cranial osteopathy
This pilot study evaluates changes in sensorimotor responses in premature infants after receiving craniosacral therapy. The study included a total of 63 infants born between 28 and 31 weeks of gestation. These infants underwent three craniosacral therapy treatments during their hospitalization. The assessment used
a sensorimotor reactivity scale to evaluate eye contact, response to two-point static and kinetic tactile stimulation, turning onto the side, and willingness to grasp and suck an offered finger. Differences in gross scores between pairs of measurements for each item were tested at a 5% significance level using the Wilcoxon paired test. All differences within the evaluated items were statistically significant (p<0.05).
The strongest effect of the statistically significant dependence was found in the eye contact item. This difference was more pronounced in bottle-fed infants than in breast-fed infants. Therefore, craniosacral therapy may have the potential to enhance self-regulation and promote healthy development in premature infants, but this finding needs to be supported by further research.
The author concluded that craniosacral therapy offers a natural way to strengthen self-regulation and the healthy development of premature babies. The therapy leads to significant improvements in infant sensorimotor responses, especially in eye contact, which is crucial for social interactions, cognitive and language development, and for the formation of an emotional bond with the parent. More significant positive changes were noted in bottle-fed infants. However, the study was observational, without a control group, and the results need to be confirmed by further research with better methodological quality. Thus, CST represents a promising approach to relieving tension, reducing stress, and improving the ability of self-regulation, concentration, and learning in very immature infants.
Where to begin?
Let me just point out two major limitations of the study.
- A pilot study is supposed to determine the feaibility of a project followed by a definitive trial. This study did not aim at doing this. It therefore is not a pilot study but a useless observation.
- The author states that the therapy leads to significant improvements… She thus claims that the therapy caused the observed outcome. This claim ignores numerous other causes, e.g. a placebo response, other therapies and care, or the natural history of the condition. The latter seems particularly important. Premature babies develope regardless of whether they receive treatments or not.
Craniosacral therapy is nonsense. Conducting nonsensical research of nonsense does not turn it in good sense.
- Biological Mimicry: In biology, mimicry refers to the phenomenon where one species evolves to resemble another, often for survival advantages like predator avoidance.
- Social Mimicry: In social sciences, mimicry theory explores how individuals mimic behaviors, mannerisms, or speech patterns of others to build rapport, establish social connections, or manipulate others.
- Postcolonial Mimicry: In postcolonial studies, mimicry theory refers to the ways colonized peoples imitate and adapt the culture of the colonizers, often as a strategy of survival, resistance, or subversion.
“Man is the creature who does not know what to desire, and he turns to others in order to make up his mind. We desire what others desire because we imitate their desires”, claimed the inventor of mimicry theory, René Girard (1923–2015).
Here I propose that homeopathy too can be viewed and explained by that kind of mimicry. Homeopaths attempt to mimic the appearance or approach of real medicine in order to gain legitimacy, credibility and income.
- Homeopaths adopt certain trappings or terminology of evidence-based medicine without necessarily adhering to its underlying principles or scientific rigor.
- They behave like real healthcare professional without having any effective healthcare at their disposal.
- They dispense homeopathics that are bar of any active molecules pretending they are real medicines.
- Etc, etc.
It has been reported that members of the U.S. House and Senate are proposing the Chiropractic Medicare Coverage Modernization Act, ensuring reimbursement for all medically necessary services provided by chiropractors. However, the American College of Radiology and American Society of Neuroradiology have now joined over 90 other groups led by the AMA to announce their disapproval. They shared their concerns in a recent letter to the two bills’ sponsors, which ASNR promoted in an update published Tuesday.
“Our organizations are concerned that permitting chiropractors to bill Medicare for the full and likely expanded scope of their license in a given state will lead to an unnecessary redistribution of scarce Medicare resources,” the American Medical Association, all 50 state physician societies, ACR and ASNR recently wrote to lawmakers. Doing so, they added, will likely take funds from medical groups, redistributing them “to nonphysician practitioners for services that they lack sufficient training and expertise to perform. Such expansion would increase overall Medicare costs and jeopardize the health and safety of Medicare patients.”
Supporters of the bill claim the legislation would provide a path for Medicare recipients to better manage pain without resorting to opioids. Currently, the program only covers chiropractic care deemed “medically necessary, subjecting beneficiaries to “burdensome red tape requirements.” The Chiropractic Medicare Coverage Modernization Act seeks to remove these obstacles, bringing coverage rules more in line with rules imposed by private payers.
