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The Somatic Connection  |   July 2015
Manual Therapy Effectiveness for Pediatric Dysfunctional Voiding
Author Affiliations
  • Alyssa Horne, OMS III
    Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Northwest, Lebanon, Oregon
  • Michael A. Seffinger, DO
    Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California
Article Information
The Somatic Connection   |   July 2015
Manual Therapy Effectiveness for Pediatric Dysfunctional Voiding
The Journal of the American Osteopathic Association, July 2015, Vol. 115, 461-462. doi:10.7556/jaoa.2015.095
The Journal of the American Osteopathic Association, July 2015, Vol. 115, 461-462. doi:10.7556/jaoa.2015.095
Nemett DR, Fivush BA, Mathews R, et al. A randomized controlled trial of the effectiveness of osteopathy-based manual physical therapy in treating pediatric dysfunctional voiding [published online January 11, 2008]. J Pediatr Urol. 2008;4(2):100-106. doi:10.1016/j.jpurol.2007.11.006. 
The incidence of dysfunctional voiding is 10% in children aged 4 to 6 years and 5% in children aged 6 to 12 years. Dysfunctional voiding is more common in girls than in boys. In a randomized controlled trial, the authors evaluated the effect of manual physical therapy based on an osteopathic approach (MPT-OA) in addition to standard treatment on pediatric dysfunctional voiding. A review of the literature yielded no other studies that assessed the efficacy of MPT-OA in children with dysfunctional voiding. 
Children aged 4 to 11 years who were referred to a pediatric urology clinic and had reported voiding dysfunction symptoms for at least 6 months were enrolled in this pilot study. Inclusion criteria were diagnosis of dysfunctional voiding with daytime incontinence or vesicoureteral reflux. Exclusion criteria were children with neurologic, spinal, or urogenital structural anomalies; a history of abuse; and Tanner stage IV pubertal development in girls. 
Participants were randomly assigned to a treatment group who received MPT-OA and standard treatment or to a control group who received standard treatment. Standard treatment included medical therapy, behavioral training, lifestyle changes, and hour-long appointments. The treatment group received standard therapy and 4 hour-long weekly MPT-OA treatments, which were individualized on the basis of findings on structural examination. Therapy consisted of gentle mobilizations of joints and muscles along the spine, pelvis, lower extremities, visceral organs, and cranium as indicated. The goal was to improve motion restriction and postural symmetry. The primary outcome measures included postvoid residuals, urinary tract infection diagnosis, daytime incontinence, dyssynergic voiding, vesicoureteral reflux, and improvement in findings from the initial structural examination. 
In total, 21 participants (14 girls [67%], 7 boys [33%]; mean age [range], 6.8 [4.5-10] years) completed the study. The treatment group had improvement in a significantly greater proportion of outcome measures (P=.008). The change in subgroup analyses for daytime incontinence and vesicoureteral reflux were not statistically significant but had a positive trend (P=.065; P=.114). Improvement or resolution of vesicoureteral reflux and elimination of postvoid residual urine were also more prominent in the treatment group. The treatment group had reduced motion restrictions after MPT-OA. In particular, a correction of pelvic asymmetry and lower extremity motion restrictions improved dysfunctional voiding (P<.002). The results suggested that MPT-OA can improve outcomes that standard treatment cannot. 
This study’s findings lend further support to the use of manual therapy for pediatric patients with dysfunctional voiding. A large multicenter randomized controlled trial is the next step in further elucidating the value of MPT-OA in treating pediatric patients with dysfunctional voiding.