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Sanchez J, Martinez ES, Loveless B, Sees JP, Zammuto J, Szurmant H, Fuchs S, Crone P, Hostoffer R. Augmentation of immune response to vaccinations through osteopathic manipulative treatment: a study of procedure. J Osteopath Med 2024; 124:163-170. [PMID: 38011280 DOI: 10.1515/jom-2023-0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
CONTEXT Anecdotal evidence suggested that osteopathic manipulative treatment (OMT) may have imparted survivability to patients in osteopathic hospitals during the 1918 influenza pandemic. In addition, previous OMT research publications throughout the past century have shown evidence of increased lymphatic movement, resulting in improved immunologic function qualitatively and quantitatively. OBJECTIVES The following is a description of a proposed protocol to evaluate OMT effects on antibody generation in the peripheral circulation in response to a vaccine and its possible use in the augmentation of various vaccines. This protocol will serve as a template for OMT vaccination studies, and by adhering to the gold standard of randomized controlled trials (RCTs), future studies utilizing this outline may contribute to the much-needed advancement of the scientific literature in this field. METHODS This manuscript intends to describe a protocol that will demonstrate increased antibody titers to a vaccine through OMT utilized in previous historical studies. Confirmation data will follow this manuscript validating the protocol. Study participants will be divided into groups with and without OMT with lymphatic pumps. Each group will receive the corresponding vaccine and have antibody titers measured against the specific vaccine pathogen drawn at determined intervals. RESULTS These results will be statistically evaluated. Our demonstration of a rational scientific OMT vaccine antibody augmentation will serve as the standard for such investigation that will be reported in the future. These vaccines could include COVID-19 mRNA, influenza, shingles, rabies, and various others. The antibody response to vaccines is the resulting conclusion of its administration. Osteopathic manipulative medicine (OMM) lymphatic pumps have, in the past through anecdotal reports and smaller pilot studies, shown effectiveness on peripheral immune augmentation to vaccines. CONCLUSIONS This described protocol will be the template for more extensive scientific studies supporting osteopathic medicine's benefit on vaccine response. The initial vaccine studies will include the COVID-19 mRNA, influenza, shingles, and rabies vaccines.
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Affiliation(s)
- Jesus Sanchez
- Department of Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine, College of Osteopathic Medicine of the Pacific at Western University of Health Sciences, Pomona, CA, USA
| | - Eric S Martinez
- Department of Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine, College of Osteopathic Medicine of the Pacific at Western University of Health Sciences, Pomona, CA, USA
| | - Brian Loveless
- Department of Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine, College of Osteopathic Medicine of the Pacific at Western University of Health Sciences, Pomona, CA, USA
| | - Julieanne P Sees
- Fellow Osteopathic Medicine, National Academy of Medicine, Washington, DC, USA
| | - Joseph Zammuto
- Associate Professor of Family Medicine, Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, CA, USA
| | - Hendrik Szurmant
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific at Western University of Health Sciences, Pomona, CA, USA
| | - Sebastien Fuchs
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific at Western University of Health Sciences, Pomona, CA, USA
| | - Paula Crone
- Western University of Health Sciences, Pomona, CA, USA
| | - Robert Hostoffer
- University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
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Szafarowska M, Rosiński M, Segiet-Święcicka A, Jędrzejczyk S, Jerzak M, Jerzak M. Effect of physiotherapy on infertility treatment in polycystic ovary syndrome patients. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2024; 23:14-20. [PMID: 38690069 PMCID: PMC11056729 DOI: 10.5114/pm.2024.136439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/29/2023] [Indexed: 05/02/2024]
Abstract
Introduction Polycystic ovary syndrome (PCOS) is a complex hormonal condition associated with psychological, reproductive, and metabolic features. Low-grade inflammation is a recognised factor causing metabolic and reproductive disorders in PCOS, which is why anti-inflammation approaches in PCOS treatment, especially during the COVID pandemic, are considered. A promising therapeutic option is osteopathic manipulative treatment (OMT), which activates the cholinergic anti-inflammatory pathway and can inhibit proinflammatory cytokines, such as TNF, IL-1β, and TNF-β. In our paper we analysed the influence of OMT in women with PCOS. Material and methods Seventy-three patients, aged 29-46 years, with a history of reproductive failure, who underwent a physiotherapeutic treatment were evaluated. Six months after the end of a physiotherapy session, a follow-up questionnaire was performed. Results The results show that most women (83.6%) were satisfied with the therapeutic process, and that the sessions met the patient's expectations. Reducing the level of anxiety related to infertility treatment and pregnancy was declared by 60 (82.2%) women, an improvement in well-being was declared by 72 (97.3%) (p = 0.04), and increasing awareness of the body after physiotherapy sessions was declared by 70 (95.9%) women. Conclusions The physiotherapeutic sessions improved infertility treatment, enhanced quality of life, and had a positive effect on overall health in PCOS women.
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Affiliation(s)
- Monika Szafarowska
- Department of Gynaecology and Oncological Gynaecology, Military Institute of Medicine, Warsaw, Poland
| | | | - Agnieszka Segiet-Święcicka
- Department of Coronary Artery Disease and Cardiac Rehabilitation, National Institute of Cardiology, Warsaw, Poland
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Gustowski S, Slicho T, Newsome D. Integration of Osteopathic Manipulative Treatment for Patients with Chronic Pain. MISSOURI MEDICINE 2024; 121:76-80. [PMID: 38404432 PMCID: PMC10887468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
The Five Models of Osteopathic Medicine offers guidance on creating a treatment plan that includes OMT for patients with chronic pain. Using OMT on one body region or system has numerous downstream effects and can influence multiple models. This paper describes this therapeutic modality.