The radiology societies said they “greatly value the contribution of chiropractors.” However, they’re troubled the legislation would authorize them to use the title “physician” under the Medicare Part B program and be paid the same rate as MDs and DOs. Removing the current “manual manipulation” of the spine limitation in the program opens the door for chiropractors to provide other services “they have not been specifically trained to provide.” Physicians are required to complete upward of 16,000 hours of clinical training, while chiropractic students only must meet a minimum of 4,200 instructional hours.
“Given their relatively limited education and training, chiropractors’ scope of practice is appropriately restricted under Medicare to treatment by means of manual manipulation, i.e., by the use of the hands,” the radiology societies wrote. “This limitation is aligned with chiropractic training and the treatments that chiropractors most often provide involving common musculoskeletal complaints such as back pain.”
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Needless to say what I think about this bill! Chiropractors are not sufficiently trained in medicine, science or ethics to expand their services in the proposed way. One could, of course, train them to practice real medicine. Then most of them would probably give up spinal manipulation and become physicians like MDs.
This is the path that US osteopath have chosen a long time ago.
Would that be desirable?
No, I don’t see a point in having several different types of physicians. It can only confuse patients, lead to uncertainty and to suboptimal healthcare.
This blog is now almost 13 years old. In well over 3 000 (!) posts, I have been trying to alert consumers to the things that are wrong with much of so-called alternative medicine (SCAM). In this new series of posts entitled ‘WHAT HAPPENED NEXT? …’ I intend to re-visit some of my early posts and ask: WHAT HAPPENED NEXT?
This might show us
- what has changed,
- what has remained the same
- and what needs to change.
Here we go:
In my blog post of 17/12/2012 about Craniosacral Therapy (CST) I concluded that:
1) ineffective therapies, such as CST, may seem harmless but, through their ineffectiveness, they constitute a serious threat to our health;
2) bogus treatments become bogus through the false claims which are being made for them;
3) seriously flawed studies can be worse than none at all: they generate false positive results and send us straight up the garden path.
Almost 13 years after writing this, I fear that the notion ‘SCAM MAY BE INEFFECTIVE BUT IT CANNOT DO ANY HARM!’ is still as popular as it was before. Equally, the dismal quality of research into SCAM is still a problem. And, of course, CST is still around with unsupported, often dangerous claims.
So, has anything changed at all?
I am not sure.
If nothing much has changed, what does that mean for me, my motivation and this blog?
When I started my blog I already had ~20 years experience in full-time SCAM research. If that experience had taught me anything at all, it was not to expect too much. SCAM is a most resistant phenomenon. I don’t see my blog as an instrument for abolishing SCAM (an outright impossibility, in my view). I prefer to think of it as a means of damage limitation.
Having said all this, I must admit that the often dismal quality of research and the tolerance of pseudoscience by journal editors and consumers do disappoint me. But my conclusion is not to give up and resign but to work a bit harder trying my best to prevent harm!
The ‘Healy’ has featured on this blog before and is thus known to my regulars: The ‘Healy’: deep cellular healing with quantum bollocks. Now the ‘Healy’ has won an award … albeit a negative one: the Austrian Skeptiks necative prize ‘GOLDENES BRETT VORM KOPF’ (Golden Plank before the Head)
Other nomineed for the award were:
- The broadcaster AUF1 TV, which has been categorised as right-wing extremist.
- The Austrian Veterinary Association known to support homeopathy for animals.
At yesterday’s gala in the Vienna City Hall, it was announced that the ‘Healy’ is the proud winner.
A total of 160 nominations were received by the Vienna Sceptics (Gesellschaft für kritisches Denken, GkD), which awards the prize on behalf of the Gesellschaft zur Wissenschaftlichen Untersuchung von Parawissenschaften (GWUP). On the basis of all these nominations, a ‘shortlist’ of three was subsequently agreed upon by the jury.
The organisers explained in their press release that the ‘Healy’ is advertised as a medical device for the treatment of pain, including chronic pain and migraines, as well as for the supportive treatment of mental illnesses such as depression and anxiety with a lot of pseudo-scientific phraseology.
A ‘quantum sensor’ allegedly measures the ideal ‘frequency’ of the user and causes a ‘bioenergetic field harmonisation’. However, the ‘quantum sensor’ turns out to be nothing more than a simple infrared diode, available for 20 cents. By contrast, consumers are asked to pay up to 4,500 Euros for the ‘Healy’!
