Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis
Open accessAbstract
BACKGROUND: Nonspecific back pain is common, disabling, and costly. Therefore, we assessed effectiveness of osteopathic manipulative treatment (OMT) in the management of nonspecific low back pain (LBP) regarding pain and functional status. METHODS: A systematic literature search unrestricted by language was performed in October 2013 in electronic and ongoing trials databases. Searches of reference lists and personal communications identified additional studies. Only randomized clinical trials were included; specific back pain or single treatment techniques studies were excluded. Outcomes were pain and functional status. Studies were independently reviewed using a standardized form. The mean difference (MD) or standard mean difference (SMD) with 95% confidence intervals (CIs) and overall effect size were calculated at 3 months posttreatment. GRADE was used to assess quality of evidence. RESULTS: We identified 307 studies. Thirty-one were evaluated and 16 excluded. Of the 15 studies reviewed, 10 investigated effectiveness of OMT for nonspecific LBP, 3 effect of OMT for LBP in pregnant women, and 2 effect of OMT for LBP in postpartum women. Twelve had a low risk of bias. Moderate-quality evidence suggested OMT had a significant effect on pain relief (MD, -12.91; 95% CI, -20.00 to -5.82) and functional status (SMD, -0.36; 95% CI, -0.58 to -0.14) in acute and chronic nonspecific LBP. In chronic nonspecific LBP, moderate-quality evidence suggested a significant difference in favour of OMT regarding pain (MD, -14.93; 95% CI, -25.18 to -4.68) and functional status (SMD, -0.32; 95% CI, -0.58 to -0.07). For nonspecific LBP in pregnancy, low-quality evidence suggested a significant difference in favour of OMT for pain (MD, -23.01; 95% CI, -44.13 to -1.88) and functional status (SMD, -0.80; 95% CI, -1.36 to -0.23), whereas moderate-quality evidence suggested a significant difference in favour of OMT for pain (MD, -41.85; 95% CI, -49.43 to -34.27) and functional status (SMD, -1.78; 95% CI, -2.21 to -1.35) in nonspecific LBP postpartum. CONCLUSION: Clinically relevant effects of OMT were found for reducing pain and improving functional status in patients with acute and chronic nonspecific LBP and for LBP in pregnant and postpartum women at 3 months posttreatment. However, larger, high-quality randomized controlled trials with robust comparison groups are recommended.
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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 [25]
The Results section, under ‘OMT versus other interventions for acute and chronic nonspecific low back pain,’ reports a meta-analysis of pain involving 10 studies, contrary to the claim that this review’s meta-analysis included fewer than 10 trials. The paper does not report the citing authors’ domain 15 rating; that rating is their own assessment. (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 [25]
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 the systematic review by Franke and colleagues (2014), GRADE revealed moderate quality of evidence for pain and high quality of evidence for functional status.
“The GRADE performed by the authors revealed both a moderate quality of evidence for pain and a high quality of evidence for functional status.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
The Methods (Data synthesis; page unavailable) confirm that the authors used GRADE to assess each outcome. A Results (Effect of interventions; page unavailable) table row reports MODERATE-quality evidence for a pain comparison, but the retrieved passages do not establish the claimed HIGH-quality rating for functional status. (LLM, conf=0.76)
Experimental — accuracy not yet measuredIn the systematic review by Franke and colleagues (2014), the authors using the CBRG reported low risk of bias for 13 RCTs and high risk of bias for 2 RCTs.
“The methodological quality of all RCTs, evaluated by the authors using the RoB from the CBRG,18 reported a low and a high RoB for 13 and 2 RCTs, respectively.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
The Methods say the authors used the Cochrane Back Review Group Risk of Bias tool. The Results report 13 studies at low risk and name two at high risk, but also rate Licciardone et al. (2009) at high risk; the Discussion says three of 15 studies had high risk. Thus the claim's count of only two high-risk RCTs does not reflect the paper's full account. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn the systematic review by Franke and colleagues (2014), a subanalysis evaluating OMT in CNSLBP patients (six trials, 771 participants) found similar meta-analysis results for effect and heterogeneity.
“Similar meta-analysis results (effect and heterogeneity) have also been found in a subanalysis evaluating the effectiveness of OMT in CNSLBP patients (six trials, 771 participants).”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
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 measured
The overall traffic light evidence for the outcomes of each condition in Franke and colleagues (2014) was assessed to be yellow.
“The OTLE for the outcomes of each condition was assessed to be yellow.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
The Methods (Data synthesis; page unavailable) say Franke and colleagues assessed evidence quality for each outcome using GRADE, not a traffic-light system. The Results (pregnant women and postpartum women; pages unavailable) rate the pregnancy outcomes low-quality and the postpartum outcomes moderate-quality. The paper therefore supports outcome-level assessments, but not a uniform yellow rating for every condition. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn the three trials of OMT for NSLBP in pregnant women, considerable heterogeneity was found for pain and substantial heterogeneity for functional status.
“Considerable (pain) and substantial (functional status) heterogeneity were found.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
The Results section on pregnant women reports three studies and says the evidence for both pain and functional status was downgraded for inconsistency. The Methods defines “considerable” and “substantial” heterogeneity, but the available passages do not give outcome-specific heterogeneity values establishing considerable heterogeneity for pain and substantial heterogeneity for functional status. No page numbers are provided in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIn Franke and colleagues (2014), adverse events were evaluated in only 4 out of 15 primary studies; two RCTs reported minor adverse events such as stiffness and tiredness, one reported no adverse event, and one reported adverse events not related to the treatment intervention.
