Active Visceral Manipulation Associated With Conventional Physiotherapy in People With Chronic Low Back Pain and Visceral Dysfunction: A Preliminary, Randomized, Controlled, Double-Blind Clinical Trial

EFFECT OF VISCERAL MANIPULATION ON CHILDREN WITH REFRACTORY CHRONIC FUNCTIONAL CONSTIPATION: A RANDOMIZED CONTROLLED TRIAL

BACKGROUND

Functional constipation (FC) is a common global high prevalence issue in children.

OBJECTIVE

The purpose of the present study is to evaluate the effect of visceral manipulation (VM) on children with chronic interacble FC unresponsive to the standard treatment.

METHODS

This study was conducted as a randomized, single-blind controlled trial. Fifty-two children with refractory chronic functional constipation unresponsive to the standard medical treatment were randomly allocated to two groups of 26 control (standard medical care (SMC)) and 26 intervention (SMC with VM) for 4 weeks. Abdominal pain, painful defecation, stool consistency, defecation frequency, and the dose of oral laxative were evaluated before and after the treatment period using the Pain Rating Scale, Bristol stool form scale, and patient/parents report.

RESULTS

At the end of treatment, except for the dose of oral laxative in the control group, all of the results showed a significant difference in both groups (P<0.05). The dose of oral laxative in the intervention group decreased significantly (P<0.05), however, no significant change was observed in the control group (P>0.05). In the intervention group comparison, statistically significant differences were found in all va-riables except the Bristol stool form scale (P<0.05). The Bristol stool form scale after treatments was not different when the groups were compared (P=0.32), but the number of subjects who had normal stool consistency was significantly increased in the intervention group than in the control group (P<0.05).

CONCLUSION

VM can be considered as a possible treatment without side effects besides SMC for the management of chronic FC. Further studies are needed to investigate the long-term effect of VM.

Quality of life in women with normal pregnancy

Pregnancy affects a woman's physiological and psychological state. One of the most important aspects that requires attention is the quality of life of pregnant women. The quality of life of women during this period is influenced by a number of factors, such as back and pelvic pain, physiotherapy and physical activity, and also sexual satisfaction. Eighty-five women aged 21-40 years (30.80 ± 5.05) in pregnancy trimesters participated in the study: 17 women were in the first trimester, 32 women were in the second, and 36 women in the third trimester. The World Health Organisation Quality of Life (WHOQOL-BREF), Oswestry Disability Index (ODI) and the Sexual Satisfaction Scale for Women SSS-W-R15 were used to answer the research hypotheses. Respondents also provided information on questions regarding physiotherapy treatments and physical activity. Quality of life (WHOQOL-BREF) and disability due to back pain (ODI) showed a statistical association and relationship (p-value = 0.045, rho = - 0.22). Quality of life (WHOQOL-BREF) has an association with sexual satisfaction in pregnant women (SSS-W-R15) (p-value = 0.003, rho = 0.32). The trimester of pregnancy has an effect on ODI (p-value = 0.027). A significant effect occurred in a detailed comparison between the first and third trimesters of pregnancy (p-value = 0.026). The trimester also has an impact on quality of life (WHOQOL-BREF) (p-value = 0.002). In a detailed analysis, a significant effect occurred between the first and third trimesters of pregnancy (p-value = 0.001). Moreover, the trimester of pregnancy has an impact on sexual satisfaction (SSS-W-R15) (p-value = 0.027). After detailed statistical analysis, a significant effect occurred between trimesters one and three of pregnancy (p-value = 0.046). On the other hand, the number of days of physical activity performed by pregnant women per month and the type of physical activity had no effect on the ODI (p-value = 0.071). The type of physical activity performed by pregnant women also has no effect on ODI (p-value = 0.023). The number of physiotherapy treatments used has no effect on the ODI (p-value = 0.156). Type of physiotherapy treatment has no effect on ODI (p-value = 0.620). Normal pregnancy quality of life (WHOQOL) is related to ODI and sexual satisfaction (SSS-W-R15), while the trimester of pregnancy also has an impact on quality of life, disability due to back pain and sexual satisfaction.

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.

