Licciardone JC, Kearns CM, Minotti DE. Outcomes of osteopathic manual treatment for chronic low back pain according to baseline pain severity: results from the OSTEOPATHIC Trial [published online December 2013]. Man Ther. 2013;18(6):533-540. doi:10.1016/j.math.2013.05.006.
The largest and most rigorous randomized controlled trial on osteopathic manual treatment (more commonly known as osteopathic manipulative treatment [OMT]), the OSTEOPAThic Health outcomes In Chronic low back pain Trial, was published in 2013.
1 It used a randomized, double-blind, sham-controlled, 2 × 2 factorial design to study OMT for patients with chronic low back pain (LBP).
The Journal of the American Osteopathic Association published 4 subgroup analyses of this historic trial.
2-5 Another subgroup analysis from this trial, recently published in
Manual Therapy, reported the effectiveness of OMT according to baseline severity of chronic LBP.
A total of 455 participants were divided into 2 categories: those who reported low baseline pain severity (<50 mm on a 100-mm visual analog scale; 269 participants [59%]) and those who reported high baseline pain severity (⩾50 mm on a 100-mm visual analog scale; 186 participants [41%]). Six 15-minute OMT sessions were provided every 2 weeks by the same trained osteopathic physician over 8 weeks. Outcomes were assessed at week 12. The provided OMT techniques included high-velocity, low-amplitude; articulatory; soft tissue; myofascial stretching and release; strain-counterstrain; and muscle energy. Sham OMT included active and passive range of motion, light touch, improper patient positioning, purposely misdirected movements, and diminished force.
The study revealed a large effect size for OMT vs sham OMT in providing substantial LBP improvement in patients with high baseline pain severity (response ratio, 2.04; 95% confidence interval, 1.36-3.05; P<.001). Clinically important improvement in back-specific functioning was also found in the OMT group compared with that in the sham OMT group (response ratio, 1.80; 95% confidence interval, 1.08-3.01; P⩽.02). The findings of this study suggest that OMT would be an excellent adjunct to the care of patients with severe chronic LBP.