spinal manipulation
Low back pain (LBP) is a significant public health issue due to its high prevalence and associated disability burden. Clinical practice guidelines recommend non-pharmacological/non-surgical interventions for managing pain and function in people with LBP. This overview of Cochrane review is aimed ato providing accessible, high-quality evidence on the effects of non-pharmacological and non-surgical interventions for people with LBP and to highlight areas of remaining uncertainty and gaps in the evidence regarding the effects of these interventions for people with LBP.
the team searched the Cochrane Database of Systematic Reviews from inception to 15 April 2023, to identify Cochrane reviews of randomised controlled trials testing the effect of non-pharmacological/non-surgical interventions, unrestricted by language. Major outcomes were pain intensity, function and safety. Two authors independently assessed eligibility, extracted data and assessed the quality of the reviews using AMSTAR 2 (A MeaSurement Tool to Assess Systematic Reviews) and the certainty of the evidence using GRADE. The primary comparison was placebo/sham.
A total of 31 Cochrane reviews were included of 644 trials that randomised 97,183 adults with LBP. The team had high confidence in the findings of 19 reviews, moderate confidence in the findings of two reviews, and low confidence in the findings of 10 reviews. They present results for non-pharmacological/non-surgical interventions compared to placebo/sham or no treatment/usual care at short-term (≤ three months) follow-up. Placebo/sham comparisons Acute/subacute LBP Compared to placebo, there is probably no difference in function (at one-week follow-up) for spinal manipulation (standardised mean difference (SMD) -0.08, 95% confidence interval (CI) -0.37 to 0.21; 2 trials, 205 participants; moderate-certainty evidence). Data for safety were reported only for heated back wrap. Compared to placebo, heated back wrap may result in skin pinkness (6/128 participants versus 1/130; 2 trials; low-certainty evidence). Chronic LBP Compared to sham acupuncture, acupuncture probably provides a small improvement in function (SMD -0.38, 95% CI -0.69 to -0.07; 3 trials, 957 participants; moderate-certainty evidence). Compared to sham traction, there is probably no difference in pain intensity for traction (0 to 100 scale, mean difference (MD) -4, 95% CI -17.7 to 9.7; 1 trial, 60 participants; moderate-certainty evidence). Data for safety were reported only for acupuncture. There may be no difference between acupuncture and sham acupuncture for safety outcomes (risk ratio (RR) 0.68, 95% CI 0.42 to 1.10; I2 = 0%; 4 trials, 465 participants; low-certainty evidence). No treatment/usual care comparisons Acute/subacute LBP Compared to advice to rest, advice to stay active probably provides a small reduction in pain intensity (SMD -0.22, 95% CI -0.02 to -0.41; 2 trials, 401 participants; moderate-certainty evidence). Compared to advice to rest, advice to stay active probably provides a small improvement in function (SMD -0.29, 95% CI -0.09 to -0.49; 2 trials, 400 participants; moderate-certainty evidence). Data for safety were reported only for massage. There may be no difference between massage and usual care for safety (risk difference 0, 95% CI -0.07 to 0.07; 1 trial, 51 participants; low-certainty evidence). Chronic LBP Compared to no treatment, acupuncture probably provides a medium reduction in pain intensity (0 to 100 scale, mean difference (MD) -10.1, 95% CI -16.8 to -3.4; 3 trials, 144 participants; moderate-certainty evidence), and a small improvement in function (SMD -0.39, 95% CI -0.72 to -0.06; 3 trials, 144 participants; moderate-certainty evidence). Compared to usual care, acupuncture probably provides a small improvement in function (MD 9.4, 95% CI 6.15 to 12.65; 1 trial, 734 participants; moderate-certainty evidence). Compared to no treatment/usual care, exercise therapies probably provide a small to medium reduction in pain intensity (0 to 100 scale, MD -15.2, 95% CI -18.3 to -12.2; 35 trials, 2746 participants; moderate-certainty evidence), and probably provide a small improvement in function (0 to 100 scale, MD -6.8, 95% CI -8.3 to -5.3; 38 trials, 2942 participants; moderate-certainty evidence). Compared to usual care, multidisciplinary therapies probably provide a medium reduction in pain intensity (SMD -0.55, 95% CI -0.83 to -0.28; 9 trials, 879 participants; moderate-certainty evidence), and probably provide a small improvement in function (SMD -0.41, 95% CI -0.62 to -0.19; 9 trials, 939 participants; moderate-certainty evidence). Compared to no treatment, psychological therapies using operant approaches probably provide a small reduction in pain intensity (SMD -0.43, 95% CI -0.75 to -0.11; 3 trials, 153 participants; moderate-certainty evidence). Compared to usual care, psychological therapies (including progressive muscle relaxation and behavioural approaches) probably provide a small reduction in pain intensity (0 to 100 scale, MD -5.18, 95% CI -9.79 to -0.57; 2 trials, 330 participants; moderate-certainty evidence), but there is probably no difference in function (SMD -0.2, 95% CI -0.41 to 0.02; 2 trials, 330 participants; moderate-certainty evidence). It is uncertain whether there is a difference between non-pharmacological/non-surgical interventions and no treatment/usual care for safety (very low-certainty evidence).