Several research platforms, medical information portals and consumer centres have come to damning conclusions about the device. There is talk of ‘bioresonance scams’, ‘dubious frequency therapy’ for which there is a lack of scientific evidence and an ‘esoteric scam’. In addition to the considerable commercial interest and widespread use, the jury said that the manufacturer’s way of dealing with critics was also decisive for the win.
Having recently favoured the Austrian Veterinary Association (AVA) to win the award, I am in two minds. On the one hand, I am disappointed that the AVA did not make it. On the other hand, having reported about the ‘Healy’s extraordinary quantum bollocks some time ago, I am delighted that a worthy winner has been found and crowned.
Whenever I report a case of arterial dissection after spinal manipulation, a defender of the indefensible comments that the case does not prove anything.
Let’s try again, shall we?
It has been reported that Nerissa E. Weeks has filed a negligence complaint against Dr. Jack J. Cacic and his business, Lake Worth Chiropractic & Wellness (LWCW). Weeks, a resident of Lake Worth, alleges that she suffered permanent neurological injuries due to the negligence of Dr. Cacic during chiropractic treatments at LWCW. Weeks initially sought treatment from Cacic on January 12, 2023, for low back pain related to a herniated disc in her lumbar spine. Following this initial visit, she returned to Cacic’s office several months later on June 26, 2023, complaining of neck pain and headaches.
During subsequent visits on June 26 and June 28, Cacic performed cervical manipulations and other treatments without obtaining appropriate informed consent from Weeks regarding the risks involved. On June 30, following another session of cervical manipulations by Cacic, Weeks experienced severe dizziness and vertigo shortly after the procedure. She was subsequently hospitalized and diagnosed with an acute right vertebral artery dissection and an ischemic stroke.
Weeks contends that Cacic failed to recognize symptoms indicative of a vertebral artery dissection and did not provide adequate care consistent with professional standards. The complaint states: “As a direct and proximate result of the negligence of the Defendants, WEEKS suffered permanent neurologic injuries due to an acute thromboembolic cerebrovascular accident.”
The plaintiff is seeking damages exceeding $50,000 for medical expenses, loss of earnings, pain and suffering, mental anguish, disability, impairment, and other related costs incurred due to the alleged negligence. Represented by attorney Hector Buigas from Morgan & Morgan P.A., Weeks demands compensatory damages along with interest, taxable costs, attorneys’ fees, prejudgment interest on medical bills as well as any other relief deemed proper by the court.
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How many more such cases do we need before chiropractors admit that cervical manipulations do more harm than good?
How long until all chiropractors explain to their patients that cervical manipulations do more harm than good?
How long until cervical manipulations become obsolete?
Craniosacral therapy (CST) is a widely taught component of osteopathic medical education. It is included in the standard curriculum of osteopathic medical schools, despite controversy surrounding its use. This paper seeks to systematically review randomized clinical trials (RCTs) assessing the clinical effectiveness of CST compared to standard care, sham treatment, or no treatment in adults and children.
A search of Embase, PubMed, and Scopus was conducted on 10/29/2023 with no restriction placed on the date of publication. Additionally, a Google Scholar search was conducted to capture grey literature. Backward citation searching was also implemented. All RCTs employing CST for any clinical outcome were included. Studies not available in English as well as any studies that did not report adequate data for inclusion in a meta-analysis were excluded. Multiple reviewers were used to assess for inclusions, disagreements were settled by consensus. PRISMA guidelines were followed in the reporting of this meta-analysis. Cochrane’s Risk of Bias 2 tool was used to assess for risk of bias. All data were extracted by multiple independent observers. Effect sizes were calculated using a Hedge’s G value (standardized mean difference) and aggregated using random effects models.
The primary study outcome was the effectiveness of CST for selected outcomes as applied to non-healthy adults or children and measured by standardized mean difference effect size. Twenty-four RCTs were included in the final meta-analysis with a total of 1,613 participants. When results were analyzed by primary outcome, no significant effects were found. When secondary outcomes were included, results showed that only Neonate health, structure (g = 0.66, 95% CI [0.30; 1.02], Prediction Interval [-0.73; 2.05]) and Pain, chronic somatic (g = 0.34, 95% CI [0.18; 0.50], Prediction Interval [-0.41; 1.09]) showed statistically significant effects. However, wide prediction intervals and high bias limit the real-world implications of this finding.
The authors concluded that CST did not demonstrate broad significance in this meta-analysis, suggesting limited usefulness in patient care for a wide range of indications.
