Effectiveness of osteopathic interventions in chronic non-specific low back pain: A systematic review and meta-analysis
Open accessAbstract
BACKGROUND: Chronic low back pain (CLBP) is a frequent cause of disability and it represents a medical, social and economic burden globally. Therefore, we assessed effectiveness of osteopathic interventions in the management of NS-CLBP for pain and functional status. METHODS: A systematic review and meta-analysis were conducted. Findings were reported following 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 of bias (RoB) tool. Effect size (ES) were calculated at post-treatment and at 12 weeks' follow up. We used GRADE to assess quality of evidence. RESULTS: 10 articles were included. 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 study was completely judged at low RoB. Osteopathy revealed to be more effective than control interventions in pain reduction (ES: -0.59; 95% CI: -0.81, -0.36; P < 0.00,001) and in improving functional status (ES: -0.42; 95% 95% CI: -0.68, -0.15; P = 0.002). Moderate-quality evidence suggested that MFR is more effective than control treatments in pain reduction (ES: -0.69; 95% CI: -1.05, -0.33; P = 0.0002), even at follow-up (ES: -0.73; 95% CI: -1.09, -0.37; P < 0.0001). Low-quality evidence suggested superiority of OMT in pain reduction (ES: -0.57; 95% CI: -0.90, -0.25; P = 0.001) and in changing functional status (ES: -0.34; 95% CI: -0.65, -0.03; P = 0.001). Very low-quality evidence suggested that MFR is more effective than control interventions in functional improvements (ES: -0.73; 95% CI: -1.25, -0.21; P = 0.006). CONCLUSION: Results strengthen evidence that osteopathy is effective in pain levels and functional status improvements in NS-CLBP patients. MFR reported better level of evidence for pain reduction if compared to other interventions. Further high-quality RCTs, comparing different osteopathic modalities, are recommended to produce better-quality evidence.
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Domain 15 (publication bias assessment) was rated as not applicable for all systematic reviews due to lack of a meta-analysis or inclusion in the meta-analysis of fewer than 10 trials.
“Finally, domain 15 (publication bias assessment) was rated as not applicable for all the SRs due to lack of a meta-analysis24 30–32 or the inclusion in the meta-analysis of fewer than 10 trials.25–29”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [27]
The paper’s Studies selection section reports that all 10 included studies entered the quantitative analysis. Its functional-status results likewise say all trials were included in that meta-analysis. Thus, for this cited review, the stated reason of fewer than 10 trials in the meta-analysis conflicts with our copy; the paper does not itself report a domain 15 rating. Page numbers are unavailable in our copy. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredFour reviews with 34 RCTs (41 comparators) and 3369 participants assessed the efficacy of OMT on low back pain; taking into account overlapping, there were 22 effective trials with a total of 2053 participants.
“Four reviews24–27 with 34 RCTs (41 comparators) and 3369 participants assessed the efficacy of OMT on LBP, including acute LBP, chronic LBP (CLBP), LBP with sciatica, CLBP with menopause symptoms, LBP in obese patients, acute non-specific LBP (ANSLBP), chronic non-specific LBP (CNSLBP) and/or LBP and pelvic girdle pain in pregnancy and postpartum (PP). Taking into account overlapping, there were 2”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [27]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredIn Dal Farra and colleagues, the authors using the CBN Group reported high risk of bias for all RCTs, with high-risk domains including care provider (100%), patient blinding (50%), outcome assessor blinding (17%), participant allocation (33%), and reporting bias (17%).
“The methodological quality of the primary studies, evaluated by the authors using the CBN Group,19 reported a high RoB for all RCTs [domains at high RoB (% of RCTs): high RoB for care provider (100%), patient blinding (50%), outcome assessor blinding (17%), participant allocation (33%) and reporting bias (17%)].”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [27]
Section 3.4 reports risk-of-bias concerns in all 10 included studies, with high risk for personnel blinding in all trials and participant blinding in 50%. But it reports only one of 10 trials at high risk for allocation concealment and outcome reporting, not 33% and 17%; Section 4.3 describes assessor blinding as low or unclear risk, not high risk in 17%. Section 2.6 names a 13-item tool based on the Cochrane Risk of Bias tool, not a CBN Group tool. (LLM, conf=0.90)
Experimental — accuracy not yet measuredIn Dal Farra and colleagues, a subanalysis including two trials (three comparisons) with 548 participants did not find evidence of OMT efficacy on functional status after long-term treatment (12 weeks follow-up), with low quality of evidence and no heterogeneity.
“A further subanalysis, including two trials (three comparisons) with 548 participants, did not find evidence of OMT efficacy on functional status after a long-term treatment (12 weeks follow-up). Low quality of evidence and no heterogeneity were reported.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [27]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredTwo of the nine systematic reviews registered a protocol before beginning the study.
“Two of the nine SRs registered a protocol before beginning the study.27 29”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [27]
Section 2.1 (Protocol registration; page unavailable) states that this systematic review’s protocol was approved and recorded on PROSPERO, supporting its identification as a review with a registered protocol. It does not state when registration occurred, so the claim that it happened before the study began is not established by this source. (LLM, conf=0.82)
Experimental — accuracy not yet measured
In the overview, seven systematic reviews evaluated adverse events, and from these reviews, no severe incident involving musculoskeletal, neurological, visceral, or paediatric disorders occurred after OMT.
