional alteration of the defaecation reflex. After adjunction of osteopathic manipulative treatment (OMT) to the therapeutic panel, the constipation showed gradual remission, with acquisition of autonomous defaecation 4 months after the therapy began.
This suggests the importance of investigating the efficacy of OMT inclusion in the postsurgical prokinetic protocols for ARM patients with a good prognosis. © 2020 The Author(s) Published by S. Karger AG, Basel

Background
Anorectal malformations (ARMs) are common congenital malformations of the pelvic region in the paediatric population. They have a prevalence of 1–3 on 5,000 live births, with a boy-to-girl ratio of 4:1 [1]; 43–71% of ARM cases are associated with other malformations [2]. Despite the efficacy of surgery in restoring the anorectal anatomy, functional alterations such as constipation and incontinence can be long-term complications [3].
In a child with ARM but with a good prognosis, sphincter capacity and no spinal deformities, regular bowel emptying should be restored after surgery [4].
This is functionally based on the combined integrity of bowel movement, a good sphincter seal and the integrity of the anal canal [5]. Therefore, constipation in those children is managed with constipation avoidance protocols that comprise a specific dietary schedule and laxatives. However, constipation remains a frequent concern, especially in benign forms of ARM [3].
Thus, we report the case of a child who underwent anorectoplasty [6] and experienced severe postoperative constipation managed with a protocol including osteopathic manipulative treatment (OMT).

Case Presentation
A 3,400-g male infant born by vaginal delivery at 40 gestational weeks was diagnosed with low ARM during postnatal screening. The mother was a multipara with no remarkable findings at routine serology and morphologic screening. Both parents denied any family history of ARM or other anatomical malformations.
At the delivery room examination, the obstetric personnel revealed an imperforated anus and a rectoperineal fistula. Urinary tract echography showed a 6-mm pyelic ectasia of the left renal pelvis without ureter, kidney and bladder involvement. Cardiological, orthopaedic and neurological examinations were negative.
Hence, at 5 days of life, the infant underwent anorectoplasty, without intraoperative complications, receiving a relocation of the rectus with the sphincters [6]. Hegar probe was used to dilate the sphincter after surgery with a gradual increase in calliper until the conclusion of the program. Six months after surgery, the infant was stable with an increase in normal dietary intake. However, laxative therapy with macrogol (0.7 g/kg macrogol 4000 with gradual increase), and enema if necessary, was administered, since he started suffering from severe constipation.
Despite the gradual increase in dosage of macrogol, the baby still had evacuation difficulties associated with abdominal pain, frequent urination and aerophagia. Furthermore, 18 months after surgery, he was admitted to the paediatric department for bowel obstruction due to a faecaloma. After resolution of the obstruction, the laxative therapy was modified, with daily administration of senna with a gradual increase in dose due to persistence of constipation (3.75–15 mg once daily, adjusted according to response).
Then, 21 months after surgery, the baby started soiling and experiencing intense abdominal pain that made him less active during daytime. Hence, 24 months after surgery, the child was referred to the osteopath, who examined the functional status of the musculoskeletal apparatus and the pelvic region. The main somatic dysfunctions were in the pelvic floor, which presented with an unbalanced tissue texture between the two sides, as well as in the sacroiliac region, linked with an asymmetric passive movement capacity of the sacrococcygeal region. The child received 4 OMTs that were scheduled once a month, each with a duration of 45 min. Indirect manual techniques were used for management of the somatic dysfunctions. These types of technique are characterized by passive movement of the dysfunctional region in a position of less tissue tension [7].
Along with the pharmacological regimen, the child mainly received balanced ligamentous tension treatment of the sacroiliac joint, balance and hold treatment of the sacrococcygeal ligaments and counter-strain treatment of the pelvic floor (Fig. 1). At the end of each OMT session, a balance treatment between the subdiaphragmatic region and the pelvic floor was administered together with craniosacral therapy. During the entire duration of the OMT, laxative therapy was continuously monitored by the paediatrician and adjusted according to response.
After the first OMT, an intermittent slight increase in the child’s defaecation frequency was reported by the parents, who managed the incomplete evacuations with enemas and senna. Moreover, after the third OMT, an increase in defaecation frequency was observed (from 2 to 3), associated with a reduction of the intense colic abdominal pain, which led to interruption of the laxative regimen according to the indication of the paediatrician.
Enemas were administered by the parents when needed, decreasing to 2 applications per week. In addition, after the third and fourth OMTs, the discharge frequency improved, together with an increase in frequency from 3 to 4 evacuations per week, respectively, leading to completely autonomous defaecation at the end of the treatment period. The pseudoincontinence stopped 3 months after the OMTs began, observing a modification on the Bristol Stool Chart from type 6 to type 3. Enema kept being used only sporadically with a time period of 2–3 months between each application (Fig. 2).
Osteopathic care continued after the treatment period with 2 treatments per year, managing the pelvic floor tissue tensions linked to the surgical scar. Currently, at 4 years of age, the child no longer manifests constipation and soiling, and enema use was interrupted 2 years previously.

Discussion and Conclusions
Patients with ARM frequently experience constipation after corrective surgical intervention, showing diminished bowel movements. This mechanism leads to reduced faecal passage and to faecal retention, being experienced by more than 77% of children who have undergone anorectoplasty [8]. Moreover, constipation frequently develops after surgery, independently of the ARM type, with a mean interval after the intervention of 5.2 months but with significant variability (0.2–16.2 months) [8].
Delayed recognition of constipation can be an issue that postpones prokinetic programs (PPs) and exposes the child to a higher morbidity risk. Levitt et al. [3] identified an association between delayed intervention with PPs and long-term reduction of bowel mobility, with soiling, abdominal cramps, nausea and emesis with implications for quality of life. This worsening of patients’ conditions shows once more the importance of restoring bowel movements after surgery.
In a case-control study, endoanal ultrasonography showed a significant difference in inferior sphincter thickness between postoperative ARM patients and controls. Moreover, balloon manometry showed a difference in bowel distension between the two groups, with a mild inverse correlation between balloon distension and function anal score [9]. These data mark a possible mismatch of the autonomic visceral plexuses and bowel peristalsis, possibly linked to an incomplete autonomic maturation of the anorectal membrane.
The fascial alteration, originating from an interruption or reduced physiological connection between the proctodaeum (ectoderm) and anal canal (endoderm) and re-established by surgery, results in a fascial alteration between the coccyx and pubis, including a neurovegetative alteration with an increase in tone muscle and perineal contraction. In fact, defaecation is managed by intrinsic and extrinsic reflexes that are complementarily activated for faeces expulsion [10].
Their role becomes conscious in the adult, where the external sphincter can voluntarily modulate the rectal inhibitory reflex, stopping the peristaltic wave and defaecation. This reflex is far less voluntary in the child, where rectal distension evokes the rectoanal inhibitory reflex activated by the enteric nervous plexus. Interestingly, in this case, we found an altered pelvic floor tissue tension, denoting an unbalanced myofascial load distribution on the pelvic floor, correlated to a severely difficult start of the defaecation reflex.
Furthermore, the upper cervical region and presacral fascia, anatomically linked to the parasympathetic nervous system, were found to be dysfunctional in this child as well. OMT has shown preliminary efficacy in adults with functional constipation [11], in reducing gastrointestinal symptoms caused by adjuvant chemotherapy [12] and in patients with distal intestinal obstructive syndrome [13]. However, OMT effects have been described only in 1 case of a child with chronic constipation related to Pitt-Hopkins syndrome, showing an increment in defaecation frequency and better Bristol Stool Chart scores during the treatment period [14].
In our patient, the postoperative constipation was rapidly approached with macrogol and senna, helping the child emptying his bowel in the postoperative period. However, due to obstinate constipation, even a higher dosage of senna and enemas were not able to empty his bowel. Introduction of OMT in the therapeutic management enhanced his bowel movements in the short term, and reduced the constipation and its associated symptoms in the long term. This case emphasizes the importance of considering OMT as an adjuvant therapy to PPs for chronic constipation in the postsurgical period, and the possible clinical implication of myofascial system dysfunctions of the pelvic floor in children with ARMs.

Acknowledgments
The authors wish to acknowledge the parents of the child for their willingness and active participation and to thank the Università di Torino PhD Program in Experimental Medicine and Therapy.

Statement of Ethics
Case reports are not required to have institutional review board approval. Our patient and the patient’s father signed a written consent form for publication of his clinical data and his pictures according to the Manima organization’s internal policies and statutes.

Disclosure Statement
The authors declare that they have no competing interests.

Funding Sources
No funding was obtained for this study.

Author Contributions
L.V. conceptualized and designed the case report, reviewed and revised the manuscript, and approved the final manuscript as submitted; R.G. developed the initial draft and approved the final manuscript as submitted; L.G.P. developed the final draft, revised the manuscript, and approved the manuscript as submitted; V.C. developed the literature review, revised the manuscript, and approved the final manuscript as submitted; A.G.T. developed the final draft, revised the manuscript, and approved the manuscript as submitted.

References
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3 Levitt MA, Kant A, Peña A. The morbidity of constipation in patients with anorectal malformations. J Pediatr Surg. 2010 Jun;45(6):1228–33.
4 Levitt MA, Peña A. Imperforate anus and cloacal malformations. In: Holcomb GW, Murphy JP, editors. Pediaric surgery. 5th ed. Philadelphia: Elsevier Saunders; pp. 337–59.
5 Levitt M, Peña A. Update on pediatric faecal incontinence. Eur J Pediatr Surg. 2009 Feb;19(1):1–9.
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8 Chang PC, Duh YC, Fu YW, Hsu YJ, Wei CH, Huang H. How much do we know about constipation after surgery for anorectal malformation? Pediatr Neonatol. 2019 Feb;61(1):58–62.
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12 Lagrange A, Decoux D, Briot N, Hennequin A, Coudert B, Desmoulins I, et al. Visceral osteopathic manipulative treatment reduces patient reported digestive toxicities induced by adjuvant chemotherapy in breast cancer: a randomized controlled clinical study. Eur J Obstet Gynecol Reprod Biol. 2019 Oct;241:49–55.
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14 Aquino A, Perini M, Cosmai S, Zanon S, Pisa V, Castagna C, et al. Osteopathic Manipulative Treatment Limits Chronic Constipation in a Child with Pitt-Hopkins Syndrome. Case Rep Pediatr. 2017;2017:5437830.

