Clinical effectiveness of osteopathic treatment in chronic migraine: 3-Armed randomized controlled trial

Complementary Therapies in Medicine

doi:10.1016/j.ctim.2015.01.011

Summary

Objective

To assess the effectiveness of OMT on chronic migraineurs using HIT-6 questionnaire, drug consumption, days of migraine, pain intensity and functional disability.

Design

3-Armed randomized controlled trial setting: all patients admitted in the Department of Neurology of Ancona's United Hospitals, Italy, with a diagnosis of migraine and without chronic illness, were considered eligible for the study.

Interventions

Patients were randomly divided into three groups: (1) OMT + medication therapy, (2) sham + medication therapy and (3) medication therapy only. Patients received 8 treatments in a study period of 6 months.

Main outcome measures

Changing from baseline HIT-6 score.

Results

105 subjects were included. At the end of the study, ANOVA showed that OMT significantly reduced HIT-6 score (mean change scores OMT–conventional care: −8.74; 95% confidence interval (CI) −12.96 to −4.52; p < 0.001 and OMT–sham: −6.62; 95% CI −10.85 to −2.41; p < 0.001), drug consumption (OMT–sham: RR = 0.22, 95% CI 0.11–0.40; OMT–control: RR = 0.20, 95% CI 0.10–0.36), days of migraine (OMT-conventional care: M = −21.06; 95% CI −23.19 to −18.92; p < 0.001 and OMT–sham: −17.43; 95% CI −19.57 to −15.29; p < 0.001), pain intensity (OMT–sham: RR = 0.42, 95% CI 0.24–0.69; OMT–control: RR = 0.31, 95% CI 0.19–0.49) and functional disability (p < 0.001).

Conclusions

These findings suggest that OMT may be considered a valid procedure for the management of migraineurs.

The present trial was registered on www.ClinicalTrials.gov (identifier: NCT01851148).

Keywords

Osteopathic manipulative treatment; Headache; Pain; Sham therapy; Disability; Drug, HIT-6


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A literature review of clinical tests for lumbar instability in low back pain: validity and applicability in clinical practice

Chiropractic and Manual Therapies

doi 10.1186/s12998-015-0058-7

Abstract
Background
: Several clinical tests have been proposed on low back pain (LBP), but their usefulness in detecting lumbar instability is not yet clear. The objective of this literature review was to investigate the clinical validity of the main clinical tests used for the diagnosis of lumbar instability in individuals with LBP and to verify their applicability in everyday clinical practice.
Methods: We searched studies of the accuracy and/or reliability of Prone Instability Test (PIT), Passive Lumbar Extension Test (PLE), Aberrant Movements Pattern (AMP), Posterior Shear Test (PST), Active Straight Leg Raise Test (ASLR) and Prone and Supine Bridge Tests (PB and SB) in Medline, Embase, Cinahl, PubMed, and Scopus databases. Only the studies in which each test was investigated by at least one study concerning both the accuracy and the reliability were considered eligible. The quality of the studies was evaluated by QUADAS and QAREL scales.
Results: Six papers considering 333 LBP patients were included. The PLE was the most accurate and informative clinical test, with high sensitivity (0.84, 95% CI: 0.69 - 0.91) and high specificity (0.90, 95% CI: 0.85 -0.97). The diagnostic accuracy of AMP depends on each singular test. The PIT and the PST demonstrated by fair to moderate sensitivity and specificity [PIT sensitivity = 0.71 (95% CI: 0.51 - 0.83), PIT specificity = 0.57 (95% CI: 039 - 0.78); PST sensitivity = 0.50 (95% CI: 0.41 - 0.76), PST specificity = 0.48 (95% CI: 0.22 - 0.58)]. The PLE showed a good reliability (k = 0.76), but this result comes from a single study. The inter-rater reliability of the PIT ranged by slight (k = 0.10 and 0.04), to good (k = 0.87). The inter-rater reliability of the AMP ranged by slight (k = −0.07) to moderate (k = 0.64), whereas the inter-rater reliability of the PST was fair (k = 0.27).
Conclusions: The data from the studies provided information on the methods used and suggest that PLE is the most appropriate tests to detect lumbar instability in specific LBP. However, due to the lack of available papers on other lumbar conditions, these findings should be confirmed with studies on non-specific LBP patients.
Keywords: Joint instability, Lumbar instability, Low back pain, Physical examination, Reproducibility of results, Prone instability test, Passive lumbar extension test, Aberrant movements pattern, Posterior shear test

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Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare part B beneficiaries aged 66 to 99

Spine

doi: 10.1097/BRS.0000000000000725

Abstract

Study Design. Retrospective cohort study.

Objective. In older adults with a neuromusculoskeletal complaint, to evaluate risk of injury to the head, neck, or trunk after an office visit for chiropractic spinal manipulation compared with office visit for evaluation by primary care physician.

Summary of Background Data. The risk of physical injury due to spinal manipulation has not been rigorously evaluated for older adults, a population particularly vulnerable to traumatic injury in general.