To this, one should perhaps add that CST is one of those forms of so-called alternative medicine (SCAM) that is utterly implausible; there is not conceivable mechanism by which CST might work other than a placebo effects. Therefore, the finding that it is ineffective (positive effects on secondary outcomes are most likely due to residual bias and possibly fraud) is hardly surprising. The most sensible conclusion, in my view, is that CST too ridiculous to merit further research because that would, in effect, be an unethical waste of resources.
The ‘University College of Osteopathy’ announced a proposal to merge with the AECC University College (AECC UC). Both institutions will seek to bring together the two specialist providers to offer a “unique inter-disciplinary environment for education, clinical practice and research in osteopathy, chiropractic, and across a wide range of allied health and related disciplines”.
The partnership is allegedly set to unlock significant opportunities for growth and development by bringing together the two specialist institutions’ expertise and resources across two locations – in Dorset and central London.
As a joint statement, Chair of the Board of Governors at AECC UC, Jeni Bremner and Chair of the Board of Governors at UCO, Professor Jo Price commented:
“We believe the proposed merger would further the institutional ambitions for both of our organisations and the related professional groups, by allowing us to expand our educational offering, grow student numbers and provide a unique inter-disciplinary training environment, providing students the opportunity to be immersed in multi-professional practice and research, with exposure to and participation in multi-disciplinary teams.
“There is also an exciting and compelling opportunity to expedite the development of a nationally unique, and internationally-leading MSK Centre of Excellence for Education and Research, developed and delivered across our two sites.”
The announcement is accompanied by further uncritical and promotional language:
Established as the first chiropractic training provider in Europe, AECC UC has been at the forefront of evidence-based chiropractic education, practice and research for more than 50 years. The institution is on an exciting journey of growth and development, having expanded and diversified its academic portfolio and activity beyond its traditional core offering of chiropractic across a broad range of allied health courses and apprenticeships, working closely with NHS, local authority and other system partners across Dorset and the south-west. The proposed merger with UCO would allow AECC UC to enhance the breadth and depth of its offer to support the expansion and development of the health and care workforce across a wider range of partners.
Now in its 106th year, UCO is one of the UK’s leading providers of osteopathic education and research with an established reputation for creating highly-skilled, evidence-informed graduates. UCO research is recognised as world-leading, delivering value to the osteopathic and wider health care community.
Sharon Potter, Acting Vice-Chancellor of UCO, said:
“As an institution that has long been at the forefront of osteopathic education and research, we are committed to ensuring further growth and development of the osteopathic profession.
“UCO has been proactively considering options to future-proof the institution. Following a review of strategic options, UCO is delighted by the proposed merger, working closely with AECC UC to ensure that UCO and osteopathy thrives as part of the inter-professional health sciences landscape, both academically and clinically. There is significant congruence between UCO and AECC UC in our strong aligned values, commitment to and delivery of excellent osteopathic education, clinical care and research, and opinion leadership.
“AECC UC has a strong track record of respecting the differences in professions, evidenced by the autonomy across the 10 different professional groups supported by the institution. The merger will not only mean we are protecting UCO through preserving its osteopathic heritage and creating a sustainable future, but that our staff and students can collaborate with other professional groups such as physiotherapy, chiropractic, sport rehabilitation, podiatry and diagnostic imaging, in a multidisciplinary MSK and rehabilitation environment unlike anywhere else in the UK.”
Professor Lesley Haig, Vice-Chancellor of AECC UC, commented:
“Preserving the heritage of UCO and safeguarding its future status as the flagship osteopathy training provider in the UK will be critical, just as it has been to protect the chiropractic heritage of the AECC brand. UCO is seen as synonymous with, and reflective of, the success of the osteopathy profession and we fully recognise and respect the important role that UCO plays not only as a sector-leading provider of osteopathic education, research and clinical care, but as the UK’s flagship osteopathy educational provider.
“Overall it is clear that UCO and AECC UC already have a common values base, similar understanding of approaches to academic and clinical delivery, and positive relationships upon which a future organisational structure and opportunities can be developed. It’s an exciting time for both institutions as we move forward in partnership to create something unique and become recognised nationally and internationally as a centre of excellence.”
The proposed merger would continue the already founded positive relations between the institutions, where regular visits, sharing of good practice, and collaborative research work are already taking place. Heads of terms for the potential merger have now been agreed and both institutions are entering into the next phase of discussions, which will include wide consultation with staff, students and other stakeholders to produce a comprehensive implementation plan.
