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The Somatic Connection  |   July 2016
Osteopathic Manipulative Therapy Is Feasible and Safe After Abdominal Surgery
Author Notes
  • University of California, San Diego School of Medicine 
Article Information
The Somatic Connection   |   July 2016
Osteopathic Manipulative Therapy Is Feasible and Safe After Abdominal Surgery
The Journal of the American Osteopathic Association, July 2016, Vol. 116, 489-490. doi:10.7556/jaoa.2016.098
The Journal of the American Osteopathic Association, July 2016, Vol. 116, 489-490. doi:10.7556/jaoa.2016.098
Probst P, Büchler E, Doerr-Harim C, et al. Randomized controlled pilot trial on feasibility, safety and effectiveness of osteopathic manipulative treatment following major abdominal surgery (OMANT pilot trial). Int J Osteopath Med. 2016. doi:10.1016/j.ijosm.2016.03.002. 
German researchers conducted a randomized controlled pilot trial to assess the feasibility, safety, and possible benefits of osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) administered after abdominal surgery. Retrospective studies found that postoperative ileus duration was significantly shortened by osteopathic manipulative treatment (OMT).1-3 
This study used a prospective design, with 20 patients scheduled for abdominal surgery randomly assigned to an intervention (n=10) or control group (n=10). Exclusion criteria included diseases of the spine, metastatic disease, and long-term opioid use. Control patients received standard postoperative treatment including “pain medication via peridual, patient-controlled or peripheral venous access with the goal of a subjective pain score below 6 on a numeric rating scale.” The intervention group received standard care and additional OMTh from postoperative days 1 to 5. The OMTh sessions lasted 30 minutes, with 10 minutes each of the following 3 techniques: 
  • ■ “point-of-balance fascial tension for colon,” which was directed at visceral structures
  • ■ “neuronal inhibition for intestines,” during which pressure was applied over “the sympathetic innervation of the patient’s back (T10-L2) or the region of the superior mesenteric plexus on the abdomen, with the other hand on the target bowel area”
  • ■ “compression of the fourth ventricle (CV-4),” a frequently used OMT procedure
The safety measure was the comprehensive complication index. Complications that can be managed conservatively, such as postoperative vomiting and urinary tract infection, were classified as class I or II. Complications classified as class III or higher were considered major complications, such as intra-abdominal abscess or severe sepsis. Pain was recorded before and after the OMTh sessions. Control participants were visited and their pain was recorded with the same frequency as OMTh participants. 
Results showed that the groups were demographically equal—with the exception that the OMTh group was older—and the types of surgeries were equally distributed. The comprehensive complication index safety rating was 30.8 (range, 0-67.5) in the OMTh group and 37.1 (range, 0-84.6) in the control group (Cohen d=0.24). Length of hospital stay was 11.3 days in the OMTh group and 17.4 days in the control group (Cohen d=0.77). The authors contend that these results demonstrated both the safety and feasibility of OMTh and that OMTh significantly reduced pain on postoperative day 2 (P=.01). 
These results contribute to the evidence base demonstrating the safety of OMTh and suggest the benefit of hospital-based OMT services. 
References
Herrmann EP. Postoperative adynamic ileus: its prevention and treatment by osteopathic manipulation. The DO. 1965;6(2):163-164.
Crow WT, Gorodinsky L. Does osteopathic manipulative treatment (OMT) improves [sic] outcomes in patients who develop postoperative ileus: a retrospective chart review. Int J Osteopath Med. 2009;12(1):32-37. [CrossRef]
Baltazar GA, Betler MP, Akella K, Khatri R, Asaro R, Chendrasekhar A. Effect of osteopathic manipulative treatment on incidence of postoperative ileus and hospital length of stay in general surgical patients. J Am Osteopath Assoc. 2013;113(3):204-209. [PubMed]