evidence for OMT

[saxonmacleod]

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I've been looking for evidence-based research on the efficacy of OMT, and haven't been able to find much. Since it is the primary difference in the whole MD vs DO debate, it is a question I'd like to answer before I have to choose myself. Most of the links from this site are dead, so if anyone out there can provide article citations it would be much appreciated. Thanks

 

[pags]

If you are choosing MD vs. DO based on OMT evidence, sounds to me that you've made up your mind already. It's very difficult to objectively study the subjective views of patients and establish a scientific endpoint. Also, there is a general lack of interest in osteopathic research, therefore, a lack of funding to supply such. How I've judged whether or not OMT is a legitimate medical modality is patient satisfaction and number of return visits, with the latter being most tangible. May I suggest you ask different questions regarding the MD vs. DO debate to further your inevitable decision, for they are much more important to your future beyond medical school.

Oh yea, there was a large study out about a year ago showing manipulation and medical management being equally effective/ineffective in the treatment of back pain. I don't have the link.

 

[Teufelhunden]

It was a NEJM article by Andersson, et al. "A Comparison Of Osteopathic Spinal Manipulation With Standard Care For Patients With Low Back Pain."

There isn't a link - you have to have online access to NEJM. Anyway...here's a little excerpt from the Results and Conclusions, just in case anyone's interested:

"The ostepathic treatment group required significantly less medication (analgesics, antiinflammatory agents, and muscle relaxants) (P<0.001) and used less physical therapy (0.2 percent versus 2.6 percent, P<0.05)."

"Conclusions. Ostepathic manual care and standard medical care have similar clinical results in patients with subacute low back pain. However, the use of medication is greater with standard care."

 

[saxonmacleod]

Thank you both for your responses. I am aware of the philosophical gulf between the two schools, and do, in fact, prefer the more holistic outlook of osteopathy. I am far from making a choice for one or the other, however, because I do not believe that my own philosophy of patient care will be affected by my choice of school. If it works for the patients, as the studies I've received have indicated, learning OMT becomes a selling point for the DO path...ergo, the reason for asking. 🙂

 

[John DO]

NIH just recently began funding research into the efficacy of Osteopathic Manipulative Treatment, with one of our clinicians being the first to receive such a grant. You will begin to see more evidence-based OMT in the future as a result of this funding, I am sure. Patients have indicated for over a century that it works; now science can do the same.

 

[blondarb]

It is rather difficult to find objective evidence based medical research on OMT. I am a second year KCOM student performing a research project on an osteopathic treatment. It has been nearly impossible for me to find anything in previous literature dealing with my topic of interest. However, there is some research being done currently. Hopefully more will be done as the AOA has recently awarded a large grant to the TCOM to establish an osteopathic research center.

It is difficult to do the research due to the wide variety of techniques and claims. I think most people (based on personal discussions) agree that OMT is/can be effective for muskuloskeletal problems. However, there are massage therapists, chiropractors and PT people who probably can do the same/similar things for less money. What becomes difficult is deciding if you want to perform these techniques in your office or not.

A major point of contention for some people are the uniquely "osteopathic" techniques e.g. cranial manipulation, rib raising and thoracic pumps. These techniques are often unproven or researched. They are also often hard to swallow when the professors are discussing them in class. Until research is done on some of them it is difficult to know whether or not they are truly effective.

One possible source of some osteopathic literature is the AOA web site.

<a href="http://www.aoa-net.org/Publications/JAOA/jaoa.htm/" target="_blank">Journal of AOA site.</a>

<a href="http://www.aoa-net.org/Publications/JAOA/fulltext/1200noll.pdf" target="_blank">Interesting article on thoracic pump.</a> The author was recently awarded the first NIH grant to study a specific osteopathic treatment. Hopefully more people will follow in his footsteps.

The above links are not going to answer your question completely, but they may show you that there is some research into OMT. You should also be aware that if you are interested in research there is a ton of stuff to study dealing with OMT.

I hope this message made some sort of sense. Good luck in your decision. I know it is a difficult one to make. Remember that everything works out in the end.

Steve
KCOM 04

 

[saxonmacleod]

Thanks for taking the time to comment on my question. I just have one more before I head back to the pre-med forums: Do you feel as if you have, as one poster put it, an effective medical kit in your hands themselves? I am thinking along the lines of the "hands on" approach to diagnosis, and although it is difficult to judge (having never been trained the MD way), would you say that this approach is a useful component of the osteopathic education? FYI, I do now have the articles mentioned herein so thanks again.

 

[Sweaty Paul]

saxonmacleod,

Like Steve, I too am a MS-II at KCOM. I don't know that I have a diagnostic kit in my hands, but, I think they are certainly part of my diagnostic kit. That is to say, that in my limited experience, I wouldn't want to not have my hands. I need the stethoscope, opthalmoscope, etc. and I need my hands. The one thing that you will learn above all else at a D.O. school is to be comfortable touching another person. This is a skill that has to be worked upon, especially in our society, where touching has so many negative or sexual conotations and it is often unsettling to touch another person with whom your are not familiar. OTM, by its very nature, is very tactile, and in learning OTM you become very comfortable in touching people.

In addition to learning to be comfortable in touching another person, and more to your question, OTM does force you to be aware of what the musculature and skeleton are doing. Am I more advanced or a better in palpation than a traditional allopathic student...I don't know, however, I am sure that I have felt more backs, necks, legs, arms, etc. than most other 2nd year medical students, and as such I have more experience to tell me when something "ain't right." And if I can feel something that isn't right perhaps it will give me a clue to look for something else that might be wrong with the patient, or, help to narrow my search when diagnosing a problem.

I realize the above ramblings aren't real specific, however, as a 2nd year student, I don't have a lot of clinical experience. Perhaps a 3rd or 4th year student with more experience, or a practicing physician could answer your question more completely and with better examples.

Sincerely

Sweaty Paul 🙂

 

[OldManDave]

In addition to the above comments by other KCOM students &lt;I'm an MS-III @ KCOM&gt;, I do know that KCOM has recently, or is just about to launch a large & well-funded center for medical research, to include somewhat of an emphasis on the efficacy of OMM.

It seems that many folks in the DO community are finally beginning to recognize, I hope, that we can't simply say, "Yeah, this stuff works...why? Cause I just know it does -- I've seen it!" Some old-world or old-world-style DOs simply wish to cling desparately to history as being sufficiently supportive of the OMM modality of intervention.

However, the new & more progressive generation of DO physicians knows that all modalities must past the litmus test of research and studies of validity and efficacy --&gt; evidence based medicine.

Personally, I have no doubt that some of the OMM armamentarium will pass and eventually be considered a portion of the standard of care. But, some it...just like many drugs and other interventions will not pass the test and be relegated to the history of medicine pile.

And that is exactly how it shold be! Keep what works and reminesce fondly about the parts that don't work over cocktails at some convention, while remembering way back when... 😛

 

[Medic171]

I have it done to me for lower back pain, it works.

 

[Realchiro]

saxonmacleod,

You may find a study useful to you. It is not specific to OMT, but rather addressed spinal maipulation in general. It is interesting to see what the study, conducted for AHCPR, a division of HHS, says about the treatment of lower back pain.

It is AHCPR publication No. 96-0644
Call fo a copy at 1-800-358-9295
ask for "Understanding Acute Low Back Problems"

Hope you find this useful.
RC