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Affiliation(s)
- Sharon Gustowski
- Campus Dean, Kansas City Campus, Associate Professor, Osteopathic Manipulative Medicine, Kansas City University, Kansas City, Missouri
| | - Turner Slicho
- Assistant Professor, Osteopathic Manipulative Medicine, Kansas City University, Kansas City, Missouri
| | - D'Angeleau Newsome
- Osteopathic Medical Student, Kansas City University, Kansas City, Missouri
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Effects of osteopathic manual therapy on the autonomic and immune systems and the hypothalamus-pituitary-adrenal axis in the horse. ACTA VET BRNO 2023. [DOI: 10.2754/avb202392010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Manual therapies, physiotherapy, and modalities are often used as a treatment and prophylactic method for preventing various injuries, as well as a rehabilitation tool in the post-operative, traumatic period for horses. Significant results have been achieved with these therapies: increased joint range of motion, tissue extensibility, and reduced pain and inflammation. This study evaluated the effect of osteopathic manual therapy (OMT) on the nervous and immune systems, as well as on the hypothalamus-pituitary-adrenal (HPA) axis. To assess changes in these systems, non-invasive biomarkers were chosen: the heart rate (HR), respiratory rate (RR), temperature (T), as well as objective measurements: blood serum cortisol (BSC) concentration and white blood cell (WBC) count. A total of 30 thoroughbred horses were randomly divided into an experimental group (n = 15) and a control group (n = 15). Blood samples and physiological indicator measurements such as HR, RR, T, BSC and WBC were taken before (p0), after (p1) and one hour after (p2) the OMT treatment for the experimental group. Analogical sequence was performed for the control group without OMT. A significant increase of BSC by 0.94 µg/dl after OMT suggest a direct influence on the HPA axis. Also, a substantial decrease of WBC by 0.57 × 109/l indicates the immune system’s response to the treatment. Moreover, an observed significant decrease in HR and RR shows that the autonomic nervous system was affected by activating the parasympathetic nervous system. Based on the results obtained, it is concluded that OMT has an effect on the HPA axis and on the nervous and immune systems.
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Tissutal and Fluidic Aspects in Osteopathic Manual Therapy: A Narrative Review. Healthcare (Basel) 2022; 10:healthcare10061014. [PMID: 35742064 PMCID: PMC9222872 DOI: 10.3390/healthcare10061014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/25/2022] [Accepted: 05/29/2022] [Indexed: 12/20/2022] Open
Abstract
Over the years, several authors have discussed the possibility of considering somatic dysfunction (SD) as a “nosological element” detectable on palpation. There are many aspects to consider regarding the etiology and diagnosis of SD, and the literature on osteopathic issues provides details on physiological signs that characterize it, including tissue texture changes. Recent knowledge suggests that how tissue and, in particular, connective tissue, responds to osteopathic treatment may depend on the modulation of the inflammation degree. Low-grade inflammation (LGI) may act on the extracellular matrix (ECM) and on cellular elements; and these mechanisms may be mediated by biological water. With its molecules organized in structures called exclusion zones (EZ), water could explain the functioning of both healthy and injured tissues, and how they can respond to osteopathic treatment with possible EZ normalization as a result. The relationship between inflammation and DS and the mechanisms involved are described by several authors; however, this review suggests a new model relating to the characteristics of DS and to its clinical implications by linking to LGI. Tissue alterations detectable by osteopathic palpation would be mediated by body fluids and in particular by biological water which has well-defined biophysical characteristics. Research in this area is certainly still to be explored, but our suggestion seems plausible to explain many dynamics related to osteopathic treatment. We believe that this could open up a fascinating scenario of therapeutic possibilities and knowledge in the future.
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Marshall S. Response to "Lymphatic osteopathic manipulative treatment and soreness after receiving the COVID-19 vaccine". J Osteopath Med 2022; 122:443-444. [PMID: 35512108 DOI: 10.1515/jom-2022-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Sylvia Marshall
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
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Sookaromdee P, Wiwanitkit V. Lymphatic osteopathic manipulative treatment and soreness after receiving the COVID-19 vaccine. J Osteopath Med 2022; 122:441. [PMID: 35334186 DOI: 10.1515/jom-2022-0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/04/2022] [Indexed: 11/15/2022]
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Beltrán-Dussán EH. ¿Qué es la medicina alternativa, complementaria e integrativa? REVISTA DE LA FACULTAD DE MEDICINA 2021. [DOI: 10.15446/revfacmed.v70n4.91413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
El concepto de medicina alternativa fue creado por la medicina occidental para identificar prácticas médicas diferentes a la medicina convencional, tales como la medicina tradicional china y acupuntura, homeopatía, terapia neural, medicina osteopática y quiropráctica, medicina ayurveda y la medicina tradicional indígena, que también tienen fundamentos filosóficos, científicos y terapéuticos. Desafortunadamente, con el tiempo se estableció la creencia de que la medicina alternativa comprende todas las prácticas médicas que no son parte de la medicina convencional, lo que ha causado muchas inexactitudes y controversias.