Abstract

Introduction
Osteopathy uses manipulative techniques to support physiological function and adaptation. These conditions are modified by the presence of Somatic Dysfunction (SD), an altered function of the components of the body’s framework system. Despite SD’s widespread use in clinical practice and education, research has previously shown poor results in terms of reliability and validity.
In this theoretical article, the authors’ proposal is to argue for a new clinical perspective for SD which suggests a different palpatory assessment of its clinical signs: the “Variability Model”.

Methods
A double simultaneous literature search was performed between January and March 2019 in Medline’s electronic database. The first one critically analysed the clinical signs most used to detect SD. The second one informed authors’ hypothesis related to movement variability assessment in the Neutral Zone (NZ).

Discussion
The Variability Model explains how the assessment of the range of motion in the NZ is essential to detect SD, its motion asymmetry and its relative restriction.
The Variability Model explains SD semeiotics which could be related to “body adaptability”, thus having implications with the concept of health. Finally, this paradigm aims to establish new developments in research, especially regarding SD reliability and clinical relevance.

Conclusions
Movement variability allows to interpretSD clinical signs as an attempt by the body to maintain a healthy condition. This paradigm should be included in the future context of osteopathy which could better explain SD’s pathophysiological mechanism, without ignoring the accuracy of its physical examination.

Keywords:

somatic dysfunction, osteopathy, palpation, diagnosis, physical examination, variability

Abstract

Introduction
Vestibular failure or hypofunction can be generated by pathologies such as vestibular neuritis (VN), causing the onset of rotatory vertigo and the vestibulo-ocular reflex (VOR) hyporeaction. VN is a post-viral inflammation-producing vestibular nerve-axon impairment, which reaches compensation in 70% of cases. Here, we present two cases of vestibular failure that did not respond to pharmacological therapy, but did show modulated vestibular response after an osteopathic manipulative treatment. Dizziness handicap inventory (DHI) was used to assess disability, while VOR was examined by means of video head impulse test (v-HIT). Case 1 showed bilateral VOR areflexia with severe related disability due to chronic vertigo, while case 2 showed sub-acute VN complicated by intense vomiting. After treatment, both cases had a complete remission of symptoms, with a reduction in DHI score of 60 and 70 points respectively, as well as a normalization of the v-HIT exam.

Conclusion
OMT might work to modulate VOR, through osteopathic manipulation of the fascial-system and interaction with proprioceptive inputs. Further clinical trials should be performed to investigate the OMT clinical efficacy in uncompensated vestibular neur.

Keywords:
Fascia, vestibulo-ocular reflex, vertigo, dizziness, proprioception, osteopathic medicine

Abstract

Preterm birth is a significant risk factor for a range of long-term health problems and developmental disabilities. Though touch plays a central role in many perinatal care strategies, the neurobiological basis of these approaches is seldom considered. C-Tactile afferents (CTs) are a class of unmyelinated nerve fibre activated by low force, dynamic touch. Consistent with an interoceptive function, touch specifically targeted to activate CTs activates posterior insular cortex and has been reported to reduce autonomic arousal. The present study compared the effect of 5 min of CT optimal velocity stroking touch to 5 min of static touch on the heart-rate and oxygen saturation levels of preterm infants between 28- & 37-weeks gestational age. CT touch produced a significant decrease in infants’ heart-rates and increase in their blood oxygenation levels, which sustained throughout a 5-min post-touch period. In contrast, there was no significant change in heart-rate or blood oxygenation levels of infants receiving static touch. These findings provide support for the hypothesis that CTs signal the affective quality of nurturing touch, providing a neurobiological substrate for the apparent beneficial effects of neonatal tactile interventions and offering insight for their optimisation.

Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.

KEYWORDS:

Affective; C-tactile; Heart-rate; Infant; Preterm; Touch

ABSTRACT

Background: The delayed transition from gavage-to-nipple feeding is one of the most significant factors that may prolong hospital length of stay (LOS). Osteopathic manipulative treatment (OMT) has been demonstrated to be effective regarding LOS reduction, but no investigations have documented its clinical validity for attaining oral feeding.
Objectives: To assess OMT utility regarding the timing of oral feeding in healthy preterm infants.
Design: Preliminary propensity score-matched retrospective cohort study.
Setting: Data were extrapolated from the neonatal intensive care unit (NICU) of Del Ponte Hospital in Varese, Italy, during the period between March 2012 and December 2013.
Interventions: Two propensity score-matched groups of healthy preterm infants aged 28+0 to 33+6 were com-pared, observing those supported with OMT until hospital discharge and control subjects.
Main outcome measures: Days from birth to the attainment of oral feeding was the primary endpoint. Body weight, body length, head circumference and LOS were considered as secondary endpoints.
Results: Seventy premature infants were included in the study as the control group (n = 35; body weight (BW) = 1457.9 ± 316.2 g; gestational age (GA) = 31.5 ± 1.73 wk) and the osteopathic group (n = 35; BW = 1509.6 ± 250.8 g; GA = 31.8 ± 1.64 wk).
The two groups had analogous characteristics at study entry. In this cohort, we observed a significant reduction in TOF (-5.00 days; p = 0.042) in the osteopathic group with a greater effect in very low birth weight infants.
Conclusions: These data demonstrate the utility and potential efficacy of OMT for the attainment of oral feeding. Further adequately powered clinical trials are recommended.

ABSTRACT

The prevalence of osteopathic practitioners, their professional profile and features of their clinical practice, particularly where statutory regulation does not yet exist, are still significantly underreported. The Osteopathic Practitioners Estimates and RAtes (OPERA) project was developed as an European-based census dedicated to profiling the osteopathic profession across Europe. The present study aimed to describe the osteopathic practitioners and the profession in Italy. A voluntary, online based, closed-ended survey was distributed across Italy in the period between February and June 2017. An e-based campaign was set up to reach the Italian osteopathic professionals. Participants were asked to complete the forms by filling in the information regarding the demographics, working status and professional activities, education, consultation fees, patient complaints, treatment and management. The survey was completed by 4816 individuals. 196 people started the survey but did not finish, which corresponds to a 4% attrition rate. The majority of respondents were males (66.7%). The modal age group was 30-39 (40.0%). 73.8% of respondents had a previous academic degree, mainly in the fields of sports science (36.4%) and physiotherapy (25.3%). 25.6% declared not to have a previous academic degree. The majority of respondents declared to work alone (58.4%), while the remaining declared to work in association with other professionals. The osteopaths /citizens ratio was 8.0 osteopaths/100,000 citizens. The profile of osteopaths in Italy seems to be characterised by a self-employed young adult male working mostly as a sole practitioner, who has been trained as osteopath through a part-time curriculum and had a previous degree mostly in the fields of sports science or physiotherapy. These results provide important insights into the osteopathic profession in Italy. The varied professional educational backgrounds need to be considered with regard to the implementation of a professional licensing process and future pre-registration education in the country. The number of respondents is an estimate of the actual number of Italian osteopaths. Only the completion of the regulatory process and the creation of the mandatory official register will allow to know the number of Italy based osteopaths.

ABSTRACT

Pudendal neuralgia is characterised by pain in the pudendal dermatome. It could be due to a stenosis of the pudendal canal, a compression along its pathway, or a pelvic trauma.

Pudendal nerve entrapment (PNE) syndrome is frequently involved in pudendal neuralgia onset. This case report describes the osteopathic manipulative treatment (OMT) of a patient with functional PNE. A 40-year-old female presented with a 12-month history of intense pelvic pain resistant to 3 months of pharmacologic treatment that arose after three proctological surgeries. A perineal retracted painful scar was visible upon examination. PNE syndrome diagnosis was based on Nantes criteria. The electromyogram of the nerve showed an increased motor response latency of the left pudendal nerve. Visual analogue scale (VAS), female National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), Oswestry Disability Index (ODI) and Tampa scale of kinesiophobia (TSK) were used to assess patient’s symptoms at baseline (T0), after pharmacologic treatment (T1), after OMT (T2), and at 6-month follow-up. Five treatments, including direct and indirect techniques, were performed for 1 month. OMT reduced pelvic neuralgia and disability indexes without any complications, maintaining a positive outcome at 6-month follow-up (VAS: T0 = 10, T1 = 10, T2 = 1.8, T3 = 1.5), (NIH-CPSI: T0 = 34, T1 = 30, T2 = 7, T3 = 6), (ODI: T0 = 48, T1 = 29, T2 = 9, T3 = 5) and (TSK: T0 = 51, T1 = 41, T2 = 20, T3 = 17). This is the first report of a patient diagnosed with functional PNE managed with OMT. A link between PNE, scar and pelvic somatic dysfunctions could suggest double crush syndrome.

ACKGROUND
Pisa syndrome (PS) is a clinical condition frequently associated with Parkinson’s Disease (PD). It is characterized by a trunk lateral flexion higher than 10 degrees and reversible when lying. One pathophysiological hypothesis is the altered verticality perception, due to a somatosensory impairment. Osteopathic Manipulative Treatment (OMT) manages fascial-system alterations, linked to somatic dysfunctions. Fascial system showed to be implicated in proprioceptive sensibility.

OBJECTIVE
The aim of the study was to assess OMT efficacy on postural control in PD-PS patients by stabilometry.

METHODS
In this single-blinded trial we studied 24 PD-PS patients, 12 of whom were

RESULTS
At one month, the sway area of the OMT group significantly decreased compared to placebo (mean delta OMT – 326.00±491.24 mm2 , p  = 0.01). In the experimental group TLF showed a mean inclination reduction of 3.33 degrees after treatment (p  = 0.044, mean d  = 0.54). Moreover, a significant positive association between delta ECSA and delta TLF was observed (p  = 0.04, r  = 0.46).