The authors concluded that spinal manipulation probably makes no difference to function compared to placebo for people with acute/subacute LBP. Acupuncture probably improves function slightly for people with chronic LBP, compared to sham acupuncture. There is probably no difference between traction and sham traction for pain intensity in people with chronic LBP. Compared to advice to rest, advice to stay active probably reduces pain intensity slightly and improves function slightly for people with acute LBP. Acupuncture probably reduces pain intensity, and improves function slightly for people with chronic LBP, compared to no treatment. Acupuncture probably improves function slightly for people with chronic LBP, compared to usual care. Exercise therapies probably reduce pain intensity, and improve function slightly for people with chronic LBP, compared to no treatment/usual care. Multidisciplinary therapies probably reduce pain intensity, and improve function slightly for people with chronic LBP, compared to usual care. Compared to usual care, psychological therapies probably reduce pain intensity slightly, but probably make no difference to function for people with chronic LBP.
The findings of this overview might surprise some chiropractors, however, it did not surprise me at all*. I have stated more often than I care to remember that, for LBP, we currently have no approach that is truly convincing. One form of so-called alternative medicine (SCAM) seems to be roughly as effective (or ineffective) as the next. Where they might differ is safety and cost. On both of these measures chiropractic spinal manipulation is less convincing than some of the other options available, as we have discussed ad nauseam on this blog.
So, in a nutshell, the message to LBP patients can be put simply: stay away from chiros, keep active and, if you insist, use whatever other form of SCAM that you fancy, that is safe and inexpensive.
PS
*I was, however, surprised that the authors had low confidence in the findings of 10 of the 31 reviews. Cochrane reviews should be the most reliable evidence available to date!!!
- The authors claim to evaluate OMT for managing headaches associated with musculoskeletal dysfunction. Yet few of the trials were specifically aimed at this aim.
- Comparator treatment included sham manipulation, waitlist or no treatment, treatment as usual, a different type of OMT technique or protocol that was not the same as the experimental intervention, or any standard of care intervention, such as exercise therapy or medication. Most of these do not allow conclusions about specific effects of OMT.
- There was no attempt to control for placebo effects which might be significant in the case of OMT.
- In general, the methodological quality of the primary studies was low.
- There are too few studies to adequately assess the multitude of different OMT techniques.
- The fact that multiple forms of headache exist is not adequately addressed.
Yes, the authors try to be cautious in their conclusions and admit that the evidence is weak. Yet, I simply do not see enough compelling evidence to agree with them that the data are even suggestive of a positive effect.
This study analyzed the prevalence and characteristics of misinformation in YouTube videos about chiropractic treatment for otitis media (OM).
YouTube was searched in January 2023 (Incognito mode, US region) using the terms “chiropractic treatment for otitis media”, “chiropractic ear infection”, and “chiropractic ear problems”. The first 50 English-language videos ranked by relevance were evaluated. Two independent reviewers extracted metadata (views, duration, likes, comments, upload source) and coded for references to evidence-based therapies, chiropractic techniques, and misinformation themes (“fixing” nerves or the Eustachian tube); a third reviewer resolved discrepancies. Descriptive statistics summarized video characteristics and engagement. A parallel PubMed search identified published literature on the most commonly mentioned techniques.