La medicina surgió como necesidad de auto preservación del ser humano y que considera a la salud como bienestar completo y a la enfermedad, como pérdida de esta condición. A lo largo de su evolución han emergido diversas racionalidades y algunas de ellas se han convertido en sistemas médicos. La medicina convencional se estructuró en Occidente, fundamentada en racionalidades médicas existentes para la época y enfocada en modificar la enfermedad, lo que resultó en marcadas diferencias conceptuales con sistemas de tratamiento ya existentes que se centraban en el individuo y en modificar los procesos de la enfermedad.
Todos los sistemas médicos han generado un impacto en diversos campos sociales. Asimismo, han surgido tendencias y estrategias de integración de la medicina convencional con otros sistemas médicos comoLa electroacupuntura de Voll, la homotoxicología, el balance polar electromagnético, la antroposofía, la sintergética y la biofotónica. Actualmente se considera que el objetivo de la medicina es integrar y complementar conocimientos de diferentes racionalidades médicas dentro del concepto de una sola medicina. Teniendo en cuenta lo anterior, el objetivo del presente artículo es clarificar los conceptos de las diferentes formas de medicina, plantear algunas definiciones al respecto, y proponer una definición de medicina alternativa, complementaria e integrativa.
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Brown M, Nassoiy S, Plackett T, Luchette F, Posluszny J. Red blood cell distribution width and outcome in trauma patients. J Osteopath Med 2021; 121:221-228. [PMID: 33567079 PMCID: PMC8086633 DOI: 10.1515/jom-2020-0089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Context Red blood cell distribution width (RDW) has been used to predict mortality during infection and inflammatory diseases. It also been purported to be predictive of mortality following traumatic injury. Objective To identify the role of RDW in predicting mortality in trauma patients. We also sought to identify the role of RDW in predicting the development of sepsis in trauma patients. Methods A retrospective observational study was performed of the medical records for all adult trauma patients admitted to Loyola University Medical Center from 2007 to 2014. Patients admitted for fewer than four days were excluded. Admission, peak, and change from admission to peak (Δ) RDW were recorded to determine the relationship with in-hospital mortality. Patient age, development of sepsis during the hospitalization, admission to the intensive care unit (ICU), and discharge disposition were also examined. Results A total of 9,845 patients were admitted to the trauma service between 2007 and 2014, and a total of 2,512 (25.5%) patients fit the inclusion criteria and had both admission and peak values available. One-hundred twenty (4.6%) died while in the hospital. RDW values for all patients were (mean [standard deviation, SD]): admission 14.09 (1.88), peak 15.09 (2.34), and Δ RDW 1.00 (1.44). Admission, peak, and Δ RDW were not significant predictors of mortality (all p>0.50; hazard ratio [HR], 1.01-1.03). However, trauma patients who eventually developed sepsis had significantly higher RDW values (admission RDW: 14.27 (2.02) sepsis vs. 13.98 (1.73) no sepsis, p<0.001; peak RDW: 15.95 (2.55) vs. 14.51 (1.97), p<0.001; Δ RDW: 1.68 (1.77) vs. 0.53 (0.91), p<0.001). Conclusion Admission, peak, and Δ RDW were not associated with in-hospital mortality in adult trauma patients with a length of stay (LOS) ≥four days. However, the development of sepsis in trauma patients is closely linked to increased RDW values and in-hospital mortality.
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Affiliation(s)
- McKenzie Brown
- Department of Surgery and Public Health Sciences , Loyola University Medical Center , Maywood , IL , USA
| | - Sean Nassoiy
- Department of Surgery and Public Health Sciences , Loyola University Medical Center , Maywood , IL , USA
| | - Timothy Plackett
- Department of Surgery and Public Health Sciences , Loyola University Medical Center , Maywood , IL , USA.,759th Forward Surgical Team , BLDG A-6631 Gorham Street , 28310-0001 Fort Bragg , NC , USA
| | - Fred Luchette
- Department of Surgery and Public Health Sciences , Loyola University Medical Center , Maywood , IL , USA.,Department of Surgery , Edward Hines Jr. Veterans Administration Hospital , Hines , IL , USA
| | - Joseph Posluszny
- Department of Surgery and Public Health Sciences , Loyola University Medical Center , Maywood , IL , USA
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Lesho E, McKeown A, Laguio-Vila M. The rationale for including osteopathic manipulative treatment in the management of infections: a hermeneutic review. Expert Rev Anti Infect Ther 2021; 20:23-31. [PMID: 34034598 DOI: 10.1080/14787210.2021.1935236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION As the prevalence of drug-resistant infections continues to outpace the development of new antibiotics, we must explore all reasonable options for enhancing the effectiveness of existing anti-infectives. The emergence of novel pathogens without initial drug treatments or vaccines, typified by the severe acute respiratory syndrome coronavirus-2 pandemic, further underscores the need for non-pharmacologic adjunctive measures for infection management. Osteopathic manipulative treatment (OMT) may represent such an adjunct. AREAS COVERED PubMed, CINAHL, Google Scholar, Cochrane databases and relevant chapters of major osteopathic texts were searched for animal experiments, case reports, observational studies, non-randomized, and randomized trials pertaining to infection, OMT, and the complications or safety of OMT. OMT was associated with one or more of the following: decreased bacterial colony counts in lung tissue; changes in immunologic profiles manifested by significant differences dendritic cells and levels of IL-8, MCP-1, MIP-1a, and G-CSF; shorter durations of IV antibiotics; decreased length of hospitalization; decreased rates of respiratory failure and death; decreased post-surgical lengths of stay; and enhanced patient satisfaction. EXPERT OPINION Preliminary, lower-grade evidence suggests that OMT can improve some infection-related outcomes, and is safe. The role of OMT in infection management should undergo further controlled trials without delay.
