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Irving R, Schmidt E, Stone M, Fleming RK, Xie JY. Meta-epidemiologic review: blinding and sham treatment in clinical trial design for osteopathic manipulative treatment research. INT J OSTEOPATH MED 2024; 51:100705. [PMID: 38312536 PMCID: PMC10836155 DOI: 10.1016/j.ijosm.2023.100705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
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.
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Affiliation(s)
- Richard Irving
- Department of Basic Sciences, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR, USA
| | - Emma Schmidt
- Department of Basic Sciences, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR, USA
| | - Michaela Stone
- Biology Department, Arkansas Biosciences Institute, Arkansas State University, Jonesboro, AR, USA
| | - Regina K. Fleming
- Department of Osteopathic Manipulative Medicine, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR, USA
| | - Jennifer Yanhua Xie
- Department of Basic Sciences, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR, USA
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Sposato Sinderholm N, Bjerså K. Manual therapies in cystic fibrosis care: a scoping review. Chiropr Man Therap 2023; 31:7. [PMID: 36747207 PMCID: PMC9903555 DOI: 10.1186/s12998-023-00478-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/22/2023] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES To review the use of manual therapies (MT) for pain, respiratory muscle strength and pulmonary function in cystic fibrosis (CF) care. METHODS A search with a systematic approach was conducted by two independent reviewers, using the databases Medline, PubMed, Scopus and Cinahl from their respective inception dates to March 2021. RESULTS A total of 199 publications were initially screened by title and abstract, after which 190 were excluded. Following a full-text review of the remaining articles, six studies with a total of 234 participants were included. Decreased pain levels following MT were observed in two studies and, in three studies, patient reports on improvement in ease of breathing and peak airflow were presented. No significant effects on spirometry measures were observed and none of the included studies investigated respiratory muscle strength. CONCLUSION Current research on MT in CF care indicates positive trends based on subjective measures. However, research in this context is sparse and disparate in terms of both interventions and methodology. Further investigations including MT as part of multimodal interventions are therefore suggested before any specific recommendations for clinical implementation of MT in CF can be provided.
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Affiliation(s)
- Niklas Sposato Sinderholm
- grid.8761.80000 0000 9919 9582Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - Kristofer Bjerså
- Department of Surgery, Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden.
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Hoffmann AT, Dillenhöfer S, Lücke T, Maier C, Brinkmann F. [The challenges of managing thoracic pain in cystic fibrosis (CF)]. Schmerz 2022; 36:422-428. [PMID: 34762202 PMCID: PMC9674729 DOI: 10.1007/s00482-021-00603-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) is a rare genetic multisystemic disorder with progressive abdominal and pulmonary involvement. Pain is still an underestimated symptom in CF patients. METHODS A comprehensive review of guidelines and scientific literature on the topic was performed and combined with findings from pain management in a young CF patient with progressive thoracic pain. RESULTS German CF guidelines do not cover diagnosis and management of pain in these patients. Studies from Europe and the United States report interactions between intensity of pain and mortality in CF, but do not include data on the efficacy of pain management. These data and clinical observations of a CF patient with episodes of intense thoracic pain are used to illustrate the specific challenges in pain relief. CONCLUSION Pain management in CF requires meticulous monitoring as well as an interdisciplinary approach and should be implemented in the German CF guidelines. The authors also want to suggest recommendations for the treatment of thoracic pain in CF. The range and severity of organ involvement complicates the use both of opioids and non-opioids. Especially opioid treatment carries the risk of hypoxia and opioid-induced constipation (OIC) and needs close medical supervision.
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Affiliation(s)
- A T Hoffmann
- Universitätsklinik für Kinder- und Jugendmedizin, Ruhr-Universität Bochum, Alexandrinenstraße 5, 44791, Bochum, Deutschland
| | - S Dillenhöfer
- Universitätsklinik für Kinder- und Jugendmedizin, Ruhr-Universität Bochum, Alexandrinenstraße 5, 44791, Bochum, Deutschland
| | - T Lücke
- Universitätsklinik für Kinder- und Jugendmedizin, Ruhr-Universität Bochum, Alexandrinenstraße 5, 44791, Bochum, Deutschland
| | - C Maier
- Universitätsklinik für Kinder- und Jugendmedizin, Ruhr-Universität Bochum, Alexandrinenstraße 5, 44791, Bochum, Deutschland
| | - F Brinkmann
- Universitätsklinik für Kinder- und Jugendmedizin, Ruhr-Universität Bochum, Alexandrinenstraße 5, 44791, Bochum, Deutschland.
