Orrock PJ, Myers SP. Osteopathic intervention in chronic non-specific low back pain: a systematic review. BMC Musculoskelet Disord. 2013;14:129. doi:10.1186/1471-2474-14-129.  

A recent systematic review by Orrock and Myers of randomized clinical trials investigating “osteopathic intervention” (ie, osteopathic manual therapy or osteopathic manipulative treatment [OMT]) for patients with chronic low back pain took an interesting approach that differed from previous systematic reviews. Osteopathic intervention for this study was defined as “manual intervention and lifestyle advice applied by an osteopath which would be considered by the osteopathic community to be consistent with osteopathic practice.” The authors considered “authentic” osteopathic intervention to be that using a multitechnique approach—similar to the approach used by osteopaths in Australia and the United Kingdom. Only 2 trials met the researchers' inclusion criteria. According to Orrock and Myers, neither trial indicated that osteopathic intervention was superior to sham therapy, physiotherapy, or exercises, and because the studies included in the review had small sample sizes, definitive statements about whether osteopathic intervention is effective for this patient population could not be made. 

The last systematic review¹ on this topic, published in 2005, revealed that OMT was more efficacious than sham, placebo, or exercise in reducing pain in patients with acute, subacute, or chronic low back pain. That review was used as a basis for the American Osteopathic Association's national guidelines for use of OMT in patients with low back pain.² However, Orrock and Myers did not include the clinical trials reviewed in the 2005 systematic review because those trials either did not treat only chronic low back pain patients, did not treat only nonspecific low back pain patients, or did not specify the type of back pain. In their conclusion, they request that future studies use a pragmatic approach that reflects actual practice, enrolls a large sample size, maintains participant compliance with the protocols, blinds the participants to group allocation, and includes appropriate sham and control groups. 

In addition, because Orrock and Myers included trials only published before 2011, they did not include the OSTEOPATHIC Trial that was published earlier this year,³ the results of which were summarized in the July 2013 installment of “The Somatic Connection.”⁴ The OSTEOPATHIC Trial addressed many of the requests made by Orrock and Myers in their conclusion, including a larger sample size (455 participants), high patient adherence to protocols, blinding of participants, and use of sham and control groups. It is likely that another systematic review that includes the results of the OSTEOPATHIC Trial will conclude that OMT is indeed an effective treatment for this patient population.