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Affiliation(s)
- Emil Lesho
- Healthcare Epidemiologist and Infectious Diseases Physician, Infectious Diseases Department, Rochester Regional Health, Rochester, NY, USA
| | - Allison McKeown
- Resident, Family Medicine, University of Rochester/Highland Hospital, NY, USA
| | - Maryrose Laguio-Vila
- Chief of Infectious Diseases, Infectious Diseases Department, Rochester Regional Health, Rochester, NY, USA
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Adly AS, Adly MS, Adly AS. Telemanagement of Home-Isolated COVID-19 Patients Using Oxygen Therapy With Noninvasive Positive Pressure Ventilation and Physical Therapy Techniques: Randomized Clinical Trial. J Med Internet Res 2021; 23:e23446. [PMID: 33819166 PMCID: PMC8080964 DOI: 10.2196/23446] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/25/2020] [Accepted: 04/01/2021] [Indexed: 12/21/2022] Open
Abstract
Background With the growing stress on hospitals caused by the COVID-19 pandemic, the need for home-based solutions has become a necessity to support these overwhelmed hospitals. Objective The goal of this study was to compare two nonpharmacological respiratory treatment methods for home-isolated COVID-19 patients using a newly developed telemanagement health care system. Methods In this single-blinded randomized clinical trial, 60 patients with stage 1 pneumonia caused by SARS-CoV-2 infection were treated. Group A (n=30) received oxygen therapy with bilevel positive airway pressure (BiPAP) ventilation, and Group B (n=30) received osteopathic manipulative respiratory and physical therapy techniques. Arterial blood gases of PaO2 and PaCO2, pH, vital signs (ie, temperature, respiratory rate, oxygen saturation, heart rate, and blood pressure), and chest computed tomography scans were used for follow-up and for assessment of the course and duration of recovery. Results Analysis of the results showed a significant difference between the two groups (P<.05), with Group A showing shorter recovery periods than Group B (mean 14.9, SD 1.7 days, and mean 23.9, SD 2.3 days, respectively). Significant differences were also observed between baseline and final readings in all of the outcome measures in both groups (P<.05). Regarding posttreatment satisfaction with our proposed telemanagement health care system, positive responses were given by most of the patients in both groups. Conclusions It was found that home-based oxygen therapy with BiPAP can be a more effective prophylactic treatment approach than osteopathic manipulative respiratory and physical therapy techniques, as it can impede exacerbation of early-stage COVID-19 pneumonia. Telemanagement health care systems are promising methods to help in the pandemic-related shortage of hospital beds, as they showed reasonable effectiveness and reliability in the monitoring and management of patients with early-stage COVID-19 pneumonia. Trial Registration ClinicalTrials.gov NCT04368923; https://clinicaltrials.gov/ct2/show/NCT04368923
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Affiliation(s)
- Aya Sedky Adly
- Faculty of Computers and Artificial Intelligence, Helwan University, Cairo, Egypt.,Faculty of Engineering and Technology, Badr University in Cairo (BUC), Cairo, Egypt
| | - Mahmoud Sedky Adly
- Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt.,Royal College of Surgeons of Edinburgh, Scotland, United Kingdom
| | - Afnan Sedky Adly
- Faculty of Physical Therapy, Cardiovascular-Respiratory Disorders and Geriatrics, Laser Applications in Physical Medicine, Cairo University, Cairo, Egypt.,Faculty of Physical Therapy, Internal Medicine, Beni-Suef University, Beni-Suef, Egypt
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Chow N, Hogg-Johnson S, Mior S, Cancelliere C, Injeyan S, Teodorczyk-Injeyan J, Cassidy JD, Taylor-Vaisey A, Côté P. Assessment of Studies Evaluating Spinal Manipulative Therapy and Infectious Disease and Immune System Outcomes: A Systematic Review. JAMA Netw Open 2021; 4:e215493. [PMID: 33847753 PMCID: PMC8044731 DOI: 10.1001/jamanetworkopen.2021.5493] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Claims that spinal manipulative therapy (SMT) can improve immune function have increased substantially during the COVID-19 pandemic and may have contributed to the rapid spread of both accurate and inaccurate information (referred to as an infodemic by the World Health Organization). OBJECTIVE To identify, appraise, and synthesize the scientific literature on the efficacy and effectiveness of SMT in preventing the development of infectious disease or improving disease-specific outcomes in patients with infectious disease and to examine the association between SMT and selected immunological, endocrine, and other physiological biomarkers. EVIDENCE REVIEW A literature search of MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, the Index to Chiropractic Literature, the Cochrane Central Register of Controlled Trials, and Embase was conducted from inception to April 15, 2020. Randomized clinical trials and cohort studies were included. Eligible studies were critically appraised, and evidence with high and acceptable quality was synthesized using the Synthesis Without Meta-Analysis guideline. FINDINGS A total of 2593 records were retrieved; after exclusions, 50 full-text articles were screened, and 16 articles reporting the findings of 13 studies comprising 795 participants were critically appraised. The literature search found no clinical studies that investigated the efficacy or effectiveness of SMT in preventing the development of infectious disease or improving disease-specific outcomes among patients with infectious disease. Eight articles reporting the results of 6 high- and acceptable-quality RCTs comprising 529 participants investigated the effect of SMT on biomarkers. Spinal manipulative therapy was not associated with changes in lymphocyte levels or physiological markers among patients with low back pain or participants who were asymptomatic compared with sham manipulation, a lecture series, and venipuncture control groups. Spinal manipulative therapy was associated with short-term changes in selected immunological biomarkers among asymptomatic participants compared with sham manipulation, a lecture series, and venipuncture control groups. CONCLUSIONS AND RELEVANCE In this systematic review of 13 studies, no clinical evidence was found to support or refute claims that SMT was efficacious or effective in changing immune system outcomes. Although there were limited preliminary data from basic scientific studies suggesting that SMT may be associated with short-term changes in immunological and endocrine biomarkers, the clinical relevance of these findings is unknown. Given the lack of evidence that SMT is associated with the prevention of infectious diseases or improvements in immune function, further studies should be completed before claims of efficacy or effectiveness are made.
