Osteopathic manipulative treatment of patients with chronic low back pain in the United States: a retrospective cohort study

Author:

Licciardone John C.1,Moore Samuel2,Fix Kassidy2,Blair Lillian Gowen2,Ta Khanh2

Affiliation:

1. The Osteopathic Research Center and Department of Family Medicine , University of North Texas Health Science Center-Texas College of Osteopathic Medicine , Fort Worth , TX , USA

2. University of North Texas Health Science Center-Texas College of Osteopathic Medicine , Fort Worth , TX , USA

Abstract

Abstract Context The practice of osteopathic manipulative treatment (OMT) varies substantially across nations. Much of this variability may be attributed to disparate international educational, licensing, and regulatory environments that govern the practice of osteopathy by nonphysicians. This is in contrast with the United States, where osteopathic physicians are trained to integrate OMT as part of comprehensive patient management. Objectives This study will analyze the factors associated with OMT use and its outcomes when integrated within the overall medical care for chronic low back pain (CLBP) provided by osteopathic physicians in the United States. Methods A retrospective cohort study was conducted within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION) from April 2016 through April 2022 to study the effectiveness of OMT integrated within medical care provided by osteopathic physicians. The outcome measures, which included pain intensity, pain impact, physical function, and health-related quality of life, were assessed with the National Institutes of Health Minimum Dataset, Patient-Reported Outcomes Measurement Information System, and Roland-Morris Disability Questionnaire. Results A total of 1,358 adults with CLBP entered the cohort (mean age, 53.2 years; 74.4% female), 913 completed the final quarterly encounter, 348 were in various stages of follow-up, and 97 had withdrawn. Blacks (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.21–0.63; p<0.001), cigarette smokers (OR, 0.56; 95% CI, 0.33–0.93; p=0.02), and nonsteroidal anti-inflammatory drug users (OR, 0.59; 95% CI, 0.43–0.81; p=0.001) were less likely to have utilized OMT in the multivariable analysis. Mean between-group differences among 753 participants with no OMT crossover and complete follow-up favored OMT: 1.02 (95% CI, 0.63–1.42; p<0.001) for pain intensity; 5.12 (95% CI, 3.09–7.16; p<0.001) for pain impact; 3.59 (95% CI, 2.23–4.95; p<0.001) for physical function, and 2.73 (95% CI, 1.19–4.27; p<0.001) for health-related quality of life. Analyses involving propensity-score adjustment and inclusion of participants with missing data yielded similar conclusions. None of 12 prespecified participant characteristics demonstrated an OMT interaction effect. Conclusions OMT integrated within medical care provided by osteopathic physicians for CLBP was associated with improved pain and related outcomes. Its use may be facilitated by the growing osteopathic physician workforce in the United States and adherence to relevant clinical practice guidelines.

Funder

Osteopathic Heritage Foundation

Publisher

Walter de Gruyter GmbH

Subject

Complementary and alternative medicine,Complementary and Manual Therapy

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