The relationships between spinal amplitude of movement, pain and disability in low back pain: A systematic review and meta-analysis

BACKGROUND AND OBJECTIVES

The role of spinal movement alterations in low back pain (LBP) remains unclear. This systematic review and meta-analyses examined the relationships between spinal amplitude of movement, disability and pain intensity in patients with LBP.

DATABASES AND DATA TREATMENT

We searched PubMed, CINAHL, Embase, Pedro and Web of Science for relevant articles until 14th March 2023. Risk of bias was assessed with the Quality in Prognostic Studies Tool. We analysed the relationships between amplitude of movement, disability and pain intensity with standard correlational meta-analyses and meta-analytic structural equation modelling (MASEM) in cross-sectional and longitudinal data.

RESULTS

A total of 106 studies (9001 participants) were included. In cross-sectional data, larger amplitude of movement was associated with lower disability (pooled coefficient: -0.25, 95% confidence interval: [-0.29 to -0.21]; 69/5899 studies/participants) and pain intensity (-0.13, [-0.17 to -0.09]; 74/5806). An increase in amplitude of movement was associated with a decrease in disability (-0.23, [-0.31 to -0.15]; 33/2437) and pain intensity (-0.25, [-0.33 to -0.17]; 38/2172) in longitudinal data. MASEM revealed similar results and, in addition, showed that amplitude of movement had a very small influence on the pain intensity-disability relationship.

CONCLUSIONS

These results showed a significant but small association between amplitude of movement and disability or pain intensity. Moreover, they demonstrated a direct association between an increase in amplitude of movement and a decrease in pain intensity or disability, supporting interventions aiming to reduce protective spinal movements in patients with LBP.

SIGNIFICANCE

The large meta-analyses performed in this work revealed an association between reductions in spinal amplitude of movement and increased levels of disability and pain intensity in people with LBP. Moreover, it highlighted that LBP recovery is associated with a reduction in protective motor behaviour (increased amplitude of movement), supporting the inclusion of spinal movement in the biopsychosocial understanding and management of LBP.

Evaluation of effectiveness of osteopathic visceral manipulation in patients with chronic mechanical low back pain: A multi-center, single-blind, randomized-controlled study

Objectives

In this study, we aimed to evaluate the effectiveness of osteopathic visceral manipulation (OVM) combined with physical therapy in pain, depression, and functional impairment in patients with chronic mechanical low back pain (LBP).

Patients and methods

A total of 118 patients with chronic mechanical LBP were assessed, and 86 who met the inclusion criteria were included in the randomized-controlled study between January 2021 and August 2022. The patients were randomized to either Group 1 (n=43), which underwent physical therapy (5 days/week, for a total of 15 sessions) combined with OVM (2 days/week with three-day intervals), or Group 2 (n=43), which underwent physical therapy (5 days/week, for a total of 15 sessions) combined with sham OVM (2 days/week with three-day intervals). Both groups were assessed before and after treatment and at the fourth week post-treatment.

Results

Seven patients were lost to follow-up, and the study was completed with 79 patients (25 males, 54 females; mean age: 46.87±14.12 years; range, 19 to 75 years). Pain, depression, and functional impairment scores were all improved in both groups (p=0.001 for all). This improvement was sustained at week four after the end of treatment. However, improvement in the pain, depression, and functional impairment scores was significantly higher in Group 1 than in Group 2 (p=0.001 for all).

Conclusion

The results suggest that OVM combined with physical therapy is useful to improve pain, depression, and functional impairment in patients with chronic mechanical low back pain. We believe that OVM techniques should be combined with other physical therapy modalities in this patient population.

Blinding and sham control methods in trials of physical, psychological, and self-management interventions for pain (article I): a systematic review and description of methods

ABSTRACT

Blinding is challenging in randomised controlled trials of physical, psychological, and self-management therapies for pain, mainly because of their complex and participatory nature. To develop standards for the design, implementation, and reporting of control interventions in efficacy and mechanistic trials, a systematic overview of currently used sham interventions and other blinding methods was required. Twelve databases were searched for placebo or sham-controlled randomised clinical trials of physical, psychological, and self-management treatments in a clinical pain population. Screening and data extraction were performed in duplicate, and trial features, description of control methods, and their similarity to the active intervention under investigation were extracted (protocol registration ID: CRD42020206590). The review included 198 unique control interventions, published between 2008 and December 2021. Most trials studied people with chronic pain, and more than half were manual therapy trials. The described control interventions ranged from clearly modelled based on the active treatment to largely dissimilar control interventions. Similarity between control and active interventions was more frequent for certain aspects (eg, duration and frequency of treatments) than others (eg, physical treatment procedures and patient sensory experiences). We also provide an overview of additional, potentially useful methods to enhance blinding, as well as the reporting of processes involved in developing control interventions. A comprehensive picture of prevalent blinding methods is provided, including a detailed assessment of the resemblance between active and control interventions. These findings can inform future developments of control interventions in efficacy and mechanistic trials and best-practice recommendations.