Methods. We analyzed Medicare administrative data on Medicare B beneficiaries aged 66 to 99 years with an office visit in 2007 for a neuromusculoskeletal complaint. Using a Cox proportional hazards model, we evaluated for adjusted risk of injury within 7 days, comparing 2 cohorts: those treated by chiropractic spinal manipulation versus those evaluated by a primary care physician. We used direct adjusted survival curves to estimate the cumulative probability of injury. In the chiropractic cohort only, we used logistic regression to evaluate the effect of specific chronic conditions on likelihood of injury.

Results. The adjusted risk of injury in the chiropractic cohort was lower than that of the primary care cohort (hazard ratio, 0.24; 95% confidence interval, 0.23–0.25). The cumulative probability of injury in the chiropractic cohort was 40 injury incidents per 100,000 subjects compared with 153 incidents per 100,000 subjects in the primary care cohort. Among subjects who saw a chiropractic physician, the likelihood of injury was increased in those with a chronic coagulation defect, inflammatory spondylopathy, osteoporosis, aortic aneurysm and dissection, or long-term use of anticoagulant therapy.

Conclusion. Among Medicare beneficiaries aged 66 to 99 years with an office visit risk for a neuromusculoskeletal problem, risk of injury to the head, neck, or trunk within 7 days was 76% lower among subjects with a chiropractic office visit than among those who saw a primary care physician.


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Comparison of spinal manipulation methods and usual medical care for acute and subacute low back pain: A randomized clinical trial

Spine

doi: 10.1097/BRS.0000000000000724

Abstract

 

Study Design. Randomized controlled trial with follow-up to 6 months.

Objective. This was a comparative effectiveness trial of manual-thrust manipulation (MTM) versus mechanical-assisted manipulation (MAM); and manipulation versus usual medical care (UMC).

Summary of Background Data. Low back pain (LBP) is one of the most common conditions seen in primary care and physical medicine practice. MTM is a common treatment for LBP. Claims that MAM is an effective alternative to MTM have yet to be substantiated. There is also question about the effectiveness of manipulation in acute and subacute LBP compared with UMC.

Methods. A total of 107 adults with onset of LBP within the past 12 weeks were randomized to 1 of 3 treatment groups: MTM, MAM, or UMC. Outcome measures included the Oswestry LBP Disability Index (0–100 scale) and numeric pain rating (0–10 scale). Participants in the manipulation groups were treated twice weekly during 4 weeks; subjects in UMC were seen for 3 visits during this time. Outcome measures were captured at baseline, 4 weeks, 3 months, and 6 months.

Results. Linear regression showed a statistically significant advantage of MTM at 4 weeks compared with MAM (disability = −8.1, P = 0.009; pain = −1.4, P = 0.002) and UMC (disability = −6.5, P = 0.032; pain = −1.7, P < 0.001). Responder analysis, defined as 30% and 50% reductions in Oswestry LBP Disability Index scores revealed a significantly greater proportion of responders at 4 weeks in MTM (76%; 50%) compared with MAM (50%; 16%) and UMC (48%; 39%). Similar between-group results were found for pain: MTM (94%; 76%); MAM (69%; 47%); and UMC (56%; 41%). No statistically significant group differences were found between MAM and UMC, and for any comparison at 3 or 6 months.

Conclusion. MTM provides greater short-term reductions in self-reported disability and pain scores compared with UMC or MAM.

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Osteopathic manipulative treatment use in the emergency department: A retrospective medical record review

The Journal of the American Osteopathic Association

doi: 10.7556/jaoa.2015.026

Abstract

Context: Although the use of osteopathic manipulative treatment (OMT) appears to be declining, data on the use of OMT in the emergency department (ED) are not available.

Objective: To determine the quantity and characteristics of OMT performed in a single, community academic ED that houses an osteopathic emergency medicine residency.

Design: Retrospective medical record review.

Setting: A single large community academic ED with an osteopathic emergency medicine residency from July 14, 2005, to March 4, 2013.

Participants: Patients in the ED who received OMT (N=2076).

Main Outcome Measures: Medical record data were analyzed to determine patient demographics; treatment characteristics including number of procedures and patients per physician, OMT techniques used, night vs day procedure variation, and financial implication of future billing for OMT; chief complaints; primary discharge diagnoses; and length of stay in the ED.

Results: Patients were aged 0 to 95 years (mean, 39 years) and were predominately female (1260 [60.69%]) and white (1300 [62.62%]). A mean of 0.74 patients received OMT per day, and a mean of 29.65 procedures were performed per physician. When data for residents were looked at separately, the mean was higher at 40.32 procedures per physician. The top 3 discharge diagnoses were low back pain (189 patients [9.10%]), muscle spasm (106 patients [5.11%]), and spasm: muscle, back (93 patients [4.48%]). Eleven different OMT techniques were recorded, with myofascial release being used most frequently (1150 of 2868 procedures [40.09%]), followed by muscle energy (672 [23.43%]). The average length of stay in the ED was 206 minutes. A total of 1663 OMT procedures (80%) were performed during the day, whereas 413 (20%) were performed at night. Potential procedural billing for all OMT performed during the study period was $33.09 per day.

Conclusion: In contrast to perceptions that OMT use is declining, the authors found that OMT is being performed on a near daily basis in the ED. Additional research is needed to fully understand the impact of OMT in the ED.

 

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