Osteopathic manipulative treatment for low back and pelvic girdle pain during and after pregnancy: A systematic review and meta-analysis

Four 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”

In Franke and colleagues (2017), the authors using the CBRG identified low risk of bias for all RCTs.

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

In Franke and colleagues (2017), pooled analysis of five RCTs with 677 pregnancy participants reported efficacy of OMT in reducing pain and improving functional status, with a medium effect and considerable heterogeneity, and GRADE indicated moderate quality of evidence.

“The pooled analysis of five RCTs with 677 pregnancy participants reported the efficacy of OMT in reducing pain and improving functional status; however, a medium effect and a considerable heterogeneity were revealed. The GRADE performed by the authors indicated a moderate quality of evidence.”

The overall traffic light evidence for the outcomes of each condition in Franke and colleagues (2017) was assessed to be yellow.

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

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”

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.”

In Franke and colleagues (2017), meta-analysis including three studies with 173 postpartum participants revealed a significant effect favouring OMT in reducing pain and improving functional status, with a large effect and substantial/considerable heterogeneity, and GRADE found low quality of evidence.

“The meta-analysis including three studies with 173 PP participants revealed a significant effect in favour of OMT in reducing pain and improving functional status, although a large effect and substantial/considerable heterogeneity for both outcomes were reported. The GRADE performed by the authors also found a low quality of evidence.”

Franke and colleagues (2017) identified eight RCTs with 850 participants evaluating OMT on NSLBP and pelvic girdle pain in pregnancy (five RCTs, seven comparisons) and on NSLBP in postpartum women (three trials, three comparisons).

“In another SR, Franke and colleagues26 identified eight RCTs with 850 participants evaluating the efficacy of OMT on NSLBP and pelvic girdle pain in pregnancy (five RCTs, seven comparisons) and on NSLBP in PP women (three trials and three comparisons)”

In Franke and colleagues (2017), one study reported occasional tiredness after OMT, two studies did not find adverse events, and the remaining five studies did not analyse adverse events.

“Concerning the adverse events, one study reported occasional tiredness in some patients after OMT, two studies (personal communications to authors SR) did not find adverse events and the remaining five studies did not analyse adverse events.”

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.”

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

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

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”

Eight systematic reviews performed an appropriate literature search.

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

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”

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.”

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.”