The Somatic Connection  |   May 2015
Systematic Review Challenges Efficacy of Pediatric OMT
Author Notes
  • Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California 
Article Information
The Somatic Connection   |   May 2015
Systematic Review Challenges Efficacy of Pediatric OMT
The Journal of the American Osteopathic Association, May 2015, Vol. 115, 342-343. doi:10.7556/jaoa.2015.066
The Journal of the American Osteopathic Association, May 2015, Vol. 115, 342-343. doi:10.7556/jaoa.2015.066
Posadzki P, Lee MS, Ernst E. Osteopathic manipulative treatment for pediatric conditions: a systematic review [published online June 17, 2013]. Pediatrics. 2013;132(1):140-152. doi:10.1542/peds.2012-3959. 
The authors performed a systematic review of randomized controlled trials (RCTs) on osteopathic manipulative treatment (OMT) and osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) for patients aged 18 years or younger to evaluate the evidence on the efficacy of OMT and OMTh for pediatric conditions. A literature search yielded 19,509 RCTs, 17 of which met the author’s inclusion criteria. These RCTs included a total of 887 pediatric patients from the United States and Europe and assessed OMT and OMTh efficacy in the management of various conditions. 
All 17 RCTs had an uncertain risk of bias and methodologic limitations. Four RCTs did not include details outlining the OMT or OMTh protocol, making replication difficult. Eleven RCTs did not include the incidence rates of adverse events, which the authors believed could signify a breach of ethics. Results were mixed regarding the efficacy of OMT and OMTh in the pediatric population. Of the 17 RCTs, 7 studies favored OMT or OMTh, 7 revealed no effect, and 3 did not report between-group comparisons. The RCTs that demonstrated OMT or OMTh efficacy were smaller and more biased, whereas those that did not demonstrate OMT or OMTh efficacy were larger and more rigorous. Of the 5 RCTs that were determined to be of high methodologic quality, 1 revealed favorable effects of OMT or OMTh and 4 revealed no effects. Of the 4 RCTs that were not led by osteopathic physicians or foreign-trained osteopaths, none demonstrated OMT or OMTh efficacy. 
Although the authors noted several limitations of their systematic review, they concluded that “OMT [and OMTh] cannot be regarded as an effective therapy for pediatric conditions, and osteopaths should not claim otherwise.” They suggested that future OMT and OMTh studies follow standards of reporting trials, increase sample sizes, use blinding procedures, use intention-to-treat data analysis, and include control measures. 
This systematic review is notable for being published in a highly respected pediatric journal and for reaching conclusions that are unfavorable for the use of OMT in the pediatric population. In our experiences, OMT has indeed improved pediatric patient outcomes. We believe the authors may have over-looked other studies that support OMT efficacy. Osteopathic physicians who perform OMT on pediatric patients must be prepared to respond to these claims by publishing high-quality studies that demonstrate OMT efficacy.