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Affiliation(s)
- Ngai Chow
- Centre for Disability Prevention and Rehabilitation, Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Sheilah Hogg-Johnson
- Centre for Disability Prevention and Rehabilitation, Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Silvano Mior
- Centre for Disability Prevention and Rehabilitation, Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Carol Cancelliere
- Centre for Disability Prevention and Rehabilitation, Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Stephen Injeyan
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | | | - J. David Cassidy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anne Taylor-Vaisey
- Centre for Disability Prevention and Rehabilitation, Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Pierre Côté
- Centre for Disability Prevention and Rehabilitation, Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Marin T, Maxel X, Robin A, Stubbe L. The importance of epistemological consideration in the reporting of evidence for osteopathic care in Covid-19 papers. Explore (NY) 2021; 17:186-187. [PMID: 33820738 PMCID: PMC7905373 DOI: 10.1016/j.explore.2021.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Thibault Marin
- ESO Paris Recherche, Ecole Supérieure d'Ostéopathie, Cité Descartes, 77420 Champs sur Marne, France; Laboratoire Performance, Santé, Métrologie, Société (PSMS, EA 7507), UFR STAPS, Campus Moulin de la Housse, Université de Reims Champagne-Ardenne, Chemin des rouliers, 51100 Reims, France
| | - Xuan Maxel
- ESO Paris Recherche, Ecole Supérieure d'Ostéopathie, Cité Descartes, 77420 Champs sur Marne, France.
| | - Alexandra Robin
- ESO Paris Recherche, Ecole Supérieure d'Ostéopathie, Cité Descartes, 77420 Champs sur Marne, France
| | - Laurent Stubbe
- ESO Paris Recherche, Ecole Supérieure d'Ostéopathie, Cité Descartes, 77420 Champs sur Marne, France
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Marin T, Maxel X, Robin A, Stubbe L. Evidence-based assessment of potential therapeutic effects of adjunct osteopathic medicine for multidisciplinary care of acute and convalescent COVID-19 patients. Explore (NY) 2020; 17:141-147. [PMID: 33158784 PMCID: PMC7516474 DOI: 10.1016/j.explore.2020.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/12/2020] [Accepted: 09/13/2020] [Indexed: 12/28/2022]
Abstract
Although the COVID-19 pandemic affects predominantly the respiratory function, epidemiological studies show that multiple systems can be affected. The severe complications of SARS-CoV-2 infection seem to be induced by an inflammatory dysregulation (“cytokine storm”), which can also induce an immunodepression. Several studies highlight beneficial effects of osteopathic medicine on inflammation and immune regulation. A careful review of evidence-based literature brings to the fore significant improvements of osteopathic manipulative treatment (OMT) in adjunction to conventional care. OMT can improve the condition of infected patients by decreasing symptoms and boosting the efficiency of conventional care. OMT might also benefit surviving patients by reducing the long-lasting consequences of the infection as well as improving their quality of life during convalescence. This review should constitute an argument in favor of multidisciplinary care, although further biological and clinical research is essential to better assess the potential beneficial contributions of adjunct osteopathic medicine to conventional care in the fight against pandemics such as COVID-19.
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Affiliation(s)
- Thibault Marin
- ESO Paris Recherche, Ecole Supérieure d'Ostéopathie, Cité Descartes, 77420 Champs sur Marne, France; Laboratoire Performance, Santé, Métrologie, Société (PSMS, EA 7507), UFR STAPS, Campus Moulin de la Housse, Université de Reims Champagne-Ardenne, Chemin des Rouliers, 51100 Reims, France
| | - Xuan Maxel
- ESO Paris Recherche, Ecole Supérieure d'Ostéopathie, Cité Descartes, 77420 Champs sur Marne, France.