Abdominal and Diaphragmatic Mobility in Adults With Chronic Gastritis: A Cross-Sectional Study

Objective

The purpose of this study was to assess abdominal and diaphragmatic mobility in adults with chronic gastritis compared with healthy individuals and to analyze the impact of chronic gastritis on musculoskeletal signs and symptoms of the cervical and thoracic spine.

Methods

This was a cross-sectional study conducted by the physiotherapy department at the Universidade Federal de Pernambuco in Brazil. Fifty-seven individuals participated, 28 with chronic gastritis (gastritis group [GG]) and 29 healthy individuals (control group [CG]). We assessed the following: restricted abdominal mobility in the transverse, coronal, and sagittal planes; diaphragmatic mobility; restricted cervical vertebral segmental mobility; restricted thoracic vertebral segmental mobility; and pain on palpation, asymmetry, and density and texture of the soft tissues on the cervical and thoracic spine. The measure of diaphragmatic mobility was assessed with ultrasound imaging. The Fisher exact and χ2 tests were applied to compare the groups (GG and CG) in relation to the restricted mobility of the abdominal tissues near the stomach on all planes and diaphragm, and the independent samples t test to compare the mobility measurements of the diaphragm. A significance level of 5% was considered for all tests.

Results

Restricted abdominal mobility in all directions (P < .05) was greater in GG when compared with CG except for the counterclockwise direction (P = .09). In GG, 93% of the individuals presented restricted diaphragmatic mobility, with a mean mobility of 3.1 ± 1.9 cm, and in the CG, 36.8% with a mean of 6.9 + 1.7 cm (P < .001). The GG presented a higher occurrence of restricted rotation and lateral glide mobility of the cervical vertebrae, pain to palpation, and density and texture dysfunction of the adjacent tissues when compared with CG (P < .05). In the thoracic region, there was no difference between GG and CG regarding musculoskeletal signs and symptoms.

Conclusion

Individuals with chronic gastritis presented greater abdominal restriction and lower diaphragmatic mobility, in addition to a higher occurrence of musculoskeletal dysfunction in the cervical spine when compared with healthy individuals.

The effectiveness of visceral osteopathy in pain, disability, and physical function in patients with low-back pain. A systematic review and meta-analysis

BACKGROUND AND PURPOSE

Systematic review and meta-analysis to assess the effectiveness of visceral osteopathy in improving pain intensity, disability and physical function in patients with low-back pain (LBP).

MATERIALS AND METHODS

MEDLINE (Pubmed), PEDro, SCOPUS, Cochrane Library and Web of Science databases were searched from inception to February 2022. PICO search strategy was used to identify randomized controlled trials applying visceral techniques in patients with LBP. Eligible studies and data extraction were conducted independently by two reviewers. Quality of the studies was assessed with the Physiotherapy Evidence Database scale, and the risk of bias with Cochrane Collaboration tool. Meta-analyses were conducted using random effects models according to heterogeneity assessed with I² coefficient. Data on outcomes of interest were extracted by a researcher using RevMan 5.4 software.

RESULTS

Five studies were included in the systematic review involving 268 patients with LBP. The methodological quality of the included ranged from high to low and the risk of bias was high. Visceral osteopathy techniques have shown no improvements in pain intensity (Standardized mean difference (SMD) = -0.53; 95% CI; -1.09, 0.03; I²: 78%), disability (SMD = -0.08; 95% CI; -0.44, 0.27; I²: 0%) and physical function (SMD = -0.26; 95% CI; -0.62, 0.10; I²: 0%) in patients with LBP.