DISCUSSION
Among PD-PS patients, MIRT plus OMT showed preliminary evidence of postural control and TLF improvement, compared to the control group.

Keywords: Fascia, osteopathic medicine, complementary therapies, Parkinson, proprioception, ClinicalTrials.gov NCT04137848

Abstract

Background
The purpose of this study is to evaluate the efficacy of preventive an curative osteopathic manipulative treatment (OMT) on chronic groin pain in the short and medium term in a group of football players. The groin pain is common in a football players and its symptoms like pain and discomfort causes functional capacity reduction. Evidence and guideline for the treatment of this pathology are poor in literature.

Methods
Patients: the athletes considered were twenty-three male semi-professional soccer players (mean age 26±4.10 years); seventeen of them had already had a physioterapic intervention uselessly while six players underwent OMT after a period of 2 to 3 weeks of activity restriction without successful results. They have been selected according to previously published criteria. Evaluation: was evaluated palpatory pain, VAS at rest and during sport activity, Osteopathic evaluation and personal evaluation. Treatment protocol: patients were treated for 6 sessions of 45 minutes whit an 8-days interval between each session with a final evaluation at four months. Subject continue their sport activity despite pain. Outcome measure: the result was evaluated in a blind trial by an external evaluator at the end of each session and four months after the completion of the treatment.

Results
The number of patients scoring pain zero on the VAS scale has increased during the treatments. Four months after the treatment 21 individuals (91%) scored 0 on the VAS scale at rest; as for the pain perceived during sports, 15 players (65%) scored 0 on the VAS scale. At the end of OMT and without the suspension of the sport, the clinical picture has improved in almost all of the group; furthermore at 4 months, in 44% of individuals the problem has completely resolved without having to cease activity. All patients perceived improvement in symptoms.

Conclusions
After 6 OMT treatments we observed that the pain perceived by the soccer players both at rest and during the specific sports activity dropped significantly. In almost half of the study sample, the pain disappeared completely and they do not have to stop their sport during the treatment phase.

Keywords
Groin – Soccer – Manipulation, osteopathic

Abstract

BACKGROUND:
Osteopathic medicine is an emerging and complementary method used in neonatology.

METHODS:
Outcomes were the mean difference in length of stay (LOS) and costs between osteopathy and alternative treatment group. A comprehensive literature search of (quasi)- randomized controlled trials (RCTs), was conducted from journal inception to May, 2015. Eligible studies must have treated preterm infants directly in the crib or bed and Osteopathic Manipulative Treatment (OMT) must have been performed by osteopaths. A rigorous Cochrane-like method was used for study screening and selection, risk of bias assessment and data reporting. Fixed effect meta-analysis was performed to synthesize data.

RESULTS:
5 trials enrolling 1306 infants met our inclusion criteria. Although the heterogeneity was moderate (I = 61%, P = 0.03), meta-analysis of all five studies showed that preterm infants treated with OMT had a significant reduction of LOS by 2.71 days (95% CI -3.99, -1.43; P < 0.001). Considering costs, meta-analysis showed reduction in the OMT group (-1,545.66&OV0556;, -1,888.03&OV0556;, -1,203.29&OV0556;, P < 0.0001). All studies reported no adverse events associated to OMT. Subgroup analysis showed that the benefit of OMT is inversely associated to gestational age.

CONCLUSIONS:
The present systematic review showed the clinical effectiveness of OMT on the reduction of LOS and costs in a large population of preterm infants.

Abstract

Background

Coccydynia is a disorder associated with pain/discomfort at the base of the spine. The role of osteopathic manipulative treatment (OMT) in chronic coccydynia as well as for low back pain (LBP) and radicular pain (RP) associated with coccydynia, has not previously been investigated. This study seeks to analyse the effects of OMT on chronic coccydynia compared to physical therapy and pharmacological treatment (PTPT). The secondary objective is to analyse the effect of OMT on LBP and RP associated with coccydynia.

Methods

Clinical records of 50 patients were examined. These patients (aged 39.94 ± 15.34 years, BMI 21.22 ± 3.15) who complained of chronic coccydynia were assessed 3 times: before any treatment (t0), after PTPT (t1) and after OMT (t2). Patients were treated with PTPT during the first 3 months and then referred by physicians to osteopaths to receive 3 sessions of OMT over a period of 5 weeks. The outcome measurements were made by a visual analogue scale (VAS 0-10 cm) and the Oswestry Low Back Pain Disability Questionnaire.

Results

Before starting OMT treatment, patients showed a stable condition of coccydynia (mean VAS values from 7.1 to 6.5 p = 0.065) and a slight but significant reduction in disability (mean OD values from 17.7 to 14.5 p = 0.017) after PTPT. After the 3 sessions of OMT, all subjects gained a successful reduction in pain (mean VAS values from 6.5 to 1.2, p ≤ 0.001) and demonstrated a higher significant reduction in disability (mean Oswestry scale values from 14.5 to 2.5, p Conclusions

This case series shows that OMT elicits a positive benefit for pain relief and reduction in disability in patients complaining of coccydynia (with or without LBP and RP associated with coccydynia). Therefore, OMT could be considered as a valid therapeutic approach for treating chronic coccydynia. Nevertheless, further research is required to test the hypothesis and to better determine the benefits of OMT.

Copyright © 2017 Elsevier Ltd. All rights reserved.

The Journal of Bodywork and Movement Therapies mette a disposizione per soli 50 giorni il testo completo dell’articolo pubblicato nel 2017 “Trattamento Osteopatico Manipolativo in coccigodinia cronica: una serie di casi” (Osteopathic manipulative treatment in chronic coccydynia: A case series)redatto da Daniele Origo DO MROI, uno dei responsabili di SOMA Istituto Osteopatia Milano, Andrea Tarantino DO MROI, Luca Vismara DO MROI e il Dott. Alessandro Nonis.

Questa è una interessante opportunità per coloro i quali vogliono approfondire questo argomento, potendo consultare e scaricare l’intero scritto a quasi un anno dalla sua pubblicazione ufficiale.

Condividere il sapere è un dovere!

Abstract

Introduction
Osteopathic Manipulative Treatment (OMT) is effective in improving function, movement and restoring pain conditions. Despite clinical results, the mechanisms of how OMT achieves its’ effects remain unclear. The fascial system is described as a tensional network that envelops the human body. Direct or indirect manipulations of the fascial system are a distinctive part of OMT.

Objective
This review describes the biological effects of direct and indirect manipulation of the fascial system.
Material and methods
Literature search was performed in February 2016 in the electronic databases: Cochrane, Medline, Scopus, Ostmed, Pedro and authors’ publications relative to Fascia Research Congress Website.

Results
Manipulation of the fascial system seems to interfere with some cellular processes providing various pro-inflammatory and anti-inflammatory cells and molecules.

Discussion
Despite growing research in the osteopathic field, biological effects of direct or indirect manipulation of the fascial system are not conclusive.

Conclusion
To elevate manual medicine as a primary intervention in clinical settings, it’s necessary to clarify how OMT modalities work in order to underpin their clinical efficacies.

Abstract

Background

Prader-Willi syndrome (PWS) is the most frequent type of syndromic obesity and major clinical features include muscular hypotonia, early onset of obesity, short stature, scoliosis, developmental delays, reduced spontaneous physical activity, gait and postural disorders. Improving balance and walking ability in these patients could enhance their health status and quality of life.

Objective

The aim of this study was to quantify the effects of an Osteopathic Manipulative Treatment (OMT) session on gait pattern and posture in adults with PWS.

Methods

Ten patients with PWS (age: 37.0+4.3 years) were evaluated at admission (PRE session) and 24 hours after the conclusion of one single 45-minute OMT session (POST session), using gait analysis and static posturography. Two control groups were recruited: the first one included 15 obese subjects and the second group included 20 normal weight subjects.

Results

After the OMT treatment, significant effects on posture and on walking were reported. In particular, significant improvements were observed in knee kinematics (knee position at initial contact and in mid-stance) and ankle kinetics (in terms of the peaks of ankle moment and power during terminal stance), with higher value of ground reaction force at push-off. Significant improvements were found in terms of postural analysis of the centre of pressure, which decreased its excursion in antero-posterior and medio-lateral direction and its trace length.

Conclusions

These preliminary results suggest that OMT within a comprehensive rehabilitation program could reduce costs and increase effectiveness of the rehabilitation treatment of these patients.

Pubblicato sulla rivista di terapie complementari “Complementary Therapies in Medicine” il progetto di ricerca svolto al termine del corso di formazione in osteopatia part-time di SOMA da Andrea Manstretta, Andrea Civardi e Sabina Rossetti. Lo studio pilota riguarda l’efficacia del trattamento manipolativo osteopatico – OMT nelle broncopneumopatie croniche ostruttive – BPCO.

Efficacia del trattamento manipolativo osteopatico nella broncopneumopatia cronica ostruttiva grave: uno studio pilota.

Osteopathic manipulative treatment effectiveness in severe chronic obstructive pulmonary disease: A pilot study.

Zanotti E, Berardinelli P, Bizzarri C, Civardi A, Manstretta A, Rossetti S, Fracchia C.

Complementary Therapies in Medicine 2012;20(1-2):16-22.

Pubblicato sulla rivista Manual Therapy lo studio condotto da Luca Vismara e Fabio Zaina al termine del corso di formazione in osteopatia part-time di SOMA in merito al trattamento manipolativo osteopatico nelle lombalgie croniche in pazienti obesi.

Trattamento manipolativo osteopatico in pazienti obesi con lombalgia cronica: uno studio pilota.

Osteopathic manipulative treatment in obese patients with chronic low back pain: A pilot study.

Vismara L, Cimolin V, Menegoni F, Zaina F, Galli M, Negrini S, Villa V, Capodaglio P.

Manual Therapy 2012;17(4).

ABSTRACT

BACKGROUND

Obesity is frequently associated with various musculoskeletal disorders including chronic low back pain (cLBP). Osteopathy is a discipline emphasizing the conservative treatment of the disease in an olistic vision. We designed a randomized controlled study to investigate whether Osteopathic Manipulative Treatment (OMT) combined with specific exercises (SE) is more effective than SE alone in obese patients with cLBP.