| | - Alexandra Robin
- ESO Paris Recherche, Ecole Supérieure d'Ostéopathie, Cité Descartes, 77420 Champs sur Marne, France
| | - Laurent Stubbe
- ESO Paris Recherche, Ecole Supérieure d'Ostéopathie, Cité Descartes, 77420 Champs sur Marne, France
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15
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Hosono S, Fujita K, Nimura A, Akita K. Release of cervical muscular tension improved severe pruritus in moderate-to-severe atopic dermatitis: A case series. JAAD Case Rep 2020; 6:510-513. [PMID: 32490112 PMCID: PMC7256226 DOI: 10.1016/j.jdcr.2020.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Key Words
- AD, atopic dermatitis
- AEC, absolute eosinophil counts
- DLQI, Dermatology Life Quality Index
- EASI, eczema area severity index
- LDH, lactate dehydrogenase
- OMT, osteopathic manipulative treatment
- ROM, range of motion
- TARC, serum thymus and activation-regulated chemokine
- VAS, visual analog scale
- atopic dermatitis
- cervical muscular tension
- complementary and alternative therapy
- pruritus
- sIGA, static Investigator's Global Assessment
- stressor
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Affiliation(s)
- Shusaku Hosono
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Hosono Clinic, Tokyo, Japan
| | - Koji Fujita
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akimoto Nimura
- Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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16
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Abstract
Historically, osteopathic principles have focused on the appropriate drainage of cranial structures to relieve symptoms of rhinitis, which include nasal congestion, anterior/posterior rhinorrhea, sneezing, and itching. Allergic rhinitis is primarily an aberrant immunologic reaction caused by cytokines secreted from lymphocytes that traverse the lymphatic pathway throughout the body. Several studies have documented that, when manipulated, the lymphatic system enhanced the motion of these lymphocytes to important immune structures in both human and animal models. Additionally, modulation of both sympathetic and parasympathetic outflow has been found either to inhibit or enhance secretion and/or drainage of important allergic sites. Osteopathic approaches to rhinitis play an effective role in the comprehensive management of rhinitis, and techniques based on these approaches are therapeutic options for rhinitis. This article provides an up-to-date literature review about the management of rhinitis using the 5 models of osteopathic medicine: biomechanical, respiratory-circulatory, metabolic, neurologic, and behavioral.
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Bicalho E, Vieira L, Makita DK, Rivas L. Inhibitory Tests as Assessment Tools for Somatic Dysfunctions: Mechanisms and Practical Applications. Cureus 2020; 12:e7700. [PMID: 32431979 PMCID: PMC7233498 DOI: 10.7759/cureus.7700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The capital element in the field of osteopathy and several other manual therapy methods, is the somatic dysfunction (SD), a functional imbalance that can involve different tissues and mechanisms in its genesis and maintenance. The main challenges found in the clinical scope are to understand the interaction, hierarchy, and relevance of the SD. Several manual tests are available to functionally evaluate the SD, each one with its applicability to analyze the different parameters of the SD. The so-called inhibitory tests are a category of functional manual tests that can be added to the diagnostic context of the SD. It is a particular type of test in which the evaluator applies manual mechanical stimuli to dysfunctional tissues and assesses the biological responses that occur simultaneously with the application of the stimulus. Its use can consider biomechanical and neurological principles in such a way that different conditions can be analyzed. The objective of this article is to review well-established knowledge and recent scientific discoveries about the SD and its local and global repercussions, in an attempt to offer ideas that can be applied to better understand the mechanisms that imply the use of inhibitory tests as complementary clinical diagnostic tools. It will be discussed some of the possible mechanisms involved in the physiology of the inhibitory tests, their practical applications in some distinct conditions, as well as new proposals of utilization based on the sensitization of metameric related structures under a dysfunctional state.
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Affiliation(s)
| | - Leonardo Vieira
- Osteopathy, Brazilian Academy of Fascias, Belo Horizonte, BRA
| | - Daniel K Makita
- Osteopathy, Brazilian Academy of Fascias, Belo Horizonte, BRA
| | - Luis Rivas
- Osteopathy, Osteopathy School Germany, Hamburg, DEU
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18
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Dixon L, Fotinos K, Sherifi E, Lokuge S, Fine A, Furtado M, Anand L, Liberatore K, Katzman MA. Effect of Osteopathic Manipulative Therapy on Generalized Anxiety Disorder. J Osteopath Med 2020; 120:133-143. [PMID: 32091557 DOI: 10.7556/jaoa.2020.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Context Traditional management options for generalized anxiety disorder (GAD) have produced low remission rates. As a result, the medical community has turned to complementary and alternative medicine for adjunctive treatment. Objective To investigate the efficacy of adjunctive osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) in individuals with GAD. Methods This open-label, nonrandomized, black-box study took place at a tertiary care mental health clinic in Toronto, Canada. Adult outpatient participants aged 18 to 65 years with a primary diagnosis of moderate-severe GAD (HAM-A score of ≥20) with or without comorbidities were enrolled in the study between June 2014 and January 2015. Patients who qualified and completed the study received 5 individually tailored OMTh sessions over the course of 8 to 9 weeks. A diagnostic psychiatric assessment (Mini International Neuropsychiatric Interview version 6.0.0) was conducted to confirm diagnoses, along with physician-administered and self-reported measures of anxiety, including the Hamilton Anxiety Scale (HAM-A), the Beck Anxiety Inventory, and the Intolerance for Uncertainty Scale. Results Significant reductions in total HAM-A scores after OMTh were observed (P<.0001). Significant reductions in total Intolerance for Uncertainty Scale scores were also observed (P<.0001). Beck Anxiety Inventory scores were not found to change significantly with OMTh. Response (defined as 50% reduction of symptoms) and remission (defined as HAM-A score of ≤7) rates were found to be 62% and 26.9%, respectively. Conclusion Osteopathic manipulative therapy may be a valuable adjunct to conventional therapy in patients with GAD, thus warranting further investigation using double-blind procedures.