CONCLUSIONS

This systematic review and meta-analysis showed a lack of high-quality studies showing the effectiveness of visceral osteopathy in pain, disability, and physical function in patients with LBP.

Visceral Therapy and Physical Activity for Selected Dysfunctions, with Particular Emphasis on Locomotive Organ Pain in Pregnant Women-Importance of Reducing Oxidative Stress

Movement is a physiological phenomenon and a fundamental aspect of the living human body in a global context (e.g., musculoskeletal system function) and local one (e.g., visceral system function). The local activity of the body is expressed in the rhythm of pulsations, peristalsis and vibrations. Visceral therapy supports movement, articulation and tissue rhythm. The use of visceral treatment for pain is complementary and is relevant for pregnant women. Maintaining the mobility and motility of internal organs by means of visceral techniques can regulate anatomical relations and physiological processes within the urogenital diaphragm. The role of physical activity is also important. A scoping review was conducted to analyze the relevant literature on pain in pregnant women, the role of visceral therapy in pregnant women and oxidative stress. Eligible articles presented aspects of the occurrence of pain in locomotive organs in pregnant women, the use of visceral therapy in pain management, and the reduction of oxidative stress. The use of visceral therapy and physical activity in the treatment of pain is complementary and also important for pregnant women, and so may have an effect on reducing oxidative stress in pregnant women.

Fascial Nomenclature: Update 2021, Part 1

The fascial continuum is a topic for which all clinicians and other healthcare professionals come into contact on a daily basis, both consciously and without having the idea that the tissues they deal with can fall within the concept of fascia. The Foundation of Osteopathic Research and Clinical Endorsement (FORCE) organization includes many clinicians and health professionals, as well as researchers in different scientific disciplines. The goal is to dissect some concepts related to daily practice, such as fascial tissue, from a scientific point of view and impartially. Proof of the impartiality of FORCE is the fact that it does not sell any fascial products, no tools, and, above all, all the fascial terminology used has no copyright: research and knowledge are the right of anyone who wishes improvement for the good of the patient. The article aims to review the themes that could add new elements for a broader view of the meaning and nomenclature of the fascial system.

Effectiveness of osteopathic interventions in chronic non-specific low back pain: A systematic review and meta-analysis

BACKGROUND

Chronic low back pain (CLBP) is a frequent cause of disability and it represents a medical, social and economic burden globally. Therefore, we assessed effectiveness of osteopathic interventions in the management of NS-CLBP for pain and functional status.

METHODS

A systematic review and meta-analysis were conducted. Findings were reported following the PRISMA statement. Six databases were searched for RCTs. Studies were independently assessed using a standardized form. Each article was assessed using the Cochrane risk of bias (RoB) tool. Effect size (ES) were calculated at post-treatment and at 12 weeks' follow up. We used GRADE to assess quality of evidence.

RESULTS

10 articles were included. Studies investigated osteopathic manipulative treatment (OMT, n = 6), myofascial release (MFR, n = 2), craniosacral treatment (CST, n = 1) and osteopathic visceral manipulation (OVM, n = 1). None of the study was completely judged at low RoB. Osteopathy revealed to be more effective than control interventions in pain reduction (ES: -0.59; 95% CI: -0.81, -0.36; P < 0.00,001) and in improving functional status (ES: -0.42; 95% 95% CI: -0.68, -0.15; P = 0.002). Moderate-quality evidence suggested that MFR is more effective than control treatments in pain reduction (ES: -0.69; 95% CI: -1.05, -0.33; P = 0.0002), even at follow-up (ES: -0.73; 95% CI: -1.09, -0.37; P < 0.0001). Low-quality evidence suggested superiority of OMT in pain reduction (ES: -0.57; 95% CI: -0.90, -0.25; P = 0.001) and in changing functional status (ES: -0.34; 95% CI: -0.65, -0.03; P = 0.001). Very low-quality evidence suggested that MFR is more effective than control interventions in functional improvements (ES: -0.73; 95% CI: -1.25, -0.21; P = 0.006).

CONCLUSION

Results strengthen evidence that osteopathy is effective in pain levels and functional status improvements in NS-CLBP patients. MFR reported better level of evidence for pain reduction if compared to other interventions. Further high-quality RCTs, comparing different osteopathic modalities, are recommended to produce better-quality evidence.