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D'Alessandro G, Ruffini N, Iacopini A, Annoni M, Kossowsky J, Cerritelli F. Overcoming placebo-related challenges in manual therapy trials: The ‘whats and hows’ and the ‘touch equality assumption’ proposals. INT J OSTEOPATH MED 2021. [DOI: 10.1016/j.ijosm.2021.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Santiago RJ, Esteves J, Baptista JS, Marques AT, Costa JT. Instrumentation used to assess pain in osteopathic interventions: A critical literature review. INT J OSTEOPATH MED 2020. [DOI: 10.1016/j.ijosm.2020.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Alvarez Bustins G, López Plaza PV, Carvajal SR. Profile of osteopathic practice in Spain: results from a standardized data collection study. Altern Ther Health Med 2018; 18:129. [PMID: 29642901 PMCID: PMC5896131 DOI: 10.1186/s12906-018-2190-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 03/26/2018] [Indexed: 12/28/2022]
Abstract
Background There is limited research regarding patients’ profiles and consumer attitudes and habits of osteopathy in Spain. The purpose of this study was to profile patients who regularly receive osteopathic care in Spain using an internationally developed standardized data collection tool. Method During the period between April 2014 and December 2015, a UK-developed standardized data collection tool was distributed to Spanish osteopaths who voluntarily agreed to participate in this cross-sectional study. Results Thirty-six osteopaths participated in this study and returned a total of 314 completed datasets. Of 314 patients, 61% were women and 39% were men, with a mean age of 40 years (SD 17.02 years, range 0 to 83 years). Forty-four percent were full-time salaried workers, and in 78% of cases, receiving osteopathic treatment was the patient’s own choice. Chronic spinal pain presentations were the most frequent reasons for consultation. Seventy-five percent of patients presented with a coexisting condition, mainly gastrointestinal disorders and headaches. The main treatment approach consisted of mobilization techniques, followed by soft tissue, cranial and high velocity thrust techniques. Improvement or resolution of the complaint was experienced by 93% of patients after a small number of sessions. Adverse events were minor and occurred in 7% of all cases. Conclusion This is the first study carried out in Spain analyzing the profile of patients who receive osteopathic care. The typical patient who receives osteopathic care in Spain is middle-aged, presents mainly with chronic spinal pain, and voluntarily seeks osteopathic treatment. Osteopathic treatment produces a significant improvement in the majority of cases with a low rate of minor adverse events reported. Electronic supplementary material The online version of this article (10.1186/s12906-018-2190-0) contains supplementary material, which is available to authorized users.