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Nuño V, Siu A, Deol N, Juster RP. Osteopathic Manipulative Treatment for Allostatic Load Lowering. J Osteopath Med 2019; 119:646-654. [PMID: 31566692 DOI: 10.7556/jaoa.2019.112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Context Limited research has been done to examine osteopathic manipulative treatment (OMT) effects on modulating a compilation of allostatic load (AL) biomarkers that work to measure the body's multisystem response to homeostatic deviation. Objective To examine the efficacy of OMT on graduate students' overall health through an objective index of representative AL biomarkers. Methods A within-subject pre- and postintervention study was conducted at Touro University College of Osteopathic Medicine in California during the fall 2017 semester. Graduate students enrolled in the Masters of Science in Medical Health Sciences program volunteered to participate in the study and received treatment by an osteopathic physician. The participants were evaluated using the following measures: Trier Inventory for the Assessment of Chronic Stress; diurnal urine cortisol and catecholamines; dried blood glycated hemoglobin, dehydroepiandrosterone, high-density lipoprotein, and high-sensitivity C-reactive protein; blood pressure, body mass index, and waist-to-hip ratio before (preintervention) and after (postintervention) OMT. Results The study consisted of 1 man (participant 1) and 1 woman (participant 2) aged 23 and 22 years, respectively. Participants were enrolled in the same academic program and received 3 OMT sessions in 7 weeks. Analysis of AL biomarkers revealed a decrease in overall AL scores from preintervention to postintervention in participant 1 (from 7 to 4) and participant 2 (from 9 to 7). Analysis of Trier Inventory for the Assessment of Chronic Stress scores revealed a decrease in self-perceived stress from preintervention to postintervention in participant 1 (from 18 to 15) and in participant 2 (from 40 to 13). Conclusion The OMT protocol used in the current study decreased measures of overall AL and self-perceived stress in both participants. This finding suggests that OMT may represent a reasonable modality to reduce AL and self-perceived stress in graduate students. Since the current study is limited by its small sample size, further research is warranted.
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21
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Bordoni B, Simonelli M, Morabito B. The Other Side of the Fascia: Visceral Fascia, Part 2. Cureus 2019; 11:e4632. [PMID: 31312558 PMCID: PMC6623997 DOI: 10.7759/cureus.4632] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/10/2019] [Indexed: 12/15/2022] Open
Abstract
In osteopathic clinical practice and in the teaching of osteopathic medicine, the visceral manipulation approach is included. The knowledge that some viscera satisfy the definition of fascial tissue will allow the osteopath to improve its practice. In the second part of the article, we will give a conclusive definition of fascia, and we will explain the embryological development of the heart and how the fascial tissue can be subject to manual treatment. This text is the first in the international scientific field that discusses the inclusion of some viscera in the context of what is considered fascia, through our committee for the definition and nomenclature of the fascial tissue of the Foundation of Osteopathic Research and Clinical Endorsement (FORCE).
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Affiliation(s)
- Bruno Bordoni
- Cardiology, Foundation Don Carlo Gnocchi, Milan, ITA
| | | | - Bruno Morabito
- Osteopathy, School of Osteopathic Centre for Research and Studies, Milan, ITA
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22
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Noll DR. The Potential of Osteopathic Manipulative Treatment in Antimicrobial Stewardship: A Narrative Review. J Osteopath Med 2017; 116:600-8. [PMID: 27571297 DOI: 10.7556/jaoa.2016.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The contemporary management of infectious diseases is built around antimicrobial therapy. However, the development of antimicrobial resistance threatens to create a post-antibiotic era. Antimicrobial stewardship attempts to reduce the development of antimicrobial resistance by improving their appropriate use. Osteopathic manipulative treatment as an adjunctive treatment has the potential for enhancing antimicrobial stewardship by enhancing the human immune system, shortening the duration of antimicrobial therapy, reducing complications, and improving treatment outcomes. The present article reviews the evidence published in the literature since this unique treatment approach was first developed more than 100 years ago. The evidence suggests that adjunctive osteopathic manipulative treatment has great potential for enhancing antimicrobial stewardship and should be further investigated.
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Lanaro D, Ruffini N, Manzotti A, Lista G. Osteopathic manipulative treatment showed reduction of length of stay and costs in preterm infants: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e6408. [PMID: 28328840 PMCID: PMC5371477 DOI: 10.1097/md.0000000000006408] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Osteopathic medicine is an emerging and complementary method used in neonatology. METHODS Outcomes were the mean difference in length of stay (LOS) and costs between osteopathy and alternative treatment group. A comprehensive literature search of (quasi)- randomized controlled trials (RCTs), was conducted from journal inception to May, 2015. Eligible studies must have treated preterm infants directly in the crib or bed and Osteopathic Manipulative Treatment (OMT) must have been performed by osteopaths. A rigorous Cochrane-like method was used for study screening and selection, risk of bias assessment and data reporting. Fixed effect meta-analysis was performed to synthesize data. RESULTS 5 trials enrolling 1306 infants met our inclusion criteria. Although the heterogeneity was moderate (I = 61%, P = 0.03), meta-analysis of all five studies showed that preterm infants treated with OMT had a significant reduction of LOS by 2.71 days (95% CI -3.99, -1.43; P < 0.001). Considering costs, meta-analysis showed reduction in the OMT group (-1,545.66&OV0556;, -1,888.03&OV0556;, -1,203.29&OV0556;, P < 0.0001). All studies reported no adverse events associated to OMT. Subgroup analysis showed that the benefit of OMT is inversely associated to gestational age. CONCLUSIONS The present systematic review showed the clinical effectiveness of OMT on the reduction of LOS and costs in a large population of preterm infants.