Fifty videos accrued 2,600,209 views, with a mean of 192 seconds, and generated 21,102 likes and 1,766 comments. Chiropractors produced 42 videos (84% of the content); hospital or academic channels contributed two videos (4%).
The findings are both revealing and frightening:
- Only three videos (6%) cited scientific sources.
- Twenty-five (50%) videos claimed that chiropractic manipulation could “fix” the Eustachian tube.
- Forteen videos (28%) asserted nerve correction.
- None of the videos mentioned antibiotics or tympanostomy tubes.
- Upper‑cervical adjustments (32 videos, 64%) and ear‑massage maneuvers (25 videos, 50%) were the most frequently promoted techniques, despite limited or low‑quality supporting evidence in the published literature.
The authors concluded that misinformation about chiropractic treatment for OM is widespread and highly viewed on YouTube. The omission of proven therapies and promotion of unverified claims pose risks for delayed care
and preventable harm. Efforts from clinicians, professional societies, educators, and platforms are needed to
elevate accurate content, promote media literacy, and reduce exposure to misleading medical information.
I suppose most of us have seen such videos. They are surprisingly popular, are by no means confined to relatively benign conditions like otits media, and reach vast audiences. Therefore, I often was tempted to conduct a proper study of them. I praise the US authors for having me beaten to it!
After reading this paper and after watching some of the videos, I foremost have one question:
HOW CAN ANYONE STILL BELIEVE THAT CHIROPRACTORS ARE SERIOUS HEALTHCARE PROFESSIONALS?
Guest post by Catherine de Jong
About the Master Kackadorisprize
The Master Kackadorisprize is awarded annually, this year for the 23rd time, by the Dutch Association against Quackery (Vereniging tegen de Kwakzalverij, VtdK, www.kwakzalverij.nl) to a person or institution that promotes quackery. It is emphatically not about quack practitioners themselves, but about persons and institutions that facilitate and/or legitimize quackery. The goals of the prize are to stimulate discussion and prevent the unjust tolerance of quackery, so-called alternative medicine (SCAM), and healthcare scams. The prize is named after a figure in a play published in 1596, the quack “meester Kackadoris”.
The Executive Board of Vrije Universiteit Amsterdam has been awarded the Master Kackadoris Prize 2025 for appointing a chiropractor named Sidney Rubinstein as professor by special appointment (https://www.kwakzalverij.nl/nieuws/vrije-universiteit-krijgt-meester-kackadorisprijs-2025/ ).
Who is Sydney Rubinstein?
Sidney Rubinstein did his training in chiropractic in the USA. Apparently he managed to get into a training scheme for epidemiologists in the Free University in Amsterdam. On the website of the Free University it says: “I am a registered epidemiologist and work in the Department of Health Sciences, section Musculoskeletal Health (MSH). Additionally, I work as a chiropractor in Soest. (https://research.vu.nl/en/persons/sidney-rubinstein-2)”.
He defended and published his PhD thesis on 20 June 2008, a thesis that got a lot of criticism from scientists (https://www.kwakzalverij.nl/tijdschrift/tijdschrift-archief-2008/proefschrift-bijwerkingen-chiropraxie/).
Chiropractic is seen as quackery in the Netherlands
The profession “chiropractor” is not recognized in the Netherlands. The training of chiropractors is not recognized by de NVAO (Nederlands Vlaamse Accreditatie Organisatie, www.nvao.net, the organization that controls the quality of schools for higher education and university education). Chiropractic in the Netherlands is an alternative treatment and not paid for by the basic healthcare insurance that everybody has in the Netherlands. Only people who pay extra for the insurance for alternative treatments can get (limited) reimbursement for visits to a chiropractor.
So why did the Executive Board of the Free University Amsterdam get the Master Kackadorisprize?
The VtdK believes that with the appointment of Rubinstein, the Free University Amsterdam (VU) has brought quackery into the university. ‘VU Amsterdam has a first with this, a quack as a professor,’ says em. Prof. Michiel W. Hengeveld, psychiatrist and chairman of the jury of the Master Kackadoris Prize.
The prize was awarded in Utrecht on Saturday 4 October during the annual symposium of the VtdK.
The board of the VU did not take advantage of the association’s invitation to explain its appointment decision. In an e-mail to the jury chairman, the VU said: “Thank you for your message. We have taken note of your decision. We will not use your offer. For more information about this chair and what we stand for as a university, we would like to refer you to our website”.
