Osteopathic manual therapy in heart failure patients: A randomized clinical trial

Meta-epidemiologic review: blinding and sham treatment in clinical trial design for osteopathic manipulative treatment research

Objective

To analyze the consistency of study designs in osteopathic manipulative treatment (OMT) research, focusing on blinding protocols and the use of sham treatments.

Data Source and Study Selection

PubMed and CINAHL were searched in January 2022. A total of 83 research studies between 2009 and 2021 were selected based on the presence of a double- or single-blind study design and/or sham treatment.

Data Extraction and Analysis

Data regarding the primary outcome measures, blinding design, measures used to determine success of blinding, osteopathic technique used, and sham technique used for each eligible study were extracted and compared among different study designs.

Results

A total of 5968 subjects participated in the 83 trials. The study population mainly consisted of asymptomatic individuals (25%) and chronic back pain patients (19%). Light touch was employed most commonly (49%) as the sham treatment, followed by unrelated sham (20%) and incomplete maneuvers (20%). Most studies blinded the subjects (80%) or the outcome evaluator/data analyzer (71%), while only 20% studies blinded the osteopathic physicians.

Conclusions

Strict double-blinding is achievable for OMT clinical research by blinding the subjects and data collectors/analyzers rather than the osteopaths providing the actual treatment. The use of questionnaires to determine the success of blinding should be considered. Additionally, including OMT-naïve subjects is preferred to enhance blinding success. When designing a sham treatment, careful consideration should be given to blinding the data collector, accounting for the placebo effect, and incorporating an additional no-treatment control group to improve the rigor of the study design.

Effectiveness of visceral fascial therapy targeting visceral dysfunctions outcome: systematic review of randomized controlled trials

BACKGROUND

Fascial Therapy is an ancient and widespread practice throughout the world. These approaches are very common in osteopathic practice and taught in workshops for professionals from different areas of health care, including Physiotherapy. This type of treatment is quite specialized and centered on the therapist. However, there is a lack of high-quality and low-risk bias studies that justify the use of this practice. Despite this, there is little scientific evidence about the effectiveness of Fascial Therapy to treat some visceral disorders. The purpose of this study was to critically appraise the scientific literature concerning the clinical efficacy of techniques used in Fascial Therapy targeting the visceral system.

METHODS

This systematic review included randomized controlled trials in any language or date of publication. All primary outcomes reported were included. The methodological quality and statistical reporting of each eligible trial were evaluated using the version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2). This systematic review provided a synthesis of current evidence on the effects of Fascial Therapy in patients with visceral disorders and/or pain. A total of 11 studies were included, with five of them covering gastrointestinal dysfunction, two covering cardiorespiratory dysfunction, two covering musculoskeletal dysfunction, and two covering urogenital dysfunction.

RESULTS

Fascial Therapy targeting the visceral system has been shown to be effective in reducing pain over the long term in people with low back pain when combined with standard physical therapy and effective in reducing gastroesophageal reflux symptoms over the short term. Considering the overall bias, six studies were at high risk of bias, two studies had some concerns and only three studies were at low risk of bias. Of the three studies with a low risk of bias, only two showed positive results and were effective in improving the studied outcome.

CONCLUSION

This systematic review shows that currently, there is poor evidence for the efficacy of the techniques used in Fascial Therapy targeting the visceral system, and this information can help healthcare professionals in decision-making related to the use of Fascial Therapy targeting the visceral system in patients with visceral disorders and/or pain.