“Adverse events were evaluated in only 4 out of the 15 primary studies. Two RCTs reported minor adverse events such as stiffness and tiredness, one no adverse event and the last one evidenced adverse events not related to the treatment intervention.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
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 measuredTwo RCTs with 119 participants evaluated OMT for NSLBP in postpartum women, identifying a large effect in reducing pain and improving functional status, no heterogeneity, and moderate quality of evidence for both outcomes.
“Two RCTs with 119 participants evaluated the effectiveness of OMT for NSLBP in PP women. A large effect of OMT in reducing pain and improving functional status was identified. No heterogeneity was found. However, a moderate quality of evidence for both outcomes was revealed.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
The Results section on postpartum women (page unavailable) reports two studies and moderate-quality evidence of substantial improvements in pain and functional status with OMT. Our copy does not establish the claimed total of 119 participants or explicitly report no heterogeneity for the postpartum comparison; searches for those figures and the postpartum heterogeneity result did not resolve them. (LLM, conf=0.83)
Experimental — accuracy not yet measuredIn the systematic review by Franke and colleagues (2014), considerable heterogeneity was found for pain and moderate heterogeneity for functional status.
“Moreover, considerable (pain) and moderate (functional status) heterogeneities were found.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
The Discussion (page not provided) reports considerable heterogeneity in many forest plots, supporting the claim that the review found considerable heterogeneity. It does not assign that description specifically to pain or report moderate heterogeneity specifically for functional status. The Methods define moderate heterogeneity but do not establish that finding for functional status. (LLM, conf=0.79)
Experimental — accuracy not yet measuredIn 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 [25]
The Results > Adverse events section evaluates adverse events in this review of low back pain studies and says that none of the reported serious events appeared related to treatment. It does not say that no serious events occurred after OMT, or address neurological, visceral, or paediatric disorders. The count of seven reviews is the citing overview’s own finding, not a finding of this source. (LLM, conf=0.87)
Experimental — accuracy not yet measuredGRADE evaluation reported low quality of evidence for both pain and functional status in NSLBP in pregnant women.
“GRADE evaluation by the authors reported a low quality of evidence for both outcomes.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
In the systematic review by Franke and colleagues (2014), the meta-analysis revealed a medium effect in reducing pain and a small effect in improving functional status, with moderate quality of evidence downgraded due to inconsistency.
“The meta-analysis revealed a medium and small effect in reducing pain and improving functional status, respectively, and a moderate quality of evidence (downgraded due to inconsistency).”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
Three trials (four comparators) with 242 participants evaluated OMT versus obstetric care, sham ultrasound and untreated for NSLBP in pregnant women, identifying a large effect in reducing pain and a medium effect in improving functional status.
“Three trials (four comparators) with 242 participants evaluated the effectiveness of OMT versus obstetric care, sham ultrasound and untreated, for NSLBP in pregnant women. A large and a medium effects in reducing pain and improving functional status, respectively, were identified.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
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 [25]
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 [25]
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”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [25]
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 [25]
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 [25]
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 [25]
The Methods > Data synthesis passage assesses evidence from included trials using GRADE, and Methods > Assessment of risk of bias evaluates those trials. Neither passage reports a Shea critical-domain assessment of systematic reviews or the claimed counts of seven low-quality and two critically low-quality reviews; searches for those terms found no supporting passage in our copy. (LLM, conf=0.72)
Experimental — accuracy not yet measured
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Research works printed but not linked: 8
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- The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-2474/15/286/prepub
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Pelletier, J., Capistrant, T., & Nordt, S. P. (2024) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2024.07.050 · Cited by 7 · see citing works
Belash, V. O., Urazgalieva, L. R., Fayzullina, R., & Agasarov, L. G. (2020) · Russian Osteopathic Journal · doi:10.32885/2220-0975-2020-3-82-94 · Cited by 7 · see citing works
Montrose, S., Vogel, M. E., & Barber, K. R. (2021) · Journal of Osteopathic Medicine · doi:10.1515/jom-2019-0193 · Cited by 7 · see citing works
- Authors
- Franke, H., Franke, J.-D., & Fryer, G.
- Affiliations
- University of Siegen (DE)
- Victoria University (AU)
- Corresponding author
- Fryer, Gary
- Venue
- BMC Musculoskeletal Disorders
- Published
- 2014-08-30
- Volume
- 15
- Issue
- 1
- Pages
- 286-286
- ISSN
- 1471-2474 (ISSN-L)
- PMC
- PMC4159549
- OpenAlex
- W2100515050
- Cited by
- 261
- References
- 65
- Citations by year
- 2026: 20 · 2025: 26 · 2024: 30 · 2023: 17 · 2022: 20 · 2021: 33 · 2020: 33 · 2019: 19 · 2018: 22 · 2017: 19 · 2016: 14 · 2015: 8
- FWCI
- 1.75
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Musculoskeletal Disorders (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Victoria University Research Repository (Victoria University) (submittedVersion, cc-by)
- Funders
- A.T. Still University
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Myofascial pain diagnosis and treatment
- Keywords
- osteopathic manipulative treatment, non-specific low back pain, analgesia, functional status, chronic low back pain, acute low back pain, pregnancy, postpartum women, manual therapy, quality of evidence, GRADE assessment, risk of bias, treatment effect heterogeneity, subgroup analysis
- MeSH terms
- Female, Humans, Postnatal Care, Pregnancy, Randomized Controlled Trials as Topic, Treatment Outcome, Low Back Pain, Manipulation, Osteopathic
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