JAMA study raises question on OMT utility for low back pain
France: A recent study published in the journal JAMA Internal Medicine raise the issue of osteopathic manipulative treatment (OMT) usefulness in people with low back pain (LBP). The study found that OMT had a statistically significant but small effect on patients with nonspecific subacute and chronic LBP.
According to the researchers, clinical usefulness of the treatment is questionable is LBP patients.
Osteopathic manipulative treatment is frequently used in people with nonspecific LBP but is never compared with sham OMT for the reduction of LBP-specific activity limitations. Christelle Nguyen, Faculté de Santé, Université de Paris, Paris, France, and colleagues, therefore, aimed to compare the efficacy of standard OMT vs sham OMT for reducing LBP-specific activity limitations at 3 months in persons with nonspecific subacute or chronic LBP.
For the purpose, the researchers performed a prospective, parallel-group, single-blind, single-center, sham-controlled randomized clinical trial. It recruited articipants with nonspecific subacute or chronic LBP from a tertiary care center in France starting February 17, 2014 and followed till October 23, 2017.
Participants were randomly allocated to interventions in a 1:1 ratio to receive either six sessions (1 every 2 weeks) of standard OMT (n=200) or sham OMT (n=200) delivered by nonphysician, nonphysiotherapist osteopathic practitioners.
The primary end point was mean reduction in LBP-specific activity limitations at 3 months as measured by the self-administered Quebec Back Pain Disability Index (score range, 0-100).
Key findings of the study include:
- The mean (SD) duration of the current LBP episode was 7.5 (14.2) months. Overall, 164 (83.2%) patients in the standard OMT group and 159 (80.7%) patients in the sham OMT group had the primary outcome data available at 3 months.
- The mean (SD) Quebec Back Pain Disability Index scores for the standard OMT group were 31.5 (14.1) at baseline and 25.3 (15.3) at 3 months, and in the sham OMT group were 27.2 (14.8) at baseline and 26.1 (15.1) at 3 months.
- The mean reduction in LBP-specific activity limitations at 3 months was −4.7 and −1.3 for the standard OMT and sham OMT groups, respectively.
- At 12 months, the mean difference in mean reduction in LBP-specific activity limitations was −4.3, and at 3 and 12 months, the mean difference in mean reduction in pain was −1.0 and −2.0 respectively.
- There were no statistically significant differences in other secondary outcomes.
- Four and 8 serious adverse events were self-reported in the standard OMT and sham OMT groups, respectively, though none was considered related to OMT.
"In this randomized clinical trial of patients with nonspecific subacute or chronic LBP, standard OMT had a small effect on LBP-specific activity limitations vs sham OMT. However, the clinical relevance of this effect is questionable," wrote the authors.
The study titled, "Effect of Osteopathic Manipulative Treatment vs Sham Treatment on Activity Limitations in Patients With Nonspecific Subacute and Chronic Low Back Pain: A Randomized Clinical Trial," is published in the journal JAMA Internal Medicine.
DOI: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2777527