The Free University did find the courage to give a comment on the Student Magazine website Ad Valvas: https://advalvas.vu.nl/wetenschap-onderwijs/vu-krijgt-kwakzalversprijs-voor-hoogleraar-chiropractie/
So far at least some discussion and about the unjust tolerance of quackery, SCAM, and healthcare scams.
- (1) SMT,
- (2) ambulatory ibuprofen prescription,
using propensity matching for OUD risk factors. The primary outcome was the risk ratio (RR) of OUD. The RR for long-term opioid use, and opioid prescription RR and mean count were also explored. Primary analyses conducted in TriNetX and R used logistic regression for matching, standardized mean difference to assess between-cohort balance (threshold of ≤ 0.1), and contingency tables for RRs, using a significance threshold of p < 0.05.
The United States spends more money on the care of back and neck pain than any other health condition. Despite this, the cost-effectiveness for many recommended treatments is unclear. Our primary objective for this project was to estimate the cost-effectiveness of spinal manipulative therapy (SMT), supervised exercise therapy (ET), and home exercise and advice (HEA) for spinal pain in the U.S.
The researchers analyzed cost and clinical outcome data from eight randomized trials conducted in the U.S. using an individual participant data meta-analysis approach. They calculated cost-effectiveness from the societal and healthcare perspective of various comparisons between SMT, ET, and HEA. Incremental cost-effectiveness ratios (ICERs) were calculated using quality-adjusted life years as the main outcome.
The 8 trials included a total of 1803 participants and 1488 (83%) provided complete data. Incremental cost-effectiveness ratios and probabilities of cost-effectiveness varied substantially between studies; thus, the reseaarchers did not conduct meta-analysis and report findings from individual trials.
Cost-effectiveness findings were favorable for SMT compared to HEA for acute neck pain (ICERs below $50k/QALY) and when added to HEA for chronic back-related leg pain and chronic neck pain in older adults (better outcomes and lower costs). However, SMT was not likely cost-effective compared to HEA for chronic back pain in adults or when added to HEA for older adults (higher costs and worse outcomes).
Findings for SMT were favorable when compared to ET in adults with chronic back pain and when added to ET for chronic neck pain in adults (better outcomes and lower costs) and chronic back pain in adolescents (ICERs below $50k/QALY). However, SMT is not likely cost-effective when compared to ET for chronic neck pain in adults (ICERs below $70k/QALY for exercise) and findings were inconsistent across outcomes in older adults with chronic back pain.
Finally, ET may be cost-effective compared to HEA for adults with chronic neck pain (ICERs largely between $100-$200k/QALY), but not for chronic back pain or when added to HEA for older adults with chronic neck or back pain (higher costs and worse outcomes).
The authors concluded that overall based on willingness to pay thresholds of $50-$200k/QALY, there was moderate to high probability that spinal manipulation is cost-effective relative to HEA for neck pain and back-related leg pain, but not for chronic back pain. There was also moderate to high probability spinal manipulation was cost-effective relative to exercise therapy for chronic back pain but findings were mixed for neck pain and more favorable in older adults. Cost-effectiveness findings for exercise therapy were mostly not favorable relative to less intensive home exercise programs as costs were higher, and outcomes were often worse.
The authors admit that their analyses have several limitations: Randomized clinical trials are often designed to detect important differences in disease-specific clinical outcomes that are most likely to be impacted by the treatments assessed (e.g., pain severity, disability). Important measures for assessing cost-effectiveness include general health outcomes like changes in QALYs, healthcare use, and missed work. These measures were collected alongside disease-specific measures, but the trials were not powered to detect important differences in cost-effectiveness outcomes. Participants self-reported their use of healthcare and medications along with number of missed workdays. We did not have access to administrative data for healthcare use or costs. While access to administrative data would have reduced potential measurement error for these variables, it is not without limitations due to the high variability in coverage and re-imbursement policies for healthcare procedures across insurance products in the U.S. Costs for reduced productivity due to spinal pain included missed work in and outside of the home, but costs due to reduced productivity while still at work (i.e., presenteeism) were not included. This is an important limitation as costs due to reduced productivity while at work consistently account for a large proportion of total costs in spinal pain burden of illness studies. Finally, all studies were conducted in the U.S. with resources valued using U.S. prices and findings are not likely generalizable to populations or healthcare systems in other countries.
