How Useful Is Osteopathic Manipulation for Low Back Pain?

Osteopathic manipulative treatment (OMT) may only have a small impact on reducing low back pain (LBP)-specific activity limitations, according to the results of a recent study.

To determine the efficacy of OMT for treating patients with nonspecific subacute and chronic LBP, a prospective, parallel-group, single-blind, single-center, sham-controlled, randomized trial was conducted.

The trial utilized patients from a tertiary care center in France and ran from February 2014 to October 2017. Included were 400 participants who were randomly assigned to complete standard OMT or sham OMT every 2 weeks for a total of 6 sessions.

The primary outcome of this study was the mean reduction in LBP-specific activity limitations following treatment at 3 months. The Quebec Back Pain Disability Index was self-administered to measure the primary end point.

Of the 197 participants analyzed in each group, the primary outcome data was available at 3 months for 83.2% (n = 164) of the participants in the standard OMT group and 80.7% (n = 159) of participants in the sham OMT group.

Overall, Quebec Back Pain Disability Index scores for the standard OMT group decreased from 31.5 at baseline to 25.3 at 3 months, while the sham OMT group only saw a decrease from 27.2 to 26.1. The mean reduction in LBP-specific activity limitations was −4.7 (95% CI, −6.6 to −2.8) for the standard OMT group, and 1.3 (95% CI, −3.3 to 0.6) for the sham OMT group, also at 3 months.

In addition, the mean difference in mean reduction in LBP-specific activity limitations at 12 months was −4.3 (95% CI, −7.6 to −1.0; P = .01) and the mean difference in mean reduction in pain was −1.0 (95% CI, −5.5 to 3.5; P = .66) at 3 months, and −2.0 (95% CI, −7.2 to 3.3; P = .47) at 12 months.

“In this randomized clinical trial of patients with nonspecific subacute or chronic LBP, standard OMT had a small effect on LBP-specific activity limitations vs sham OMT. However, the clinical relevance of this effect is questionable,” the researchers concluded.

—Leigh Precopio

Reference:

Nguyen C, Boutron I, Zegarra-Parodi R, et al. Effect of osteopathic manipulative treatment vs sham treatment on activity limitations in patient with nonspecific subacute and chronic low back pain: a randomized clinical trial. JAMA Intern Med. Published online March 15, 2021. http://doi.org/10.1001/jamainternmed.2021.0005