I could note that this seems to be posted in the wrong forum, but I suppose it could be of interest to any pediatric practitioners. That said, I was intrigued enough to read the article. I have one big honking problem with their study, and several smaller ones.
The smaller ones:
Very small study size - hard to draw conclusions from a single study this small. They acknowledged this in the comment.
Lack of single blinding - parents and patients knew which treatment group they were in. Some would argue that it's impossible to perform a blinded study about manipulation therapy. I disagree. Given that most of the lay public couldn't distinguish manipulation from soft tissue massage, I think it is not only possible but should be almost required for validity. Patients should have received an equal amount of "laying on" of hands by the practitioner regardless of which study group they were in. Again, they noted this limitation in their comments.
The big problem I had with this study is something they remarked on early in the section on the study participants, but didn't note as a limitation on the study in their comments. The control and study groups differed
significantly in that the group that received manipulation had only one child who was exposed to passive tobacco smoke, while the control group had
seven children exposed to passive tobacco smoke.
Since the patients were randomly assigned, this aberration is not the fault of the study design nor execution, but it should have been discussed in the comments as nearly invalidating the results.
Worse, the authors did not even try to statistically adjust for the difference in tobacco exposure. The statistical analysis appears to be merely a collection of simple comparison of means (student's t-test?) rather than a ANOVA, which should have been done for this study with such a different baseline population. Instead they draw the conclusion that manipulation is useful for AOM. My statistics knowledge is pretty rusty, so those who are more knowledgeable may correct me here.
No other demographic variable affected the relationship between group and episodes.
They say this, but it doesn't appear they actually did the statistical analysis to prove that smoke exposure didn't affect the differences. If they did, I can't find it in their publication.
Passive smoking has been
known to be a significant risk factor for AOM (Pediatrics. 1992 Aug;90(2 Pt 1):228-32.), yet they ignored this risk in their analysis. It's no surprise that the control group had a significantly higher recurrence of AOM than the study group then.
How bad is smoking for kids' ears? This Turkish study
(Arch Otolaryngol Head Neck Surg. 1999 Jul;125(7):758-62.)compared a control group and an exposure group that differed in the level of cigarette smoke exposure by only 19.4 v 14.4 cigarettes per day. They found a very significant risk even in the increased exposure of 5 extra cigarettes per day to a p < 0.001. So it seems any difference in the level of cigarettes exposure is likely to greatly increase risk of recurrent OM.
I don't fault them for the problems with their patient characteristics. I do fault them for drawing unsupported conclusions based on such questionable data and poor analysis.
Characterizing this as a "great article" is something of a stretch. Interesting, yes. Good, perhaps. Great? Not even close. The lesson here is that you have to read medical studies with a close eye. Just because it's published doesn't mean it's correct, accurate, nor well-done. It just means it's been published.
Dr Mills is a wonderful practitioner, and while I do not always agree with most tenets of what OMT can and cannot do, I think this has some merit to it.
