Franke H, Franke J-D, Fryer G. Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2014;15:286. doi:10.1186/1471-2474-15-286. 

Nonspecific low back pain (LBP) has been defined as tension, soreness, or stiffness in the lower back region, the specific cause of which is unidentifiable.¹ This systematic review and meta-analysis provides a rigorous assessment of the effectiveness of osteopathic manipulative treatment (OMT) on nonspecific LBP. 

"Randomized clinical studies" (identified by the authors as RCTs) published or unpublished and unrestricted by language were included to remove reservations held from previous studies^2-4 and to meet criteria identified by the Cochrane Handbook.⁵ Criteria for inclusion were RCTs with adult participants with nonspecific LBP for any duration who received OMT techniques on the basis of the clinical judgment of osteopaths or osteopathic physicians. The inclusion criteria identified 307 studies. Further classification identified 15 RCTs comprising a total of 1502 participants and 18 associated comparison groups. Studies were evaluated in 4 areas: (1) acute and chronic nonspecific LBP, (2) chronic nonspecific LBP, and (3) nonspecific LBP in pregnant and (4) postpartum women. Primary outcomes were pain and functional status 3 months after treatment. The GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system was used to assess the quality of evidence. 

Using 10 RCTs, 12 comparison groups, and 1141 participants, OMT was found to have a significant effect on relief of acute and chronic pain (mean difference [MD], –12.91; 95% CI, –20.00 to –5.82). Using 9 RCTs, 10 comparison groups, and 1046 participants, OMT also improved functional status in patients with acute and chronic pain (standardized MD [SMD], –0.36; 95% CI, –0.58 to –0.14). In patients with chronic nonspecific LBP, OMT was found to have a significant effect on pain using 6 RCTs, 7 comparison groups, and 769 participants (MD, –14.93; 95% CI, –25.18 to –4.68), and for functional status using 3 RCTs (SMD, –0.32; 95% CI, –0.58 to –0.07). 

Nonspecific LBP in pregnant women was evaluated using 3 RCTs, 4 comparison groups, and 242 participants comparing usual care, sham ultrasound therapy, and no treatment. A significant difference was found in the effects of OMT on pain (MD, –23.01; 95% CI, –44.13 to –1.88) and functional status (SMD, –0.80; 95% CI, –1.36 to –0.23). Two RCTs studied nonspecific LBP in postpartum women and reported moderate-quality evidence in support of OMT for improving pain (MD, –41.85; 95% CI, –49.43 to –34.27) and functional status (SMD, –1.78; 95% CI, –2.21 to –1.35). 

The results of this analysis, similar to the findings of Licciardone et al,² suggest that OMT improves pain and functional status in patients with acute and chronic nonspecific LBP. (doi:10.7556/jaoa.2015.009) 

Western University of Health Sciences College of Osteopathic Medicine of the Pacific (WesternU/COMP)-Northwest, Lebanon, Oregon 

WesternU/COMP, Pomona, California