The authors stress that additional studies are needed to assess the cost-effectiveness of these approaches relative to medical care, the most common treatment approach in the US , as well as other guideline recommended treatments such as massage, acupuncture, mindfulness-based stress reduction, tai chi, yoga, and cognitive behavioral therapy
In view of these limitations and the fact that just 8 trials could be included, the relatively firm comclusions are surprising, in my view. To me, much of the data look unconvincing, somewhat random, inconsistent and implausible. could it be that the authors were trying to generate and emphacize positive results? After all, most of them are affiliated to the “Integrative Health and Wellbeing Research Program Earl E. Bakken Center for Spirituality & Healing, University of Minnesota”!
This systematic review was aimed at evaluating if musculoskeletal manipulations (MMs), including osteopathic manipulation and chiropractic care, are effective to improve quality of life, pain intensity and function in older adults with musculoskeletal disorders.
Randomised controlled trials, controlled non-randomised trials and open label trials evaluating the efficacy and safety of MM such as osteopathic manipulation, chiropractic manipulation, myofascial release, craniosacral therapy, as monotherapy or adjunctive therapies in older people (age ≥65 years) with musculoskeletal disorders. The main outcomes included pain intensity, functionality and quality of life. Additionally, other related outcomes were considered, such as medical use duration, mood, mobility, motion, strength and endurance. Finally, we considered any adverse events.
Selection and data extraction were performed independently by two authors. The effect estimates for each study were performed using Review Manager V.5.14. Continuous outcomes were analysed using the mean difference (95% CI). The methodological quality of the included studies was assessed using the Cochrane Risk of Bias tool 2 (RoB 2). No meta-analysis was performed.
Five parallel randomised controlled trials were included, with a total sample size of 676 participants (41.6% women with a mean age of 77.3 years): 34 with chronic pain, 265 with neck pain and 377 with low back pain. MMs were not effective in patients with chronic pain, neither in pain intensity nor in functionality.
For neck pain, considering the main outcomes, only in one of the two studies was there a statistically significant improvement in neck pain intensity only at week 12 for spinal manipulative treatment (SMT)+home exercise (HE) compared with HE alone (ES=-0.90 (95% CI -1.46 to -0.34); p=0.002).
For low back pain, SMT+HE showed a statistically significant reduction in pain at 12 weeks compared with HE (ES=-0.79 (95% CI -1.39 to -0.19) p=0.010.
For neck pain and low back pain, no statistically significant improvement in functional status and quality of life was observed with MM compared with any control group.
RoB 2 showed a high risk of bias in three studies and some concerns in the others. At the domain level, the lowest risk was observed in the randomisation process (80% with some concerns). All five studies reported adverse events, none of which were serious.
The authors concluded that this systematic review highlights the need for further investigation into complementary therapies, particularly osteopathy, for chronic pain management and prevention in elderly individuals. The results of the current work emphasise that there is a need to further investigate this topic and move the focus more on the promotion of healthy and management behaviours (eg, more physical activity, self-efficacy and adaptive coping, less healthcare utilisation, medication use) and less on the pain symptoms. The fundamental need for complementary medicine, and in particular MM such as chiropractic care and osteopathic manipulative treatment, is the development of clinical trials and RCTs to assess efficacy on quality of life, pain, functionality and general health of the elderly patient. These will help us to determine where MM can be significant.
This, it seems to me, is merely a polite way of stating that neither chiropractic nor osteopathy are supported by sound evidence, and that therapeutic claims by chiropractors and osteopaths are usually hugely exaggerated. Therefore, the prudent thing to do, if you are suffering from back or neck pain, is to use treatments that are less expensive and less likely to cause severe, sometimes life-threatening adverse effects.
On Aug. 15, 2023, the defendant is said to have failed to elicit a proper medical history from the plaintiff, including current medications used. The chiropractor also is claimed to have failed to provide him with a sufficient pre-treatment screening and assessment. Thirdly, the plaintiff claimed that the chiropractor gave him a manipulation that was contraindicated for him, which caused bleeding into the epidural space, progressive spinal compression, and need for emergency decompression surgery.
