Zanotti E, Berardinelli P, Bizzarri C, et al. Osteopathic manipulative treatment effectiveness in severe chronic obstructive pulmonary disease: a pilot study. Complement Ther Med. 2012;20(1-2):16-22.  

There have been several recent clinical trials that have evaluated the effect of osteopathic manipulative treatment (OMT) or osteopathic manipulative therapy (OMTh) on pulmonary function in patients with chronic obstructive pulmonary disease (COPD). In a 2008 study,¹ researchers at the A.T. Still University-Kirksville College of Osteopathic Medicine in Missouri reported that a multitechnique OMT protocol for patients with COPD resulted in worsening of air trapping for 30 minutes after the OMT session, relative to a sham control group. Following up on those results, in 2009, Noll et al² published a study that identified how a particular OMT technique—lymphatic pump with activation—was responsible for the air trapping observed in the first study. In a study reported earlier this year, researchers at a pulmonary rehabilitation institute in Italy assessed the efficacy of OMTh as performed by 3 osteopathic practitioner-students on patients with severe COPD. 

A total of 20 stable patients with severe COPD (5 women; mean [standard deviation {SD}] age, 63.8 [5.1] years; mean [SD] forced expiratory volume in 1 second, 26.9% [6.3%] of predicted) were randomly assigned to 2 groups: (1) OMTh plus pulmonary rehabilitation or (2) sham touch plus pulmonary rehabilitation. Osteopathic manipulative therapy techniques were customized to each patient. Sham touch was not described. Pulmonary rehabilitation included individually designed exercise training, educational support, and nutritional and psychological counseling. Treatments were provided 5 days per week for 4 weeks. Exercise capacity was measured using the Borg scale in the 6-minute walk test (primary outcome) and the pulmonary function test (secondary outcome). Outcomes were measured at the beginning and at the end of the interventions. 

The results of the 6-minute walk test significantly improved in both groups. Between-group comparison showed a difference of 48.8 m (95% CI, 17 to 80.6; P=.04) farther in the OMTh group. The OMTh group also had a significant decrease in mean (SD) residual volume, from 4.4 (1.5) L to 3.9 (1.5) L. Between-group comparison further delineated the treatment effect of OMTh on residual volume (-0.44 L; 95% CI, -0.26 to -0.62; P=.001). Although the OMTh group experienced an increase of 0.14 L in forced expiratory volume in 1 second (95% CI, 0 to 0.26), there was not a significant between-group difference (0.13 L; 95% CI, -0.66 to 0.9). Authors concluded that OMTh plus pulmonary rehabilitation may improve exercise capacity and reduce residual volume in severely impaired patients with COPD with respect to pulmonary rehabilitation alone. Although this is a pilot study, it is off to an encouraging start, and further research by this group should prove to be quite interesting.—M.A.S.