METHODS

nineteen obese females with cLBP, randomized into 2 groups: SE + OMT and SE were studied during the forward flexion of the spine using an optoelectronic system. A biomechanical model was developed in order to analyse kinematics and define angles of clinical interest.

OUTCOME MEASURES

kinematic of the thoracic and lumbar spine and pelvis during forward flexion, pain according to a visual analogue scale (VAS), Roland Morris Disability Questionnaire and Oswestry Low Back Pain Disability Questionnaire.

RESULTS

significant effects on kinematics were reported only for OMT + SE with an improvement in thoracic range of motion of nearly 20%. All scores of the clinical scales used improved significantly. The greatest improvements occurred in the OMT + SE group.

CONCLUSIONS

combined rehabilitation treatment including Osteopathic Manipulative Treatment (OMT + SE) showed to be effective in improving biomechanical parameters of the thoracic spine in obese patients with cLBP. Such results are to be attributed to OMT, since they were not evident in the SE group. We also observed a reduction of disability and pain. The clinical results should be considered preliminary due to the small sample size.

Abstract

Neonatal intensive care units (NICUs) greatly expand the use of technology. There is a need to accurately diagnose discomfort, pain, and complications, such as sepsis, mainly before they occur. While specific treatments are possible, they are often time-consuming, invasive, or painful, with detrimental effects for the development of the infant. In the last 40 years, heart rate variability (HRV) has emerged as a non-invasive measurement to monitor newborns and infants, but it still is underused. Hence, the present paper aims to review the utility of HRV in neonatology and the instruments available to assess it, showing how HRV could be an innovative tool in the years to come.
When continuously monitored, HRV could help assess the baby’s overall wellbeing and neurological development to detect stress-/pain-related behaviors or pathological conditions, such as respiratory distress syndrome and hyperbilirubinemia, to address when to perform procedures to reduce the baby’s stress/pain and interventions, such as therapeutic hypothermia, and to avoid severe complications, such as sepsis and necrotizing enterocolitis, thus reducing mortality. Based on literature and previous experiences, the first step to efficiently introduce HRV in the NICUs could consist in a monitoring system that uses photoplethysmography, which is low-cost and non-invasive, and displays one or a few metrics with good clinical utility.
However, to fully harness HRV clinical potential and to greatly improve neonatal care, the monitoring systems will have to rely on modern bioinformatics (machine learning and artificial intelligence algorithms), which could easily integrate infant’s HRV metrics, vital signs, and especially past history, thus elaborating models capable to efficiently monitor and predict the infant’s clinical conditions. For this reason, hospitals and institutions will have to establish tight collaborations between the obstetric, neonatal, and pediatric departments: this way, healthcare would truly improve in every stage of the perinatal period (from conception to the first years of life), since information about patients’ health would flow freely among different professionals, and high-quality research could be performed integrating the data recorded in those departments.

INTRODUCTION

The neonatology field is growing in complexity (Biban, 2010). In essence, newborns can show many comorbidities associated with prematurity (WHO, 2016), labor complications (Tribe et al., 2018), and maternal and perinatal stress (Frasch et al., 2007; Babenko et al., 2015; Lobmaier et al., 2020), whereas the neonatal intensive care units (NICUs) are increasing the use of technology to better take care of fetuses, newborns, and infants (Biban, 2010; Chock et al., 2015).
However, many obstacles need to be overcome to efficiently assess and manage infants’ conditions: distress, pain, and sepsis need valid and reliable gauges to detect them before they happen (Cremillieux et al., 2018; Rashwan et al., 2019), but several procedures may be time-consuming (Jeng et al., 2000; Als et al., 2005; Cremillieux et al., 2018), invasive, and painful with short- and long-term negative consequences (Holsti et al., 2006; Pillai Riddell et al., 2015).
In the last 40 years, heart rate variability (HRV) has emerged as a reliable and non-invasive measure to monitor preterm and term newborns (Task Force of the European Society of Cardiology the North American Society of Pacing Electrophysiology, 1996). HRV evaluates the heart rate (HR) fluctuation—the variability of the time intervals between successive heartbeats—, and during the years, more and more techniques have appeared to improve its analysis, from which several metrics can be extracted (Table 1; Bravi et al., 2011; Thiriez et al., 2015; Javorka et al., 2017; Oliveira et al., 2019b; Patural et al., 2019).
Several studies showed that HRV correlates with the newborn’s stress and stress-related behaviors (Gardner et al., 2018; Hashiguchi et al., 2020), and that it could predict the baby’s overall wellbeing and future neurological development. HRV could also accurately identify short- and long-term complications, such as the risk of sepsis (Javorka et al., 2017; Oliveira et al., 2019b; Kumar et al., 2020). HRV was also able to reveal the impact of prenatal stress on fetal brain development (Frasch et al., 2007; Lobmaier et al., 2020).
Despite these results, HRV is still underused in NICUs. Although in the 1960s, one of the first evidences published was about the alteration of HRV metrics preceding fetal distress (Task Force of the European Society of Cardiology the North American Society of Pacing Electrophysiology, 1996); to date, some authors argued that there is a lack of understanding of the meaning of HRV metrics in infants: in fact, HRV has been studied especially in adults, and the autonomic nervous system (ANS) behaves differently in newborns, especially in preterm infants (Joshi et al., 2019b). Notwithstanding these contradictions, the only successful example of integration of HRV in NICUs is the Heart Rate Observation (HeRO) monitor developed by J. Randall Moorman’s team. The HeRO analyzes bedside electrocardiogram (ECG) in real-time and integrates various HRV metrics to calculate the “HRC index,” which can predict the risk of sepsis within 24 h in both preterms and very low birth weight infants (Andersen et al., 2019; Kumar et al., 2020).
However, based on the available literature and on the potential research to be developed, there is a need to further explore the use of HRV in neonatology. HRV may provide such useful insights since it correlates with the ANS development and functioning. The ANS regulates organic development and connects with the organism’s ability to cope with stressors, as well as with cognitive and emotional development (Thayer et al., 2012; Jennings et al., 2015; Schneider et al., 2018; Oliveira et al., 2019b).
To be an innovative tool useful for neonatologists, HRV measurement should rely on a technology that gives reliable metrics with a clear clinical meaning. Harnessing the positive experiences, such as the use of the HeRO monitor, it is paramount to create a system that continuously records HRV and expresses scores that could correlate with the baby’s clinical condition and help monitor its evolution (Zhao et al., 2016; Hayano and Yuda, 2019; Pernice et al., 2019b; Kumar et al., 2020).
For this purpose, modern machine learning (ML) and artificial intelligence (AI) algorithms could play a crucial role: through their computational power, they could define models capable of managing the complex physiological interactions between HRV, ANS, and the whole organism, thus boosting our ability to predict the infant’s prognosis. Indeed, we already have experiences about the clinical usefulness of ML in both neonatology (Semenova et al., 2018; Ostojic et al., 2020) and HRV analysis (Chiew et al., 2019; Lin et al., 2020).
ML/AI algorithms could also integrate clinical data of different hospital departments, i.e., obstetric, neonatal, and pediatric. Indeed, free clinical data and medical devices sharing among the departments involved in the perinatal care (from conception to the first years of life) would allow clinicians to better understand the prenatal and developmental factors underlying adverse neonatal outcomes (e.g., brain injury) and to better treat them.
Therefore, the present paper aims to address the HRV usefulness in neonatology to prospect it as an innovative tool in the years to come. This focused review is divided into three sections: (1) the first section describes briefly the HRV metrics and examines the relationship between ANS and HRV in fetuses and newborns; (2) the second section examines the technology available in the NICU, how to monitor HRV efficiently, and the usefulness of real-time HRV; and (3) the third and final section will summarize the main findings and outline future perspectives for the clinical use of real-time HRV in the neonatal field, with a brief subsection about its usefulness in low-income countries.

CONCLUSION

The present paper reviewed the use of HRV in the neonatal field and the utility of real-time HRV monitoring to assess the newborn’s clinical conditions, showing that several metrics and computed metrics change in conjunction with stress-/pain-related behaviors, inflammation, pathological conditions, such as cardiac failure, respiratory distress syndrome, hyperbilirubinemia, NEC, and sepsis, and neurological development.
The paper also reviewed the NICU technology to evaluate how to measure real-time HRV efficiently. Indeed, a system based on PPG could be the optimal solution due to being low-cost, easy-to- use, and non-invasive, although PPG-based computation seems less precise than ECG-based computation. Therefore, future studies will have to carefully assess if the outcomes reviewed in this paper might be influenced by this difference in precision between PPG and ECG.
In the next decade, introducing real-time HRV in NICUs would be a great step forward in the improvement of neonatal care, especially if supported by the advancements in bioinformatics, which could easily extrapolate accurate predicting models from all the data collected in the NICUs, although several concerns and limitations have to be overcome before fully implementing the system into a daily NICU routine care.

Keywords: autonomic nervous system, vagus, newborns, preterm infants, neonatology, NICU, photoplethysmography, HRV

ABSTRACT

Lymphedema is a condition occurring when the lymphatic system fails to efficiently transport the lymph, thus creating a fluid accumulation in the interstitial space. As of today, the rehabilitation treatment for lymphedema relies on the principles of Complete Decongestive Therapy (CDT), a series of treatments designed to favor the reabsorption of the lymph by the lymphatic system and to restore the functionality of the affected limb. From an osteopathic point of view, interesting results have been obtained through Lymphatic Pump Technique (LPT), a series of oscillatory techniques applied to different areas of the body such as chest, abdomen and feet. A few LPT studies on animals have shown a significant improvement not only in the lymphatic system efficiency (an increase of 271% in lymph flow) but also in the immune system.

Aim. From the scientific evidence derived from such studies, in this paper we propose a clinical trial aiming to demonstrate the benefits that this technique can bring to human beings in a specific rehabilitation process following a lower limb lymphoedema.

