Effectiveness of an Osteopathic Abdominal Manual Intervention in Pain Thresholds, Lumbopelvic Mobility, and Posture in Women with Chronic Functional Constipation

EFFECT OF VISCERAL MANIPULATION ON CHILDREN WITH REFRACTORY CHRONIC FUNCTIONAL CONSTIPATION: A RANDOMIZED CONTROLLED TRIAL

BACKGROUND

Functional constipation (FC) is a common global high prevalence issue in children.

OBJECTIVE

The purpose of the present study is to evaluate the effect of visceral manipulation (VM) on children with chronic interacble FC unresponsive to the standard treatment.

METHODS

This study was conducted as a randomized, single-blind controlled trial. Fifty-two children with refractory chronic functional constipation unresponsive to the standard medical treatment were randomly allocated to two groups of 26 control (standard medical care (SMC)) and 26 intervention (SMC with VM) for 4 weeks. Abdominal pain, painful defecation, stool consistency, defecation frequency, and the dose of oral laxative were evaluated before and after the treatment period using the Pain Rating Scale, Bristol stool form scale, and patient/parents report.

RESULTS

At the end of treatment, except for the dose of oral laxative in the control group, all of the results showed a significant difference in both groups (P<0.05). The dose of oral laxative in the intervention group decreased significantly (P<0.05), however, no significant change was observed in the control group (P>0.05). In the intervention group comparison, statistically significant differences were found in all va-riables except the Bristol stool form scale (P<0.05). The Bristol stool form scale after treatments was not different when the groups were compared (P=0.32), but the number of subjects who had normal stool consistency was significantly increased in the intervention group than in the control group (P<0.05).

CONCLUSION

VM can be considered as a possible treatment without side effects besides SMC for the management of chronic FC. Further studies are needed to investigate the long-term effect of VM.

Comparison of the effects of abdominal massage and osteopathic manipulative treatment home program on constipation in children with cerebral palsy

Background and Aim

The aim of this study is to compare the effects of osteopathic manipulative therapy home program (OMT-H) versus abdominal massage home program (AMHP) in treating constipation in children with cerebral palsy (CP).

Methods

Twenty-nine children with CP with a mean age of 12.2 ± 3.76 years, who were constipated and were not on medication, were divided into three randomized groups: (i) control group (n = 10), (ii) AMHP (n = 10), and (iii) OMT-H (n = 9). In AMHP and OMT-H groups, treatment was applied as 20-min sessions every other day for 10 sessions for 3 weeks. Modified Constipation Assessment Scale (MCAS), Rome III criteria, and the Bristol Stool Form Scale (BSFS) were used for evaluation before treatment and once a week during treatment.

Results

While there was no change in constipation symptoms in the control group, there was an improvement in constipation symptoms after treatment in the AMHP and OMT-H groups (AMHP, P = 0.003; OMT-H, P = 0.000014). While the treatment showed to be effective from the first week in the OMT-H group, the change in BSFS (P = 0.026) and MCAS sub-parameters was found to be superior.

Conclusion

AMHP and OMT-H are effective and beneficial in treating constipation. In children with CP, OMT-H was found to be quicker and more successful compared with AMHP. The OMT-H can be effectively used in clinical practice in relieving constipation in CP.

Effect of osteopathic visceral manipulation for individuals with functional constipation and chronic nonspecific low back pain: Randomized controlled trial

OBJECTIVE

To investigate the effect of osteopathic visceral manipulation (OVM) on disability and pain intensity in individuals with functional constipation and chronic nonspecific low back pain.

METHODS

This study is a randomized controlled trial with a blinded assessor. Seventy-six volunteers with functional constipation and chronic nonspecific low back pain were randomized to two groups: OVM and sham OVM. The primary clinical outcome was pain intensity measured using a numeric rating scale (NRS) and disability measured using the Oswestry Disability Index (ODI). The secondary outcomes were electromyographic signals measured during the flexion-extension cycle, the finger-to-floor distance during complete flexion of the trunk and the Fear-Avoidance Beliefs Questionnaire (FABQ). All outcomes were determined after six weeks of treatment as well as three months after randomization.

