Osteopathic manipulation for the prevention of cardiac complications?

The aim of the present study entitled “Osteopathic manipulation as a complementary treatment for the prevention of cardiac complications: 12-Months follow-up of intima media and blood pressure on a cohort affected by hypertension” was to investigate the association between osteopathic treatment and hypertension. It was designed as a non-randomized trial including consecutive subjects affected by hypertension and vascular alterations, using pre-post differences in intima-media thickness, systolic and diastolic blood pressure as primary endpoints.  A total of  31 out of 63 eligible subjects followed by a single cardiologist received osteopathic treatment in addition to routine care. Clinical measurements were recorded at baseline and after 12 months.

Univariate analysis found that osteopathic treatment was significantly associated to an improvement in all primary endpoints. Multivariate linear regression showed that, after adjusting for all potential confounders, osteopathic treatment was performing significantly better for intima-media thickness (delta between preepost differences in treated and control groups:

The author concluded that their study shows that, among patients affected by cardiovascular disorders, osteopathic treatment is significantly associated to an improvement in intima-media and systolic blood pressure after one year. Multicentric randomized trials of adequate sample size are needed to evaluate the efficacy of osteopathic manipulative treatments in the treatment of hypertension.

This conclusion is indeed wisely phrased, because:

ASSOCIATION IS NOT CAUSATION!

The data provided are far from supporting the hypothesis that osteopathic treatments caused the positive effects. In fact, the opposite might be the case: osteopathy my have slowed down the normalization of the outcome measures, and, without any intervention, they might have improved faster and more significantly.

So, are the authors correct with their 2nd conclusion that multicentric randomized trials of adequate sample size are needed to evaluate the efficacy of osteopathic manipulative treatments in the treatment of hypertension? Personally, I doubt it. Such a trial would have no plausible basis, and I fear it would be little more than a waste of resources.

My final point is about the title of the paper, “Osteopathic manipulation as a complementary treatment for the prevention of cardiac complications: 12-Months follow-up of intima media and blood pressure on a cohort affected by hypertension”. The study is NOT about the prevention of cardiac complications! It seems to be borne out by the wishful thinking of the author. As such, it tells us perhaps more about osteopathy than the rest of this article.