Material and methods. An indirect volumetric measurement of lymphedematous limbs according to the segmental technique was performed on six subjects having a history of CDT treatments with different clinical histories, age, gender, work and sport characteristics.The results of the study group treated with the LPT were compared to the results of the same subjects who previously underwent CDT treatment only. The LPT was applied in 8 sessions for two weeks, i.e. for the period of time scheduled for normal physiotherapy rehabilitation including CDT.

Results. The average volume before CDT was 9470.6 ml while after treatment was 8429 ml. The mean volume before CDT associated with LPT was 9608.5 ml, whereas after treatment the mean was 8267 ml with a significant reduction in lymphoedema.

Conclusions. Despite the small number of cases examined, the treatment described in this project has led to positive and statistically significant results, in terms of absorption of lymphedema, especially reducing the volume of the limb. LPT is safe as it is a non-invasive technique, performed with the application of light forces, and integrates perfectly with the CDT.

Keywords: complete decongestive therapy, lymphatic pump treatment, lymphedema

For citation: Bergna A., Panigada L., Benussi F., Buffone F., Caruana C., Castrignano M., Ciancone E., Cazzaniga F., Sotgiu A., Bressan V., Bressan L.C., Solimene U. The Lymphatic Pump Technique for the treatment of the Lower Limb Lymphedema. Bulletin of Rehabilitation Medicine. 2021; 20 (5): 12-18.

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ABSTRACT

Osteopathic manipulative treatment (OMT) is evolving in the neonatal intensive care unit (NICU) setting. Studies showed its efficacy in length of stay and hospitalization costs reduction. Moreover, it was suggested that OMT has a modulatory effect on the preterm infants’ autonomic nervous system (ANS), influencing saturation and heart rate. Even if OMT is based on the palpatory examination of the somatic dysfunctions (SD), there are controversies about its identification and clinical relevance. The objective of this study was to evaluate the inter-rater reliability, clinical characteristics, and functional correlation of the SD Grade score with the heart rate variability (HRV) and the salivary cortisol (sCor) using a multivariate linear model approach. To evaluate those features, we implemented an ad hoc SD examination for preterm infants that was performed by 2 trained osteopaths. It was based on the new variability model of SD that includes an SD Grade assessment procedure. The ANS features were assessed by frequency parameters of HRV studying high frequency (HF), low frequency (LF), and HF/LF, whereas sCor was tested with a radioimmunoassay. The ANS assessment was standardized and performed before SD testing. Sixty-nine premature infants were eligible. SD Grade showed excellent concordance between the blinded raters. Using SD Grade as a grouping variable, the infants presented differences in GA, Apgar, pathological findings, length of stay, and ventilatory assistance. In our multivariate model, HF, LF, and LF/HF resulted linearly correlated with SD Grade. Instead, sCor presented a linear correlation with 5’ Apgar and respiratory distress syndrome but not with SD Grade. SD Grade was in line with the natural history of the underdevelopment due to prematurity. Our models indicate that the cardiac vagal tone is linearly related with SD Grade. This finding may improve the multidisciplinary decision making inside NICU and the management of modifiable factors, like SD, for cardiac vagal tone regulation.

METHODS

In order to investigate the autonomic regulation in preterm infants and its correlation with SD Grade, we performed a single-center cross-sectional study based on the data recorded during the daily clinical practice in the period between February 2017 and October 2018 in the tertiary level of the NICU of Del Ponte Hospital in Varese. All the infants’ families provided the signed informed consent for the use of these data for research purposes. The Provincial Ethics Committee of Varese approved the study on February 14, 2017 and all the peri- and postnatal data were retrieved from an electronic dataset; they included information about demographic entities, delivery, medical procedures, and perinatal and maternal information. We assessed SD referring to the examination of the VM within NZ.

Results:

Sixty-nine patients were examined, 35 males (51%) and 34 females (49%), with a mean GA of 28.9 ± 2.4 days and a mean birth weight of 1103.4 ± 274.1 g.

The SD grading assessment revealed 0 patients with SD Grade 0 or Grade 1; this result makes us understand how a premature baby always shows significant fascial adaptations. Within the sample, 40 (58%) patients showed a SD Grade 2 and 29 (42%) a SD Grade 3. At birth, the mean Apgar 5’ score of the entire sample was 7.96 ± 1.18 and 39 (56%) of them were delivered by Cesarian section.

Among clinical variables stratified by SD Grade, the body weight, GA, Apgar 5’, RDS, Jaundice, length of stay (LOS), and time to autonomous respiration (TAR) demonstrated a statistically significant difference, as reported in Table 1. The reliability of the SD Grade was measured based on the results reported by 2 experienced, board-certified, osteopaths who were blinded to the exam results of the peer-rater. Notably, in this specific setting, the global agreement for SD Grade on 69 preterm infants was excellent with an ICC of 0.864 (0.773–0.918).

Keywords:

heart rate variability; neonatology; neutral zone; osteopathic manipulation; premature infants; variability model

References

ABSTRACT

The Italian government has started the regulatory process of osteopathy to include it among the healthcare professions mentioning terms, such as “perceptual palpation” and “somatic dysfunction” within the professional profile. ‘Palpatory findings’ are one of the multidimensional aspects that can inform osteopathic clinical reasoning. The non-regulated educational system has led to heterogenic professionals working in Italy, thus, the aim of this study was to investigate how Italian experts use palpatory findings in their clinical practice. A total of 12 experts were selected to participate in four virtual focus groups. A qualitative inductive approach with a constructivist paradigm was chosen to describe the results. The themes that emerged were: osteopathic identity; evaluation; osteopathic diagnosis; and sharing with different recipients. Participants agreed on the peculiarity and distinctiveness of osteopathic palpation, but there was some disagreement on the clinical significance of the findings, highlighting a complex multidimensional approach to diagnosis and treatment. The results seem to reflect the history of the profession in Italy, which has evolved quickly, leading professionals to seek new paradigms blending tradition and scientific evidence. The authors suggest further investigation to verify the state of art among osteopaths not involved in research or a broader consensus of the results.

Conclusions:

This qualitative research shows that expert Italian osteopaths use PFs in clinical practice with a mixed hands-on and hands-off approach. Osteopathic distinctive manual assessment is maintained by integrating it in the context of person-centred care and making use of the best available information gathered from the scientific literature. The profession placed in the healthcare setting will have to fit into a multidisciplinary context by sharing its peculiarities with other professions using an understandable language.

Furthermore, it appears that professional identity is facing a transitional phase in which one looks to the future not yet sure what to leave behind in one’s past. In this landscape that seems to show uncertainty, the profession has a great opportunity as tradition and evidence coexist. The ability to maintain tradition in a context of informed EBP could represent the innovation of osteopathic professional identity.

In order to improve consistency, plausibility, generalizability, relevance, and expected applicability of PFs in clinical practice, osteopathic practitioners, researchers, and educators could participate in an International Consensus Conference using the results of this study.

References

ABSTRACT

The aim of this systematic review and meta-analysis is to evaluate the effectiveness of osteopathic manipulative treatment (OMT) for gastrointestinal disorders in term and preterm infants. Eligible studies were searched on PubMed, Scopus, Embase, Cochrane, Cinahl, and PEDro. Two reviewers independently assessed if the studies were randomized controlled trials (RCTs) and retrospective studies with OMT compared with any kind of control in term or preterm infants to improve gastrointestinal disorders. Nine articles met the eligibility criteria, investigating OMT compared with no intervention, five involving term infants, and the remaining treating preterm infants. Five studies showed low risk of bias. In the meta-analysis, two studies were included to analyze the hours of crying due to infantile colic, showing statistically significant results (ES = −2.46 [−3.05, −1.87]; p 

Conclusions: Concerning gastrointestinal disorders in term and preterm infants, OMT is overall safe and provides many clinical and research insights. In terms of safety, no included study reported serious sequelae even when treating a sensitive population such as preterm infants. Among AEs, only one study reported a mild one, which resolved spontaneously in a short time [28]. To date, OMT effectiveness has not been shown yet due to the lack of high-quality and replication studies; further RCTs with OMT as an add-on therapy compared to the usual care alone can help to clarify its support in clinical practice, and possibly provide material to establish future guidelines accordingly. OMT may be a new field of clinical study and treatment in GI disorders in the pediatric sector.

References

ABSTRACT

Objective: The aim of this systematic review and meta-analysis is to evaluate whether osteopathic manipulative interventions can reduce pain levels and enhance the functional status in patients with non-specific neck pain (NS-NP).

Methods: A systematic review and meta-analysis was conducted following the 2020 PRISMA statement. Randomized controlled trials (RCTs) were searched in five databases, assessed through a standardized form, and evaluated using the “13 items Cochrane risk of bias (RoB) tool”. Effect sizes (ES) were calculated post-treatment, and the quality of evidence was assessed through GRADE criteria.

Results: Five articles were included in the review, and none of these was completely judged at low RoB. Four of these were included in the meta-analysis. Osteopathic interventions compared to no intervention/sham treatment showed statistically significant results for pain levels (ES = −1.57 [-2.50, −0.65]; P = 0.0008) and functional status (ES = −1.71 [-3.12, −0.31]; P = 0.02). The quality of evidence was “very low” for all the assessed outcomes. Other results were presented in a qualitative synthesis.

Conclusions: Osteopathic interventions could be effective for pain levels and functional status improvements in adults with NS-NP. However, these findings are affected by a very low quality of evidence. Therefore, further high-quality RCTs are necessary to improve the quality of evidence and generalize the results.

References

ABSTRACT

Introduction and hypothesis: Spinal and peripheral joint manipulation and mobilization are interventions used by many healthcare providers to manage musculoskeletal conditions. Although there are many reports of adverse events (or undesirable outcomes) following such interventions, there is no common definition for an adverse event or clarity on any severity classification. This impedes advances of patient safety initiatives and practice. This scoping review mapped the evidence of adverse event definitions and classification systems following spinal and peripheral joint manipulation and mobilization for musculoskeletal conditions in adults.