“In our overview, we found that seven SRs25–28 30–32 evaluated adverse events, and from these SRs, it emerges that no severe incident involving musculoskeletal, neurological, visceral or paediatric disorders occurred after OMT.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [27]
The Description of results (page unavailable) reports no adverse effects in seven included studies and only increased pain or back-muscle spasticity in two others. This supports the absence of reported severe incidents in this review’s chronic low-back-pain studies, but the seven were studies, not systematic reviews; one study collected no adverse-event data, and this paper does not establish the claim across neurological, visceral, or paediatric disorders. (LLM, conf=0.87)
Experimental — accuracy not yet measuredDal Farra and colleagues revealed a significant effect, clinically relevant according to the CBN Group, of OMT in reducing pain (medium effect) and improving functional status (small effect), with substantial heterogeneity and low quality of evidence for both outcomes.
“The authors revealed a significant effect, clinically relevant according to the CBN Group,19 of OMT in reducing pain (medium effect) and improving functional status (small effect). However, substantial heterogeneity and a low quality of evidence (GRADE) were reported for both outcomes.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [27]
In Dal Farra and colleagues, a trial reported an increase in back muscle spasticity in one patient treated with OMT.
“With regards to adverse events, a trial reported an increase in back muscle spasticity in one patient treated with OMT.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [27]
All systematic reviews evaluated the risk of bias of the included studies.
“All SRs24–32 evaluated the RoB of the included studies”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [27]
Eight systematic reviews performed an appropriate literature search.
“Eight SRs performed an appropriate literature search,25–32”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [27]
According to the critical domain established in Shea et al, seven systematic reviews were rated low quality and two were rated critically low quality.
“According to the critical domain established in Shea et al,12 seven25–29 31 32 and two SRs 24 30 were rated as low and critically low quality, respectively.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [27]
Eight systematic reviews accounted for the risk of bias when interpreting and discussing the results of the systematic review.
“Eight SRs25–32 accounted for the RoB when interpreting and discussing the results of the SR.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [27]
Five systematic reviews carried out a meta-analysis and used appropriate methods for the statistical combination of findings.
“five SRs25–29 carried out a meta-analysis and used appropriate methods for the statistical combination of findings.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [27]
In Dal Farra and colleagues, a subgroup analysis of OMT performed only by osteopaths identified six trials (eight comparisons) with 739 participants; five trials were also reported in two further systematic reviews.
“A subgroup analysis evaluating the effectiveness of OMT performed only by osteopaths identified six trials (eight comparisons) with 739 participants; five trials were also reported in other two further SRs”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [27]
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 1 unverifiable, 1 not checked. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThe overall traffic light evidence for the outcomes in Dal Farra and colleagues was assessed to be yellow.
“The OTLE for the outcomes was assessed to be yellow.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [27]
Section 4.3 and Table 3 assess evidence using GRADE, with ratings ranging from very low to moderate. Searches for OTLE and traffic-light colours found no passage assigning an overall yellow rating; the cited paper therefore does not verify that assessment. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews
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“The SR by Dal Farra and colleagues 27 evaluated the effectiveness of osteopathic interventions, performed by any type of manual therapist in CNSLBP patients.”
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Interaktion zwischen Gehirn und Herz
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Rehabilitation of Lumbar Spine Disorders
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Poster Award des Osteopathic Research Institute (ORI)
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2022 AOA Research Abstracts and Poster Competition
Gill, G., Palii, S. P., Arata, A., Dologmandin, M., Chiu, S., Schwarz, J., & Jones, G. M. (2022) · Journal of Osteopathic Medicine · doi:10.1515/jom-2022-2000
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Revisión de la efectividad de la osteopatía para diferentes afecciones médicas
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Effectiveness of osteopathic craniosacral techniques: A meta-analysisPreprint
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Osteopathy as a field of scientific knowledge: the path to evidence-based research
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Cranial rhythm generation in osteopathic diagnosis: modern concepts and evidence
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- Authors
- Dal Farra, F., Risio, R. G., Vismara, L., & Bergna, A.
- Affiliations
- IRCCS Istituto Auxologico Italiano (IT)
- Venue
- Complementary Therapies in Medicine
- Publisher
- Elsevier BV
- Published
- 2021-01
- Volume
- 56
- Pages
- 102616
- ISSN
- 0965-2299 (ISSN-L)
- OpenAlex
- W3098637714
- Cited by
- 123
- References
- 68
- Citations by year
- 2026: 20 · 2025: 25 · 2024: 29 · 2023: 19 · 2022: 21 · 2021: 9
- FWCI
- 1.60
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Complementary Therapies in Medicine (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- INFM-OAR (INFN Catania) (submittedVersion, cc-by-nc-nd)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Myofascial pain diagnosis and treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
- Keywords
- chronic non-specific low back pain, osteopathic manipulative treatment, myofascial release, craniosacral therapy, analgesia, functional status, manual therapy, quality of evidence, risk of bias, follow-up outcomes, disability burden, economic burden, medication adherence, patient satisfaction, patient-centered care
- MeSH terms
- Adult, Female, Humans, Male, Middle Aged, Randomized Controlled Trials as Topic, Treatment Outcome, Low Back Pain, Manipulation, Osteopathic, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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