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In case this bonanza of platitudes and half-truths has not yet overwhelmed you, I might be so bold as to ask 10 critical questions:
- What is an “evidence-based chiropractic education”? Does it include the messages that 1) subluxation is nonsense, 2) chiropractic manipulations can cause harm, 3) there is little evidence that they do more good than harm?
- How an an “expansion and development of the health and care workforce” be anticipated on the basis of the 3 points I just made?
- What does the term “evidence-informed graduates” mean? Does it mean they are informed that you teach them nonsense but instruct them to practice this nonsense anyway?
- Do “options to future-proof the institution” include the continuation of misleading the public about the value of chiropractic/osteopathy?
- Does the”delivery of excellent osteopathic education, clinical care and research, and opinion leadership” account for the fact that the evidence for osteopathy is weak at best and for most conditions negative?
- By “preserving its osteopathic heritage”, do you intend to preserve also the reputation of your founding father, Andrew Taylor Still, who did many dubious things. In 1874, for instance, he was excommunicated by the Methodist Church because of his “laying on of hands”; specifically, he was accused of trying to emulate Jesus Christ, labelled an agent of the Devil, and condemned as practicing voodoo. Or do you prefer to white-wash the osteopathic heritage?
- You also want “to protect the chiropractic heritage”; does that mean you aim at white-washing the juicy biography of the charlatan who created chiropractic, DD Palmer, as well?
- “UCO and AECC UC already have a common values base” – what are they? As far as I can see, they mainly consist in hiding the truth about the uselessness of your activities from the public.
- How do you want to “recognised nationally and internationally as a centre of excellence”? Might it be a good idea to begin by critically assessing your interventions and ask whether they do more good than harm?
- Crucially, what is really behing the merger that you are trying to sell us with such concentrated BS?
This case report aims to describe the effects of craniosacral therapy and acupuncture in a patient with chronic migraine.
A 33-year-old man with chronic migraine was treated with 20 sessions of craniosacral therapy and acupuncture for 8 weeks. The number of migraine and headache days were monitored every month. The pain intensity of headache was measured on the visual analog scale (VAS). Korean Headache Impact Test-6 (HIT-6) and Migraine Specific Quality of Life (MSQoL) were also used.
The number of headache days per month reduced from 28 to 7 after 8 weeks of treatment and to 3 after 3 months of treatment. The pain intensity of headache based on VAS reduced from 7.5 to 3 after 8 weeks and further to < 1 after 3 months of treatment. Furthermore, the patient’s HIT-6 and MSQoL scores improved during the treatment period, which was maintained or further improved at the 3 month follow-up. No side effects were observed during or after the treatment.
The authors concluded that this case indicates that craniosacral therapy and acupuncture could be effective treatments for chronic
migraine. Further studies are required to validate the efficacy of craniosacral therapy for chronic migraine.
So, was the treatment period 8 weeks long or was it 3 months?
No, I am not discussing this article merely for making a fairly petty point. The reason I mention it is diffteren. I think it is time to discuss the relevance of case reports.
What is the purpose of a case report in medicine/healthcare. Here is the abstract of an article entitled “The Importance of Writing and Publishing Case Reports During Medical Training“:
Case reports are valuable resources of unusual information that may lead to new research and advances in clinical practice. Many journals and medical databases recognize the time-honored importance of case reports as a valuable source of new ideas and information in clinical medicine. There are published editorials available on the continued importance of open-access case reports in our modern information-flowing world. Writing case reports is an academic duty with an artistic element.
An article in the BMJ is, I think, more informative:
It is common practice in medicine that when we come across an interesting case with an unusual presentation or a surprise twist, we must tell the rest of the medical world. This is how we continue our lifelong learning and aid faster diagnosis and treatment for patients.
It usually falls to the junior to write up the case, so here are a few simple tips to get you started.
First steps
Begin by sitting down with your medical team to discuss the interesting aspects of the case and the learning points to highlight. Ideally, a registrar or middle grade will mentor you and give you guidance. Another junior doctor or medical student may also be keen to be involved. Allocate jobs to split the workload, set a deadline and work timeframe, and discuss the order in which the authors will be listed. All listed authors should contribute substantially, with the person doing most of the work put first and the guarantor (usually the most senior team member) at the end.
Getting consent
Gain permission and written consent to write up the case from the patient or parents, if your patient is a child, and keep a copy because you will need it later for submission to journals.
Information gathering
Gather all the information from the medical notes and the hospital’s electronic systems, including copies of blood results and imaging, as medical notes often disappear when the patient is discharged and are notoriously difficult to find again. Remember to anonymise the data according to your local hospital policy.
