Effectiveness of osteopathic interventions for chronic non-specific lower back pain

Chronic low back pain is a common cause of disability and represents a medical, social and economic burden worldwide.
Therefore, we investigated the effectiveness of osteopathic interventions in the treatment of lower extremity lumbalgia in relation to pain and functional status.
A systematic review and meta-analysis were conducted by Dal Farra etl al 2021.
The results were reported according to the PRISMA statement.
Six databases were searched for RCTs.
Studies were independently assessed using a standardized form.
Each article was assessed using the Cochrane Risk Bias Tool (RoB).
Effect sizes (ES) were calculated at baseline and after 12 weeks of follow-up.
The quality of evidence was assessed using the GRADE method.
Results.
10 articles were included.
The studies investigated osteopathic manipulative treatment (OMT, n = 6), myofascial release (MFR, n = 2), craniosacral treatment (CST, n = 1) and osteopathic visceral manipulation (OVM, n = 1).
None of the studies focused exclusively on low risk of bias.
Osteopathy was found to be more effective than control interventions in reducing pain (ES: -0.59; 95% CI: -0.81, -0.36; P < 0.00.001) and improving functional status (ES: -0.42; 95% CI: -0.68, -0.15; P = 0.002).
The moderate-quality evidence suggests that MFR was more effective than control interventions for pain reduction (ES: -0.69; 95% CI: -1.05, -0.33; P = 0.0002) and also for follow-up (ES: -0.73; 95% CI: -1.09, -0.37; P < 0.0001).
Lower quality evidence indicates superiority of OMT for pain reduction (ES: -0.57; 95% CI: -0.90, -0.25; P = 0.001) and change in functional status (ES: -0.34; 95% CI: -0.65, -0.03; P = 0.001).
Very weak evidence suggests that MFR was more effective than control in terms of functional improvement (ES: -0.73; 95% CI: -1.25, -0.21; P = 0.006).
Conclusion Results from a 2021 study support the evidence that osteopathy is effective in improving pain levels and functional status in patients with chronic non-specific low back pain.
Higher evidence for pain reduction was reported for myofascial release approaches compared to other interventions.
Further high quality systematic reviews comparing different osteopathic modalities are recommended to provide higher quality evidence. Dal Farra F, Risio RG, Vismara L, Bergna A. Effectiveness of osteopathic interventions in chronic non-specific low back pain: A systematic review and meta-analysis.
Complement Ther Med. 2021 Jan;56:102616.
doi: 10.1016/j.ctim.2020.102616.
Epub 2020 Nov 13. PMID: 33197571.