Osteopathic Manipulative Treatment for Pediatric Conditions: A Systematic Review

In Posadzky and colleagues, for conditions in which more than one RCT was performed (asthma, otitis media, and cerebral palsy), contradictory results are reported.

“For conditions in which more than one RCT has been performed (asthma, otitis media and cerebral palsy), contradictory results are reported.”

The overall traffic light evidence for outcomes of each condition in Posadzky and colleagues was assessed to be red.

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

In Posadzky and colleagues, no significant effects of OMT on idiopathic scoliosis, obstructive apnoea, or temporomandibular disorders compared with various control interventions were evidenced by the single RCTs.

“By contrast, no significant effects of OMT on idiopathic scoliosis, obstructive apnoea or temporomandibular disorders compared with various control interventions have been evidenced by the single RCTs.”

In Posadzky and colleagues, the vast majority of RCTs were reported to be at high risk of bias (15 RCTs), with high-risk domains including allocation concealment (67%), patient blinding (67%), care provider blinding (100%), outcome assessor blinding (50%), addressing incomplete data (33%), selective outcome reporting (33%), and adequate sequence generation (28%), with unclear or low risk of bias

“The vast majority of the RCTs were reported by the authors to be at high RoB (15 RCTs) [domains at high RoB (% of RCTs): allocation concealment (67%), patient blinding (67%), care provider blinding (100%), outcome assessor blinding (50%), addressing of incomplete data (33%), selective outcome reporting (33%), adequate sequence generation (28%)] with unclear or low RoB for the remaining two RCTs.”

In Posadzky and colleagues, single trials provided evidence that OMT exerted beneficial effects on congenital nasolacrimal duct obstruction (post-treatment), daily weight gain and length of hospital stay, dysfunctional voiding, infantile colic, and postural asymmetry.

“The single trials provided evidence that OMT exerted beneficial effects on congenital nasolacrimal duct obstruction (post-treatment), daily weight gain and length of hospital stay, dysfunctional voiding, infantile colic and postural asymmetry.”

The systematic review by Posadzky and colleagues included 17 RCTs involving 887 participants with different paediatric conditions.

“The SR by Posadzky and colleagues30 evaluated the efficacy of OMT in paediatric conditions. This review included 17 RCTs involving a total of 887 participants with different conditions”

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

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

From the Posadzky and colleagues systematic review, low-quality RCTs favoured OMT, while moderate and high-quality RCTs failed to find OMT effectiveness.

“From the SR, it emerges that low-quality RCTs favoured OMT, while moderate and high-quality RCTs failed to find OMT effectiveness.”

In Posadzky and colleagues, adverse events were not analysed in 11 RCTs; no adverse events or serious adverse events following OMT were reported in four trials; adverse events occurred in one RCT but were not related to OMT; and one trial reported aggravation of vegetative symptoms in four patients.

“In 11 RCTs, adverse events were not analysed. No adverse events or serious adverse events following OMT were reported in four trials. Adverse events occurred in one RCT, but they were not related to OMT. One trial reported the aggravation of vegetative symptoms in four patients.”

Eight systematic reviews performed an appropriate literature search.

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

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.”

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.”

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.”

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”

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”