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Affiliation(s)
- Diego Lanaro
- Clinical-based Human Research Department, C.O.ME. Collaboration
| | - Nuria Ruffini
- Clinical-based Human Research Department, C.O.ME. Collaboration
| | | | - Gianluca Lista
- NICU-“V.Buzzi”-Ospedale dei Bambini-ASST-FBF-Sacco-Milan-Italy
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24
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McGlone F, Cerritelli F, Walker S, Esteves J. The role of gentle touch in perinatal osteopathic manual therapy. Neurosci Biobehav Rev 2016; 72:1-9. [PMID: 27845175 DOI: 10.1016/j.neubiorev.2016.11.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/22/2016] [Accepted: 11/09/2016] [Indexed: 12/31/2022]
Abstract
Osteopathic medicine is a system of manual diagnosis and treatment. While there is growing evidence that osteopathy is effective in a range of clinical conditions, the underlying biological basis of its therapeutic effects remain largely unknown. Given that the sense of touch plays a critical role in osteopathy, in this perspective article, with a particular focus on perinatal care, we explore the potential mechanisms by which stimulation of the skin senses can exert beneficial physiological and psychological effects, aiding growth and development. We propose that a class of low threshold mechanosensitive c-fibre, named c-tactile afferents, which respond optimally to gentle, slow moving touch are likely to play a direct and significant role in the efficacy of manual therapies. A greater understanding of the impact the type and quality of touch plays in therapeutic tactile interventions and in particular the neuroscience underpinning these effects will aid the development of more targeted, population specific interventions.
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Affiliation(s)
- Francis McGlone
- Research Centre for Brain & Behaviour, School of Natural Sciences & Psychology, Liverpool John Moores University, Liverpool, L3 3AF, UK; Institute of Psychology, Health and Society, University of Liverpool, UK.
| | - Francesco Cerritelli
- Department of Neuroscience and Imaging, University of Chieti-Pescara, Italy; Clinical-based Human Research Department, Centre for Osteopathic Medicine Collaboration, Pescara, Italy.
| | - Susannah Walker
- Research Centre for Brain & Behaviour, School of Natural Sciences & Psychology, Liverpool John Moores University, Liverpool, L3 3AF, UK.
| | - Jorge Esteves
- British School of Osteopathy, London, UK; Clinical-based Human Research Department, Centre for Osteopathic Medicine Collaboration, Pescara, Italy; Instituto Piaget, Lisbon, Portugal.
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D'Alessandro G, Cerritelli F, Cortelli P. Sensitization and Interoception as Key Neurological Concepts in Osteopathy and Other Manual Medicines. Front Neurosci 2016; 10:100. [PMID: 27013961 PMCID: PMC4785148 DOI: 10.3389/fnins.2016.00100] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/26/2016] [Indexed: 11/13/2022] Open
Abstract
Historically, approaches used in manual medicine to explain patient reported symptoms have been focused on the so-called exteroceptive paradigm. Arguably, this mindset lacks an appropriate "reading system" able to interpret musculoskeletal disorders from a different perspective, where the properties of the nervous system are embraced into a more holistic and functional-related context. Interestingly, if the underpinning mechanisms of a given treatment scenario/effect are taking into account, the majority of research outcomes focuses on a proprioceptive/exteroceptive explanation, leaving ting aside the additional or even central role of interoception. Currently, to date, the application of theoretical knowledge acquired on the relatively recent neuroscientific concepts and evidence concerning of interoception, sensitization, touch, autonomic functions, inflammation, and pain into a clinical/research manual medicine scenario is lacking, even if theoretically, the impact on the possible etiological mechanisms and treatment effects seems to be important. Here, we propose the conceptual foundations for a new way of interpreting and reading patients' clinical reported outcomes scenario based on interoception and sensitization. We argue that this will provide a foundation to create the ground for future research focusing on the hypotheses that manual therapies, specifically osteopathy, can intercede with sensitization states, at all levels, using interoceptive pathways.
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Affiliation(s)
- Giandomenico D'Alessandro
- Clinical-based Human Research Department, Centre for Osteopathic Medicine CollaborationPescara, Italy; Accademia Italiana Osteopatia TradizionalePescara, Italy
| | - Francesco Cerritelli
- Clinical-based Human Research Department, Centre for Osteopathic Medicine CollaborationPescara, Italy; Department of Neuroscience, Imaging and Clinical Sciences "G. D'Annunzio" University of Chieti-PescaraPescara, Italy; ITAB-Institute for Advanced Biomedical Technologies, "G. D'Annunzio" University of Chieti-PescaraPescara, Italy
| | - Pietro Cortelli
- Department of Biomedical and Neuromotor Sciences, Bellaria Hospital, University of BolognaBologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, AUSL di BolognaBologna, Italy
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