Methods: An electronic search of the following databases was performed from inception to February 2021: MEDLINE, EMBASE, CINAHL, Scopus, AMED, ICL, PEDro, Cochrane Library, Open Grey and Open Theses and Dissertations. Studies including adults (18 to 65 years old) with a musculoskeletal condition receiving spinal or peripheral joint manipulation or mobilization and providing an adverse event definition and/or classification were included. All study designs of peer-reviewed publications were considered. Data from included studies were charted using a standardized data extraction form and synthesised using narrative analysis.

Results: Seven articles were included in the review, five of these in the meta-analysis. None of these studies were completely judged at low RoB. MMT was revealed to be not significantly superior for pain reduction [ES: -0.54 (-1.16; 0.08); p = 0.09], for symptom impact [ES: -0.37 (-0.87; 0.13); p = 0.15], and for quality of life [ES: -0.44 (-1.22, 0.33), p = 0.26] compared to standard care. The quality of evidence was “very low”. Other results were presented in a qualitative synthesis.

Conclusions: From 8248 identified studies, 98 were included in the final synthesis. A direct definition for an adverse event and/or classification system was provided in 69 studies, while 29 provided an indirect definition and/or classification system. The most common descriptors to define an adverse event were causality, symptom severity, onset and duration. Twenty-three studies that provided a classification system described only the end anchors (e.g., mild/minor and/or serious) of the classification while 26 described multiple categories (e.g., moderate, severe).

Keywords: Spinal and peripheral joint manipulation; Manipulation; Manual therapy; Mobilization; Adverse Event.

References

ABSTRACT

Introduction and hypothesis: Chronic pelvic pain syndrome (CPPS) is defined as the occurrence of chronic pelvic pain (CPP) in the absence of a specific cause. People typically refer to pain associated with urological, gynaecological, and sexual dysfunction, affecting the quality of life. Therefore, we assessed the effectiveness of myofascial manual therapies (MMT) for pain and symptom impact.

Methods: A systematic review and meta-analysis were conducted. Findings were reported following the 2020 PRISMA statement. Five databases were searched for RCTs. Studies were independently assessed through a standardized form, and their internal validity was evaluated using the Cochrane risk of bias (RoB) tool. Effect sizes (ES) were calculated post-treatment, and the quality of evidence was assessed through GRADE criteria.

Results: Seven articles were included in the review, five of these in the meta-analysis. None of these studies were completely judged at low RoB. MMT was revealed to be not significantly superior for pain reduction [ES: -0.54 (-1.16; 0.08); p = 0.09], for symptom impact [ES: -0.37 (-0.87; 0.13); p = 0.15], and for quality of life [ES: -0.44 (-1.22, 0.33), p = 0.26] compared to standard care. The quality of evidence was “very low”. Other results were presented in a qualitative synthesis.

Conclusions: In patients with CPP/CPPS, MMT is not considered superior to other interventions for pain reduction and symptom impact improvements. However, a positive trend was detected, and we should find confirmation in the future. Further high-quality, double-blinded, sham-controlled RCTs are first necessary to confirm these positive effects and to improve the quality of evidence.

Keywords: Chronic pelvic pain; Chronic pelvic pain syndrome; Chronic prostatitis; Manipulation; Manual therapy; Myofascial release.

References

ABSTRACT

Background: Osteopathic manipulative treatment (OMT) is a patient-centred, whole-body intervention aimed at enhance the person’s self-regulation. OMT interventions are focused on somatic dysfunctions (SD) that can be defined as an altered regulative function associated with inflammatory signs palpable in the body framework in different body regions. The conceptual model that sustains SD, as well as its usefulness for the osteopathic profession, is still being discussed by the osteopathic community. Understanding the role and the application of SD is the aim of this scoping review. Methods: A literature search was carried out through the main biomedical databases: Pubmed (Medline), Cochrane, Central (Cochrane), Embase, PEDro and Scopus. Grey literature was considered via Google Scholar and the Osteopathic Research Web. The review was prepared by referring to the “Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews” (PRISMA-ScR). Results: A total of 37,279 records were identified through database searching and other sources. After the duplicates were removed, 27,023 titles and abstracts were screened. A total of 1495 full-text articles were assessed for eligibility. The qualitative synthesis included 280 studies. Conclusions: Treating SD is an important part of osteopathic practice that varies from country to country. SD should be considered as a clinical value that assists in the clinical assessment and guides the decision-making process of osteopathic practitioners. Further studies should be designed to better understand why and how to choose the different assessment and intervention modalities to approach SD and to evaluate new osteopathic models. View Full-Text

Keywords: osteopathic manipulative treatment; somatic dysfunction; manual therapy; osteopathic techniques

ABSTRACT

Objectives

Fibromyalgia (FM) is a chronic pain syndrome characterized by a large variety of symptoms. Evidence suggests that an alteration of central nervous system processing of pain could be involved. The purpose of this study is to analyze clinical records of patients affected by FM who underwent osteopathic manipulative treatment (OMT), predominantly based on a myofascial release approach (MFR).

Methods

This retrospective study considered records of 21 FM patients with moderate or severe functional impact, who consented to OMT in addition to their usual care. The assessment considered the following measures: FIQ (functional status), SF36 (quality of life), VAS (pain), TSK (kinesiophobia) and PSQI (quality of sleeping). Patients were preliminarily assessed over a 1 month run-in phase, then after 1, 2 and 4 months; a 1 month follow-up was also considered.

Results

After one month, 71% of patients reported a decrease in functional impact and scores remained stable until follow-up (from 69.8 to 52.37, p≤0.001). Overall, after four months, patients improved their quality of life, with a score ranging from 33.47 to 42.6 (p≤0.05). We also observed a reduction of pain (p≤0.05).

Conclusions

A series of OMT sessions based on MFR could play a therapeutic role in improving functional status, pain and quality of life over a period of 4 months.

Keywords: chronic pain; fascia; fibromyalgia; myofascial release; osteopathic manipulative treatment

Corresponding author: Luca Vismara, DO, MSc, PhD(s), Division of Neurology and Neurorehabilitation, IRCCS Istituto Auxologico Italiano, 28824Piancavallo-Verbania, Italy; and Department of Neurosciences “Rita Levi Montalcini”, University of Turin, 10126Turin, Italy, Phone: +393393422463, E-mail: lucavisma@hotmail.com

Acknowledgements

The authors thank Matteo Archi, Gaia Elmi and Nicolò Caraffa for their participation in clinical activities related to the present research, ALOMAR Onlus (Lombardia Rheumatic Patients Association) for collaboration and LV would like to thank the PhD Programme in Experimental Medicine and Therapy of University of Turin.

1.  Research funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
2.  Author contributions: All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Fulvio Dal Farra, Angelo Chiesa and Roberta Risio. The first draft of the manuscript was written by Fulvio Dal Farra and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
3.  Competing interests: The authors declare that they have no conflict of interest.
4.  Informed consent: Consent to participate: all the subjects involved in this study gave their informed consent to the treatment of personal data and to the management of their data for research purposes. Consent for publication: patients signed informed consent regarding publishing their data.
5.  Ethical approval: The experimental procedure was explained in detail to participants, the study was carried out in accordance with the ethical standards of the SOMA – Osteopathic Institute Institutional review board and with the 1964 Helsinki declaration and its latest amendments; written informed consent was obtained from the participants.

ABSTRACT

Introduction Spinal and peripheral joint manipulation (SMT) and mobilisation (MOB) are widely used and recommended in the best practice guidelines for managing musculoskeletal conditions. Although adverse events (AEs) have been reported following these interventions, a clear definition and classification system for AEs remains unsettled. With many professionals using SMT and MOB, establishing consensus on a definition and classification system is needed to assist with the assimilation of AEs data across professions and to inform research priorities to optimise safety in clinical practice.

Methods and analysis This international multidisciplinary electronic Delphi study protocol is informed by a scoping review and in accordance with the ‘Guidance on Conduction and Reporting Delphi Studies’. With oversight from an expert steering committee, the study comprises three rounds using online questionnaires. Experts in manual therapy and patient safety meeting strict eligibility criteria from the following fields will be invited to participate: clinical, medical and legal practice, health records, regulatory bodies, researchers and patients. Round 1 will include open-ended questions on participants’ working definition and/or understanding of AEs following SMT and MOB and their severity classification. In round 2, participants will rate their level of agreement with statements generated from round 1 and our scoping review. In round 3, participants will rerate their agreement with statements achieving consensus in round 2. Statements reaching consensus must meet the a priori criteria, as determined by descriptive analysis. Inferential statistics will be used to evaluate agreement between participants and stability of responses between rounds. Statements achieving consensus in round 3 will provide an expert-derived definition and classification system for AEs following SMT and MOB.

Ethics and dissemination This study was approved by the Canadian Memorial Chiropractic College Research Ethics Board and deemed exempt by Parker University’s Institutional Review Board. Results will be disseminated through scientific, professional and educational reports, publications and presentations.

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BACKGROUND
The vestibulo-ocular reflex (VOR) gain-symmetry is fundamental for gaze control. VOR is a multisensorial integrated reflex that combines vestibular, visual, and proprioceptive inputs. Osteopathic manipulative treatment (OMT) approaches fascial system for the treatment of somatic dysfunction. Fascial system was recently described as body-wide proprioceptive organ. Hence, we performed a single-blinded, with third rater-blinded, three-arm randomized controlled trial to investigate the OMT interaction with VOR-gain-symmetry (VGS) of young healthy subjects, with the aim to evaluate the interaction between: proprioception, VOR and osteopathic manipulations on fascial-system.
METHODS
Participants were treated and examined in the SOMA institute outpatient clinic. According to the randomization list, the subjects received a sham OMT, an OMT and no interventions. The primary endpoint was the VGS variation (VGS01), assessed by video head impulse test, after 30 minutes from the interventions. Besides, VGS after 1 week from the interventions was the secondary endpoint.
RESULTS
One-hundred and eighty subjects were randomized; of those, 171 subjects completed the trial. Subjects who underwent OMT reduced them VGS01 asymmetry about 3.89% with a significant difference between groups (P=0.002). At follow-up, subjects who receive OMT maintained a 2.29% asymmetry reduction in contrast to the other groups that presented no delta with baseline (P=0.011).
CONCLUSIONS
OMT compared to placebo and time control demonstrated a plausible modulatory effect on VOR asymmetry of healthy subjects, which it might be mediated by proprioceptive inputs and multisensorial integration of vestibular system. A proof-of-concept trial should be performed to test the OMT in chronic dizzy patients.