Immediately after the chiropractic manipulation, the plaintiff felt nauseous and started vomitting. He went home and began to feel right-sided weakness in his leg. Subsequently, he went to his local emergency department. The patient was immediately transferred to another hospital for an urgent laminectomy. There he remained hospitalized for a week and received physical therapy. The patient made a satisfactory recovery and was able to return to work eight weeks later.
Florence A. Carey of Crowe & Harris, Boston, the plaintiff’s expert, was of the opinion that, if the defendant had appropriately elicited information from the patient, in accordance with the accepted standard of medical care and treatment, he would have learned that the plaintiff was on anticoagulation therapy and, more likely than not, the defendant would not have performed a high velocity, low amplitude manipulation on him.
The case was settled for an amount of US $ 700,000.
This seems a fairly typical example of a serious injury caused by chiropractic spinal manipulation combined with insufficient informed consent. Such incidents do often not show up in the medical literature – instead, they are settled via legal actions which often precludes the publication of the case in a medical journal. As these cases remain undocumented in medical terms, and as chiropractors have managed to avoid creating a comprehensive monitoting system of such events, the chiropractic profession uses this situation as an opportunity to (falsely) claim that the risks of chiropractic are negligibly small or even non-existent.
And what might be the solution?
Simple!
Avoid consulting a chiropractor or any other healthcare professional who wants to manipulate your neck. Such treatments do no good and can cause serious harm.
We have often discussed the fact that chiropractic does not offer an effective option of healthcare. This begs the question, if it’s not healthcare, what is it? DD Palmer, the inventor of chiropractic, was tempted by the idea of turning it into a religion. In a way, this makes sense. As we all know, religions are not based on evidence, they are based on powerful beliefs – and so is chiropractic! Thus the concept of chiropractic as a religion might be less far-fetched as it seems at first glance.
Here is an excerpt of a letter by DD Palmer of May 1911, the period where he was very much into the religious idea:
…I occupy in chiropractic a similar position as did Mrs. Eddy in Christian Science. Mrs. Eddy claimed to receive her ideas from the other world and so do I. She founded theron a religion, so may I. I am THE ONLY ONE IN CHIROPRACTIC WHO CAN DO SO…
You ask, what I think will be the final outcome of our law getting. It will be that we will have to build a boat similar to Christian Science and hoist a religious flag. I have received chiropractic from the other world, similar as did Mrs. Eddy. No other one has laid claim to that, NOT EVEN B.J.
Exemption clauses instead of chiro laws by all means, and LET THAT EXEMPTION BE THE RIGHT TO PRACTICE OUR RELIGION. But we must have a religious head, one who is the founder, as did Christ, Mohamed, Jo. Smith, Mrs. Eddy, Martin Luther and other who have founded religions. I am the fountain head. I am the founder of chiropractic in its science, in its art, in its philosophy and in its religious phase. Now, if chiropractors desire to claim me as their head, their leader, the way is clear. My writings have been gradually steering in that direction until now it is time to assume that we have the same right to as has Christian Scientists.
Oregon is free to Chiropractors. California gives Chiropractors only one chance, that of practicing our religion.
The protective policy of the U.C.A. is O.K., but that of religion is far better. The latter can only be assumed by having a leader, a head, a person who has received chiropractic as a science, as an art, as a philosophy and as a religion. Do you catch on?
The policy of the U.C.A. is the best that B.J. can be at the head of, BUT THE RELIGIOUS MOVE IS FAR BETTER, but we must incorporate under the man who received the principles of chiropractic from the other world, who wrote the book of all chiropractic books, who today has much new matter, valuable, which is not contained in that book.
If you will watch my book closely as you read, you will find it has a religion contained in it, altho I do not so name it.
If either of the Davenport schools would take advantage of practicing our religion founded by D.D. Palmer, it will make the way of chiropractic as easy as it was for the S.C.’s…
I feel that, of the many daft and dangerous ideas of Palmer, this one is more plausible and viable than the rest (had he not died several months later, he might have succeeded with his plan). The concept of chiropractic as a religion explains the chiropractors’ stubborn rejection of science, evidence, rationality, etc. as well as their often fanatic belief in their actions. And, of course, it makes the many weird comments of chiropractors on my blog appear in an entirely different light.
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.
