Osteopathic manipulative treatment for chronic nonspecific neck pain: A systematic review and meta-analysis

The overall traffic light evidence for the outcomes in Franke and colleagues (2015) was assessed to be yellow.

“The OTLE for the outcomes was assessed to be yellow.”

In Franke and colleagues (2015), the authors using the CBRG reported low risk of bias for all RCTs.

“The methodological quality of all RCTs, evaluated by the authors using the CBRG,18 reported a low RoB for all RCTs.”

Franke and colleagues (2015) evaluating 3 RCTs (three comparators) with 123 participants provided evidence that OMT exerted beneficial effects on chronic non-specific neck pain, with a medium effect size in reducing pain, moderate quality of evidence on pain, low heterogeneity, but no significant effect on functional status.

“Franke and colleagues28 evaluating 3 RCTs (three comparators) with 123 participants, provided evidence that OMT exerted beneficial effects on chronic non-specific neck pain (CNSNP). Specifically, a medium ES in reducing pain and a moderate quality of evidence on pain outcome were reported. A low level of heterogeneity was found. However, the meta-analysis did not show a significant effect on”

No serious adverse events occurred in any RCTs in Franke and colleagues (2015), with data reported in one RCT and as personal communications to SR authors in the other two studies.

“No serious adverse events occurred in any RCTs (data reported in an RCT and as personal communications to SR authors in the other two studies).”

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.”

Eight systematic reviews performed an appropriate literature search.

“Eight SRs performed an appropriate literature search,25–32”

Five systematic reviews reported justification for the exclusion of primary studies.

“five SRs reported justification for the exclusion of primary studies.25 26 28 31 32”

All systematic reviews evaluated the risk of bias of the included studies.

“All SRs24–32 evaluated the RoB of the included studies”

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.”

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”

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.”

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.”

The lack of solid evidence stems from a small sample size, the presence of conflicting results, and high heterogeneity in participants, outcome measures, interventions, and comparison interventions.

“The lack of solid evidence stems from a small sample size,26 28–32 the presence of conflicting results24 30 31 and a high heterogeneity in participants,25 31 outcomes measures,31 32 interventions25–27 31 and comparison interventions.25–27 32”