MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Did I previously imply that osteopaths are not very research-active? Shame on me!

Here are two brand-new studies by osteopaths and they both seem to show that their treatments work.

Impressed?

Well, perhaps we better have a closer look at them before we start praising osteopathic research efforts.

THE FIRST STUDY

Researchers from the ‘European Institute for Evidence Based Osteopathic Medicine’ in Chieti, Italy, investigated the effect of  osteopathic manipulative therapy (OMT) on the length of hospital-stay (LOHS) in premature infants. They conducted an RCT on 110 preterm newborns admitted to a single specialised unit. Thus the subjects with a gestational age between 28 and 38 weeks were randomized to receive either just routine care, or routine care with OMT for the period of hospitalization. Endpoints were differences in LOHS and daily weight gain. The results showed a mean difference in LOHS between the OMT and the control group: -5.906 days (95% C.I. -7.944, -3.869; p<0.001). However, OMT was not associated with any change in daily weight gain.

The authors’ conclusion was bold: OMT may have an important role in the management of preterm infants hospitalization.

THE SECOND STUDY

The second investigation suggested similarly positive effects of OMT on LOHS in a different setting. Using a retrospective cohort study, US osteopaths wanted to determine whether there is a relationship between post-operative use of OMT and post-operative outcomes in gastrointestinal surgical patients, including time to flatus, clear liquid diet, and bowel movement [all indicators for the length of the post-operative ileus] as well as LOHS. They thus assessed the records of 55 patients who underwent a major gastrointestinal operation in a hospital that had been routinely offering OMT to its patients. The analyses showed that 17 patients had received post-operative OMT and 38 had not.The two groups were similar in terms of all variables the researchers managed to assess. The time to bowel movement and to clear liquid diet did not differ significantly between the groups. The mean time to flatus was 4.7 days in the non-OMT group and 3.1 days in the OMT group (P=.035). The mean post-operative hospital LOHS was also reduced significantly with OMT, from 11.5 days in the non-OMT group to 6.1 days in the OMT group (P=.006).

The authors concluded that OMT applied after a major gastrointestinal operation is associated with decreased time to flatus and decreased postoperative hospital LOHS.

WHAT SHOULD WE MAKE OF THESE RESULTS?

Some people may have assumed that OMT is for bad backs; these two studies imply, however, that it can do much more. If the findings are correct, they have considerable implications: shortening the time patients have to spend in hospital would not only decrease individual suffering, it would also save us all tons of money! But do these results hold water?

The devil’s advocate in me cannot help but being more than a little sceptical. I fail to see how OMT might shorten LOHS; it just does not seem plausible! Moreover, some of the results seem too good to be true. Could there be any alternative explanations for the observed findings?

The first study, I think, might merely demonstrate that more time spent handling  premature babies provides a powerful developmental stimulus. Therefore the infants are quicker ready to leave hospital compared to those children who did not receive this additional boost. But the effect might not at all be related to OMT per se; if, for instance, the parents had handled their children for the same amount of time, the outcome would probably have been quite similar, possibly even better.

The second study is not an RCT and therefore it tells us little about cause and effect. We might speculate, for instance, that those patients who elected to have OMT were more active, had lived healthier lives, adhered more rigorously to a pre-operative diet, or differed in other variables from those patients who chose not to bother with OMT. Again, the observed difference in the duration of the post-operative ileus and consequently the LOHS would be entirely unrelated to OMT.

I suggest therefore to treat these two studies with more than just a pinch of salt. Before hospitals all over the world start employing osteopaths right, left and centre in order to shorten their average LOHS, we might be well advised to plan and conduct a trial that avoids the pitfalls of the research so far. I would bet a fiver that, once we do a proper independent replication, we will find that both investigations did, in fact, generate false positive results.

My conclusion from all this is simple: RESEARCH CAN SOMETIMES BE MISLEADING, AND POOR QUALITY RESEARCH IS ALMOST INVARIABLY MISLEADING.

10 Responses to Osteopathy seems to work wonders, it even shortens hospital stay !?!

  • I’m wondering if osteopaths in the UK can be compared to same here in the States? We are told that osteopathic medical schools now (not true in the past) operate identically to other medical schools–although they do offer the manipulative therapy training as far as I know, so I’m not sure how the claims can actually be true. What seems to be the case is that most who attend do so because they were accepted at the osteopathic school, not because they want to learn the manipulative therapy.

    However, even if this is true, how do I know the motivation of a D.O. when I encounter one. Recently, I had an untrasound test at a major medical center. The results were interpreted by a young woman with D.O. after her name. It made me a little uncomfortable, but I hesitated to confront her with questions that might seem unwarranted.

    I don’t know how the osteopaths of the UK compare to ours, so I wonder if you can clarify this? As far as I can tell, such a study would not be done here as most D.O’s do not use manipulative therapy. However, a few seem to advertise it widely and also have private practices that are “alternative” in other ways as well.

    • you are right: there are important differences between US and UK osteopaths. however, this does not affect the present 2 trials. they were of OMT and one was conducted in Italy, the other in the US.

      • I am extremely glad that I chose to train as a physiotherapist because the research analysis above shows that evidence will never change some people’s opinions.

        The process goes like this; 1) decide whether you agree with a study’s conclusions based on previous opinions 2) superficial reading of paper to look for weaknesses 3) dismiss results as implausible and invalid 4) maintain unchanged opinion.

        Trashing research papers is easy. Trisha Greenhalgh states that only 1% of medical research is without methodological flaws.

        The evidence-based approach to healthcare is apparently just as loaded with bias and belief as the opinion based approach. The above two research papers probably are flawed in some respects but even if they weren’t the conclusion would not have changed a jot.

      • I looked up OMT (Osteopathic Manipulative Therapy/treatment). It would seem that DO’s in UK are akin to Chiropractors in the US.

        I’m still not sure if I should confront a DO by asking point blank if (s)he includes the manipulation nonsense in his or her practice. I think I will–it seems fair.

  • Perhaps the following study is more relevant to Osteopaths practising outside the US?

    Osteopathic Manual Treatment and Ultrasound Therapy for Chronic Low Back Pain: A Randomized Controlled Trial

    Conclusion from study “The OMT regimen met or exceeded the Cochrane Back Review Group criterion for a medium effect size in relieving chronic low back pain. It was safe, parsimonious, and well accepted by patients”

    http://www.hsc.unt.edu/ORC/Files/AFMPressRelease_2013_03_18_FINAL.pdf
    http://annfammed.org/content/11/2/122.full

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