KEY WORDS
Fascia; Reflex, vestibulo-ocular; Osteopathic medicine; Head impulse test; Proprioception; Manipulation, osteopathic

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Abstract

Parkinson’s Disease (pD) is a neurodegenerative disorder characterized by the loss of dopaminergic neurons in the substantia nigra. Several studies were carried out in time on osteopathic treatments in patients with pD, demonstrating an improved motor function, albeit short lived. Our trial was aimed at assessing the potential efficacy of the Osteopathic Manipulative treatment (OMt) on mobility, posture, and gait in patients with moderate pD, as well as the importance of “taking charge” of the patient for the Quality of Life (QoL) of individuals with pD. Material and methods. 32 subjects aged 76±7.284 were divided in two groups: group B (n=17) received the OMt, followed by the SHAM treatment; group A (n=15) received the SHAM treatment, then the OMt. the study was designed as a nine-week cross-over trial, with group cross-overperformed after a one-week wash-out. All the subjects underwent a baseline neurological blind evaluation at four weeks and post cross-over. the ADL, IADL, GDS, and GpE scales were also administered. results. 16 subjects completed the study, 32 subjects participated in the first four weeks only. An improvement of the mean and standard deviation parameters was observed in the UpDRS and the tUG test in patients receiving the OMt. A decrease of the dysfunction degree was observed in both groups upon the osteopathic evaluation. Conclusions. the data show the potential usefulness of the OMt in pD with respect to stiffness, mobility, posture and where the patient is taken charge of. Further studies will be needed to disprove the goal of the trial.

Keywords

Parkinson’s Disease (pD), Osteopathic Manipulative treatment (OMt), Quality of Life (QoL)

Abstract

Postural instability and fear of falling represent two major causes of decreased mobility and quality of life in cerebrovascular and neurologic diseases. In recent years, rehabilitation strategies were carried out considering a combined sensorimotor intervention and an active involvement of the patients during the rehabilitation sessions. Accordingly, new technological devices and paradigms have been developed to increase the effectiveness of rehabilitation by integrating multisensory information and augmented feedback promoting the involvement of the cognitive paradigm in neurorehabilitation. In this context, the vibrotactile feedback (VF) could represent a peripheral therapeutic input, in order to provide spatial proprioceptive information to guide the patient during task-oriented exercises. The present systematic review and metanalysis aimed to explore the effectiveness of the VF on balance and gait rehabilitation in patients with neurological and cerebrovascular diseases. A total of 18 studies met the inclusion criteria and were included. Due to the lack of high-quality studies and heterogeneity of treatments protocols, clinical practice recommendations on the efficacy of VF cannot be made. Results show that VF-based intervention could be a safe complementary sensory-motor approach for balance and gait rehabilitation in patients with neurological and cerebrovascular diseases. More high-quality randomized controlled trials are needed.

Keywords

balance rehabilitation; gait rehabilitation; neurological disease; cerebrovascular disease; motor-cognitive; vibrotactile feedback

Abstract

Secondary dysmenorrhea is frequently associated with dyspareunia. When the diagnostic workup is negative, its clinical management might result unspecific and frustrating for the patient. We reported a case of a young woman who suffered from dyspareunia, dysmenorrhea and chronic pelvic pain. After symptoms progression and pharmacological therapy unresponsiveness, the gynaecologist referred the patient to an osteopath for the functional evaluation of the pelvic girdle. The examination revealed the presence of pelvic, lumbosacral and sacrococcygeal dysfunctions that, once treated, significatively reduced the severity of dysmenorrhea and dyspareunia. A multidisciplinary approach might be considered in case of suspected functional impairment. This should be carefully diagnosed by exclusion, with the support of past trauma history and pelvic girdle dysfunction signs.

Keywords

Pelvic adhesions, Dyspareunia, Pelvic fascia, Somatic dysfunction, Osteopathic manipulative treatment

Abstract

INTRODUCTION

The Osteopathy Students Analysis (OSA) aims to profile osteopathy students in Italy as a target population in terms of sociodemographic characteristics, geographical distribution, health status, and previous and ongoing education specifications.

MATERIALS AND METHODS

The OSA used a cross-sectional design. A Web-based survey was distributed to the Italian Osteopathic Education Institutions (OEIs). The OSA survey was composed of items organised into four sections: 1. Sociodemographic characteristics (11 items); 2. Geographical distribution (5 items); 3. Health status (3 items); 4. Previous and ongoing education specifications (16 items). A descriptive sample population analysis was performed. Dichotomous and categorical variables were presented as frequencies and percentages, and continuous variables were displayed as means and standard deviations. Some variables were analysed using a pentenary distribution

RESULTS

49 out of the 61 OEIs identified matched the inclusion criteria, and among these, 22 accepted to propose the enrolment of their students into the study. The survey was administered to 4,720 students from all the participant OEIs. A total of 3,762 students responded to the survey, accounting for an estimated response rate of 53.7%. The majority of respondents were men (54%), with an average age of 26.9 ± 6.5 years. Almost the totality of the sample was composed of the European ethnic group (99.1%). Respondents were predominantly born in Italy (97.2%). The majority of the sample reported being in good (49.5%) to excellent (38.6%) health. To date, osteopathy students are almost evenly distributed between the two types of curricula (T1 = 46.6%; T2 = 53.4%).

CONCLUSION

The OSA is the first study that aims to profile Italian osteopathy students as a target population in terms of sociodemographic characteristics, geographical distribution, health status, and previous and ongoing education specifications. Future studies should focus on investigating the correlation between the sociodemographic characteristics of students and their academic performance.

ABSTRACT

Chronic pelvic pain (CPP) and chronic pelvic pain syndrome (CPPS) do not have a definite cause, even if their impact on quality of life was demonstrated. Furthermore, there is evidence of myofascial dysfunctions in a large number of CPP/CPPS, so that the role of fascia can be hypothesized.

METHODS

The aim of this exploratory matched case–control study was to assess whether fascial strains (FS) represent a factor associated with CPP/CPPS. The study followed the “Strengthening the Reporting of Observational Studies in Epidemiology” (STROBE) statement. We collected data from 189 subjects (cases: 58; controls: 131) who attended the clinic. The participants were managed through a 2:1 enrollment ratio. A standardized booklet requested for clinical information, previous FS and the following questionnaires: “National Institutes of Health Chronic Prostatitis Symptom Index” (NIH-CPSI), “Hospital Anxiety and Depression Scale” (HADS), “Fear Avoidance Belief Questionnaire” (FABQ). Each subject underwent a palpatory assessment to detect abnormal palpatory findings in the pelvic area.

Results:

The analyses showed that episiotomy, genito-urinary infections and surgery had a significantly increased odds ratio (OR) of 4.13, 3.1 and 3.08, respectively. FS as a whole had a significantly raised OR: 2.22 (1.14 to 4.33). The analysis was adjusted for physical activity and for type of job and OR decreased to 1.94 (0.82 to 4.61), losing its significance (p = 0.129). A strong correlation between symptoms’ impact and CPP/CPPS was detected (rpbs = 0.710; p p 

References

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

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

ABSTRACT

Ventilation weaning is a key intensive care event influencing preterm infants’ discharge from a neonatal intensive care unit (NICU). Osteopathic manipulative treatment (OMT) has been recently introduced in some Italian NICUs. This retrospective cohort study tested if OMT is associated with faster non-invasive ventilation (NIV) weaning. The time to NIV weaning was assessed in very preterm and very low birth weight infants who either received or did not receive OMT. The propensity score model included gender, antenatal steroids, gestational age (GA), birth weight (BW), and Apgar score 5′. Out of 93 infants, 40 were included in the multilevel survival analysis, showing a reduction of time to NIV weaning for GA (HR: 2.58, 95%CI: 3.91 to 1.71, p p = 0.002). Time to independent ventilation (TIV) was modeled with GA and BW as dependent variables and OMT as the factor. A negative linear effect of GA and BW on TIV was shown. OMT exposure studied as the factor of GA had effects on TIV in infants born up to the 32nd gestational week. Preterm infants exposed to OMT were associated with earlier achievement of NIV weaning. This result, together with the demonstrated OMT safety, suggests the conduct of clinical trials in preterm infants younger than 32 weeks of GA.

INTRODUCTION

Very preterm infants often need positive pressure ventilatory support due to the immaturity of their chest wall pulmonary system; the reduced quantity and quality of surfactant; the neurological and thoracoabdominal asynchrony; the weakness of the intercostal muscles; and the relative shape and position of the diaphragm affecting ventilation, causing atelectasis and subsequently the tendency of the lungs to collapse. To prevent respiratory failure, respiratory distress syndrome (RDS), and bronchopulmonary dysplasia (BPD), preterm infants often require the support of non-invasive ventilation (NIV) [1,2,3,4,5,6,7].

However, even though respiratory support is fundamental during intensive care, recent studies showed that a too-long period—either of invasive ventilation or non-invasive ventilation—is associated with an increased risk of mortality or neurodevelopmental disability, due to the hemodynamic instability and cerebral inflammatory response [8,9]. Therefore, any therapy combined with NIV that can enhance the infants’ adaptation and cardiorespiratory function—consequently reducing the time of ventilation—would have a significant impact on morbidity and mortality. Moreover, since the accomplishment of an autonomous and stable cardiorespiratory function is one of the criteria for discharge [10,11], it would also have a positive influence on human costs and expenses of the health system (only for extremely preterm infants is there a mean cost of USD 65,600) [12,13,14,15,16,17].