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Cerritelli F, Verzella M, Cicchitti L, D’Alessandro G, Vanacore N. The paradox of sham therapy and placebo effect in osteopathy: A systematic review. Medicine (Baltimore) 2016; 95:e4728. [PMID: 27583913 PMCID: PMC5008597 DOI: 10.1097/md.0000000000004728] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Placebo, defined as "false treatment," is a common gold-standard method to assess the validity of a therapy both in pharmacological trials and manual medicine research where placebo is also referred to as "sham therapy." In the medical literature, guidelines have been proposed on how to conduct robust placebo-controlled trials, but mainly in a drug-based scenario. In contrast, there are not precise guidelines on how to conduct a placebo-controlled in manual medicine trials (particularly osteopathy). The aim of the present systematic review was to report how and what type of sham methods, dosage, operator characteristics, and patient types were used in osteopathic clinical trials and, eventually, assess sham clinical effectiveness. METHODS A systematic Cochrane-based review was conducted by analyzing the osteopathic trials that used both manual and nonmanual placebo control. Searches were conducted on 8 databases from journal inception to December 2015 using a pragmatic literature search approach. Two independent reviewers conducted the study selection and data extraction for each study. The risk of bias was evaluated according to the Cochrane methods. RESULTS A total of 64 studies were eligible for analysis collecting a total of 5024 participants. More than half (43 studies) used a manual placebo; 9 studies used a nonmanual placebo; and 12 studies used both manual and nonmanual placebo. Data showed lack of reporting sham therapy information across studies. Risk of bias analysis demonstrated a high risk of bias for allocation, blinding of personnel and participants, selective, and other bias. To explore the clinical effects of sham therapies used, a quantitative analysis was planned. However, due to the high heterogeneity of sham approaches used no further analyses were performed. CONCLUSION High heterogeneity regarding placebo used between studies, lack of reporting information on placebo methods and within-study variability between sham and real treatment procedures suggest prudence in reading and interpreting study findings in manual osteopathic randomized controlled trials (RCTs). Efforts must be made to promote guidelines to design the most reliable placebo for manual RCTs as a means of increasing the internal validity and improve external validity of findings.
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Affiliation(s)
- Francesco Cerritelli
- Clinical-based Human Research Department, COME Collaboration, Pescara
- Department of Neuroscience, Imaging and Clinical Sciences
- Institute for Advanced Biomedical Technologies (ITAB), “G. d’Annunzio” University of Chieti-Pescara, Chieti
- Correspondence: Francesco Cerritelli, COME Collaboration ONLUS, Via Vespucci 188, Pescara 65126, Italy (e-mail: )
| | - Marco Verzella
- Clinical-based Human Research Department, COME Collaboration, Pescara
- Accademia Italiana Osteopatia Tradizionale, Pescara
| | - Luca Cicchitti
- Clinical-based Human Research Department, COME Collaboration, Pescara
- Accademia Italiana Osteopatia Tradizionale, Pescara
| | - Giandomenico D’Alessandro
- Clinical-based Human Research Department, COME Collaboration, Pescara
- Accademia Italiana Osteopatia Tradizionale, Pescara
| | - Nicola Vanacore
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy
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Lee AL, Rawlings S, Bennett KA, Armstrong D. Pain and its clinical associations in individuals with cystic fibrosis: A systematic review. Chron Respir Dis 2016; 13:102-17. [PMID: 26873725 DOI: 10.1177/1479972316631135] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Pain is recognized as a clinical complication in cystic fibrosis (CF), but the prevalence, characteristics and clinical associations of this co-morbidity have not been systematically reviewed. Electronic searches of six databases were performed. For inclusion in phase 1, studies reported a pain prevalence rate in CF and/or its clinical associations. For phase 2, included studies reported the measurement properties of validity, reliability and responsiveness of an instrument assessing pain in CF. Two independent reviewers rated the quality of evidence (phase 1) and the measurement properties using the 4-point COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist (phase 2). Of the 400 studies identified in the literature, 16 met the inclusion criteria for phase 1 and 5 for phase 2. The mean (SD) quality score (of 16) was 11.8 (2.3). The pooled prevalence of pain in adults with CF was 77% (95% confidence interval (CI): 57%-92%) and in children was 42% (95% CI: 0%-91%). Common regions of pain included back, abdomen, chest and limbs. In children and adults, pain was associated with a poorer quality of life (QOL) and significant interference with treatments. Measurement properties of three instruments (Brief Pain Inventory, Multidimensional Pain Inventory, Daily Pain Assessment-CF) were construct validity and criterion-predictive validity, with variable findings based on 'fair' to 'good' quality studies. Pain is a common problem in both children and adults with CF. It has negative clinical associations with QOL and the ability to successfully undertake treatment. Further research exploring the measurement properties of instruments assessing pain is required.
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Affiliation(s)
- Annemarie L Lee
- West Park Healthcare Centre, Toronto, Ontario, Canada Institute for Breathing and Sleep, Victoria, Australia
| | | | | | - David Armstrong
- Monash Health, Victoria, Australia Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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