Writing up
Write up the case emphasising the interesting points of the presentation, investigations leading to diagnosis, and management of the disease/pathology. Get input on the case from all members of the team, highlighting their involvement. Also include the prognosis of the patient, if known, as the reader will want to know the outcome.
Coming up with a title
Discuss a title with your supervisor and other members of the team, as this provides the focus for your article. The title should be concise and interesting but should also enable people to find it in medical literature search engines. Also think about how you will present your case study—for example, a poster presentation or scientific paper—and consider potential journals or conferences, as you may need to write in a particular style or format.
Background research
Research the disease/pathology that is the focus of your article and write a background paragraph or two, highlighting the relevance of your case report in relation to this. If you are struggling, seek the opinion of a specialist who may know of relevant articles or texts. Another good resource is your hospital library, where staff are often more than happy to help with literature searches.
How your case is different
Move on to explore how the case presented differently to the admitting team. Alternatively, if your report is focused on management, explore the difficulties the team came across and alternative options for treatment.
Conclusion
Finish by explaining why your case report adds to the medical literature and highlight any learning points.
Writing an abstract
The abstract should be no longer than 100-200 words and should highlight all your key points concisely. This can be harder than writing the full article and needs special care as it will be used to judge whether your case is accepted for presentation or publication.
What next
Discuss with your supervisor or team about options for presenting or publishing your case report. At the very least, you should present your article locally within a departmental or team meeting or at a hospital grand round. Well done!
Both papers agree that case reports can be important. They may provide valuable resources of unusual information that may lead to new research and advances in clinical practice and should offer an interesting case with an unusual presentation or a surprise twist.
I agree!
But perhaps it is more constructive to consider what a case report cannot do.
It cannot provide evidence about the effectiveness of a therapy. To publish something like:
- I had a patient with the common condition xy;
- I treated her with therapy yz;
- this was followed by patient feeling better;
is totally bonkers – even more so if the outcome was subjective and the therapy consisted of more than one intervention, as in the article above. We have no means of telling whether it was treatment A, or treatment B, or a placebo effect, or the regression towards the mean, or the natural history of the condition that caused the outcome. The authors might just as well just have reported:
WE RECENTLY TREATED A PATIENT WHO GOT BETTER
full stop.
Sadly – and this is the reason why I spend some time on this subject – this sort of thing happens very often in the realm of SCAM.
Case reports are particularly valuable if they enable and stimulate others to do more research on a defined and under-researched issue (e.g. an adverse effect of a therapy). Case reports like the one above do not do this. They are a waste of space and tend to be abused as some sort of indication that the treatments in question might be valuable.
This systematic review and meta-analysis was aimed at analyzing the effectiveness of craniosacral therapy in improving pain and disability among patients with headache disorders.
PubMed, Physiotherapy Evidence Database, Scopus, Cochrane Library, Web of Science, and Osteopathic Medicine Digital Library databases were searched in March 2023. Two independent reviewers searched the databases and extracted data from randomized clinical trials comparing craniosacral therapy with control or sham interventions. The same reviewers assessed the methodological quality and the risk of bias using the PEDro scale and the Cochrane Collaboration tool, respectively. Grading of recommendations, assessment, development, and evaluations was used to rate the certainty of the evidence. Meta-analyses were conducted using random effects models using RevMan 5.4 software.
The searches retrieved 735 papers, and 4 studies were finally included. The craniosacral therapy provided statistically significant but clinically unimportant change on pain intensity (Mean difference = –1.10; 95% CI: –1.85, –0.35; I2: 44%), and no change on disability or headache effect (Standardized Mean Difference = –0.34; 95% CI –0.70, 0.01; I2: 26%). The certainty of the evidence was downgraded to very low.
The authors concluded that very low certainty of evidence suggests that craniosacral therapy produces clinically unimportant effects on pain intensity, whereas no significant effects were observed in disability or headache effect.
I find it strange that researchers seem so frequently unable to formulate their conclusions clearly. Is it political correctness? Or are they somehow favorably inclined (i.e. biased) towards the treatment that they pretend to critically evaluate?
Let’s look at the facts related to this review:
- Craniosacral therapy (CST) is utterly implausible.
- Only 4 RCTs were found.
- They were of poor quality.
- They were published mostly by people who want to promote CST.
- Therefore the overall statistically significant effect is most likely a false-positive result.
- This means that the conclusion should be much more straight forward.
I suggest something along the following lines:
A critical evaluation of the existing RCTs failed to find convincing evidence that CST is an effective treatment for headache disorders.