The osteopathic manipulative treatment (OMT) is a non-invasive complementary manual therapy that enhances the functional integrity of the body, improves the physiological function, and supports homeostasis [18,19]; it evaluates and treats the somatic dysfunction (SD), which is defined as “an impaired or altered function of related components of the body framework system: skeletal, arthrodial, and myofascial structures, and their related vascular, lymphatic, and neural elements” [20,21]. Different studies have evaluated its possible contributions in the pediatric field, looking especially at prematurity: for instance, OMT is related to reduced timing to oral feeding, shorter LOS, and improvements in cardiac frequency and oxygen saturation [22,23,24,25,26,27,28]. Moreover, a recent study described the correlation of SD severity assessed with the Variability Model and the vagal tone in preterm infants [29]. In this perspective, the OMT added to the standard therapies may play a fundamental role in the short-term effects during the stay in the neonatal intensive care unit (NICU) and in the medium- and long-term effects for the prevention of respiratory diseases.

The main aim of this propensity-score-matched retrospective cohort study is to understand if the OMT is associated with faster NIV weaning; as secondary aims, it was assessed if the OMT is also associated with LOS, anthropometric growth, and time to autonomous respiration.

Results:

Out of 94 screened infants, 20 infants per group were eligible and were included via the propensity score matching. At baseline, there was homogeneity for the main variables in the two groups, and the propensity score efficacy was tested with the standardized mean difference (SMD). Concerning the diseases, both groups mainly reported RDS, followed by PDA, apneas, and BPD. Instead, the prevalent type of NIV was nasal high-frequency oscillatory ventilation (NHFOV), followed by NCPAP. On average, a TIV difference of 9.85 (−0.93 to 20.62) days was registered between groups combined with a difference of 5.34 (−10.07 to 21.98) days of LOS, which was lower in the exposed group, although non-statistically significant.

Keywords:

osteopathic manipulative treatment; preterm infants; non-invasive ventilation weaning; neonatal intensive care unit

References

La SOMA e il trattamento manipolativo osteopatico indicizzati su MedLine grazie ad un articolo pubblicato da Luca Vismara e coll. riguardante la riabilitazione nei pazienti con sindrome di Prader-Willi, una malattia complessa di origine genetica:

Implicazioni cliniche dell’analisi del cammino nella riabilitazione di pazienti adulti con sindrome di “Prader-Willi”: uno studio comparativo trasversale (sindrome di “Prader-Willi” versus pazienti obesi e soggetti sani confrontabili).

Clinical implications of gait analysis in the rehabilitation of adult patients with “Prader-Willi” Syndrome: a cross-sectional comparative study (“Prader-Willi” Syndrome vs matched obese patients and healthy subjects).

Vismara L, Romei M, Galli M, Montesano A, Baccalaro G, Crivellini M, Grugni G.

Journal of NeuroEngineering and Rehabilitation 2007;4:14.

EFFECTIVENESS OF OSTEOPATHIC MANIPULATIVE TREATMENT IN SECONDARY DISMENORRHEA: DESCRIPTION OF A CLINICAL CASE WITH ULTRASOUND DOCUMENTATION

Tesi Agapito Davide, Corrada Beatrice, Fagnani Marco Lorenzo, Gamba Leonardo, Mucchetti Laura, Pecchia Alex, Tocchio Matteo Antonio

Relatori: Dott. Origo Daniele DO MROI

2021-2022

Riassunto

Introduzione: La dismenorrea cronica secondaria può essere definita come la presenza di dolore mestruali associati a una patologia pelvica di diversa natura e origine.

Materiali e Metodi: Dopo la progressione dei sintomi e una non responsività farmacologica, la ginecologa indirizza la paziente ad una visita osteopatica. È stata inoltre effettuata un’ecografia transvaginale che ha rilevato un’alterata posizione di un ovaio. Sono stati somministrati questionari riguardanti il dolore pelvico cronico e la dismenorrea in diverse tempistiche. I questionari utilizzati sono: WALID-D, NIH-CPSI, BPI, FSDS-R, NSR 0-10. Durante la visita osteopatica si rivela la presenza di disfunzioni pelviche, sacrali e coccigee, le quali una volta trattate ridurranno significativamente la sintomatologia.

Risultati: Risultano migliorati anche i punteggi dei questionari somministrati post-trattamenti. È stata effettuata anche un ulteriore ecografia che ha dimostrato la normalizzazione posizionale dell’ovaio precedentemente indagato.

Conclusione: Il trattamento osteopatico potrebbe essere incluso all’interno di un approccio multidisciplinare per il trattamento del dolore pelvico cronico causato da dismenorrea secondaria.

Abstract

Introduction: Secondary chronic dysmenorrhea can be defined as the presence of menstrual pain associated with a pelvic pathology of different nature and origin. The case we present is that of a woman suffering (has suffered) from secondary dysmenorrhea and chronic pelvic pain.

Materials and Methods: After the progression of the symptoms and a pharmacological non-responsiveness, the gynecologist refers the patient to an osteopathic visit. A transvaginal ultrasound was also performed which revealed an altered position of an ovary. Questionnaires regarding chronic pelvic pain and dysmenorrhea were administered at different timings. The questionnaires used are: WALID-D, NIH-CPSI, BPI, FSDS-R, NSR 0-10. During the osteopathic visit, the presence of pelvic, sacral and coccygeal dysfunctions is revealed, which after the treatment have significantly reduced.

Results: The scores of the questionnaires administered post-treatment also improved. An additional ultrasound was also performed which demonstrated the normalization of the position of the previously investigated ovary.

Conclusion: Osteopathic treatment could be included within a multidisciplinary approach for the treatment of chronic pelvic pain caused by secondary dysmenorrhea.

The effects of the MYND protocol on the quality of childbirth and the general condition of the newborn assessed by NAME Index: A pilot study

Tesi Albani Eleonora Sofia, Aldeni Giulia, Brignoli Giulia, Gandin Giulia, Maculan Nicole, Madini Lorenzo

Relatori: Dott. Manzotti Andrea DO MROI,

Correlatore: Galli Matteo DO MROI, Dott.ssa Lombardi Erica DO MROI

2021-2022

Riassunto

Introduzione: MYNd&CO è un programma per le donne in gravidanza che comprende Mindfulness, Yoga, Nutrizione, sviluppo e Counselling, Coaching, lezioni prenatali e trattamento osteopatico secondo un approccio olistico. Il Manuale di valutazione neonatale scorE (NAME) è stato sviluppato per assistere nella gestione clinica dei bambini nel reparto neonatale valutando la compliance e l’omogeneità del loro corpo. Il presente studio inizia il suo processo di validazione. Durante lo sviluppo del programma MYNd&CO per le neomamme, viene offerta la possibilità di una valutazione osteopatica al neonato, seguita da un trattamento osteopatico. Ciò ci permette di considerare l’effetto che il protocollo MYNd&Co potrebbe avere sui neonati attraverso la valutazione della qualità tissutale degli stessi avvalendoci del modello NAME. L’obiettivo del nostro studio è continuare lo studio MYNd&Co sulla base del protocollo di studio già esistente, aggiungendo i dati che verranno raccolti sulla valutazione NAME dei neonati e bambini delle donne che hanno partecipato al percorso MYNd&co e di un gruppo di neonati e bambini di controllo.

Materiali e Metodi: Studio pilota. Le partecipanti sono state reclutate presso l’ambulatorio della Clinica Mangiagalli per un programma di 28 settimane. I criteri di inclusione: donne nullipare, gravidanze singole, gravidanze spontanee, età gestazionale ≥12, nessuna condizione medica materna, età materna tra i 18 e i 44 anni, nessuna barriera linguistica. I criteri di esclusione: gravidanze multiple, gravidanze con fecondazione in vitro, condizioni mediche materne o fetali, età <18 o >45 anni, barriere linguistiche. Secondo questi criteri sono state reclutate 200 donne per il progetto MYNd&CO. Di queste mamme aderenti al MYNd&CO in 22 hanno preso parte al nostro studio aderendo al progetto NAME dando quindi la possibilità di valutazione del proprio bambino. I questionari analizzati sono stati 17.

Risultati: Lo studio con i risultati ottenuti non dimostra che i progetti MYNd&Co e NAME migliorino significativamente parametri di dolore e funzione nelle donne in gravidanza e di omogeneità e conformità nei bambini.

Conclusione: L’intervento non ha prodotto risultati ma riteniamo che sia necessario aumentare il campione per poter avere dati che indaghino maggiormente il miglioramento del dolore, la gravidanza, il parto e i bambini.

Abstract

Introduction: MYNd&CO is a program for pregnant women that includes Mindfulness, Yoga, Nutrition, Development and Counseling, Coaching, prenatal classes and osteopathic treatment according to a holistic approach. The Neonatal Assessment Manual scorE (NAME) was developed to assist in the clinical management of babies in the neonatal ward by assessing their compliance and homogeneity. The following study begins its validation process. During the development of the MYNd&CO program for new mothers, an osteopathic assessment is offered to the newborn, followed by an osteopathic treatment. This allows us to consider the effect that the MYND&Co protocol could have on newborns by assessing their tissue quality using the NAME model. The aim of our study is to continue the MYND&Co study based on the existing study protocol, adding the data that will be collected on the NAME assessment of the infants and children of the women who participated in the MYND&Co pathway and a control group of infants and children.

Materials and Methods: A Pilot study. The participants were recruited at the outpatient clinic of the Clinica Mangiagalli for a 28-week program. Inclusion criteria: nulliparous women, single pregnancies, spontaneous pregnancies, gestational age ≥12, no maternal medical condition, maternal age between 18 and 44, no language barrier. Exclusion criteria: multiple pregnancies, IVF pregnancies, maternal or fetal medical conditions, age <18 or >45 years, language barriers. [1] According to these criteria, 200 women were recruited for the MYND&CO project. Of these MYND&CO member mothers, 22 took part in our study by joining the NAME project, thus giving the opportunity to assess their child. 17 questionnaires were analyzed.

Results: The study results do not show that the MYND and NAME projects significantly improve parameters of pain and function in pregnant women and homogeneity and compliance in children.

Conclusion: The intervention did not produce any results, but we believe that it is necessary to increase the sample in order to have much more consistent, therefore accurate result, the number of samples should have been higher: with the available number of samples, data regarding pain relief, pregnancy itself, childbirth process and child growth was not relevant enough.