RESULTS

The OVM group reported a reduction in pain intensity after six weeks of treatment and at the three-month evaluation (p < .0002) and the sham group reported a reduction in pain intensity after three-month evaluation (p < .007). For the ODI was also found in the OVM group six weeks after the end of treatment (treatment effect = -6.59, 95% CI: -12.01 to -1.17, p = .01) and at the three-month evaluation (treatment effect = -6.02, 95% CI: -11.55 to -0.49, p = .03). Significant differences were also found for paravertebral muscle activity during the dynamic phases (flexion and extension) six-week evaluations.

CONCLUSIONS

The OVM group demonstrated a reduction in pain intensity and improvement in disability after six-weeks and three-month follow-up while the sham group reduction in pain three-month follow-up.

Abdominal and Diaphragmatic Mobility in Adults With Chronic Gastritis: A Cross-Sectional Study

Objective

The purpose of this study was to assess abdominal and diaphragmatic mobility in adults with chronic gastritis compared with healthy individuals and to analyze the impact of chronic gastritis on musculoskeletal signs and symptoms of the cervical and thoracic spine.

Methods

This was a cross-sectional study conducted by the physiotherapy department at the Universidade Federal de Pernambuco in Brazil. Fifty-seven individuals participated, 28 with chronic gastritis (gastritis group [GG]) and 29 healthy individuals (control group [CG]). We assessed the following: restricted abdominal mobility in the transverse, coronal, and sagittal planes; diaphragmatic mobility; restricted cervical vertebral segmental mobility; restricted thoracic vertebral segmental mobility; and pain on palpation, asymmetry, and density and texture of the soft tissues on the cervical and thoracic spine. The measure of diaphragmatic mobility was assessed with ultrasound imaging. The Fisher exact and χ2 tests were applied to compare the groups (GG and CG) in relation to the restricted mobility of the abdominal tissues near the stomach on all planes and diaphragm, and the independent samples t test to compare the mobility measurements of the diaphragm. A significance level of 5% was considered for all tests.

Results

Restricted abdominal mobility in all directions (P < .05) was greater in GG when compared with CG except for the counterclockwise direction (P = .09). In GG, 93% of the individuals presented restricted diaphragmatic mobility, with a mean mobility of 3.1 ± 1.9 cm, and in the CG, 36.8% with a mean of 6.9 + 1.7 cm (P < .001). The GG presented a higher occurrence of restricted rotation and lateral glide mobility of the cervical vertebrae, pain to palpation, and density and texture dysfunction of the adjacent tissues when compared with CG (P < .05). In the thoracic region, there was no difference between GG and CG regarding musculoskeletal signs and symptoms.

Conclusion

Individuals with chronic gastritis presented greater abdominal restriction and lower diaphragmatic mobility, in addition to a higher occurrence of musculoskeletal dysfunction in the cervical spine when compared with healthy individuals.

Abdominal massage: A review of clinical and experimental studies from 1990 to 2021

OBJECTIVE

To systematically review the current state and holistic application of abdominal massage (AM).

DESIGN

A systematic review of qualitative evidence was conducted. All English articles exploring the topic of AM that had been published until the end of June 2021 were retrieved.

DATA SOURCES

The PubMed, Cochrane library, and Embase databases were accessed. Some original texts were obtained from Google Scholar.

DATA EXTRACTION AND SYNTHESIS

Two authors independently evaluated all search data to identify relevant studies. Disagreements were settled by discussion with a third author. Results were independently extracted into standardized sheets and checked for accuracy.

MAIN RESULTS

A total of 107 full-text reports were eligible for inclusion. Adult digestive disorders, pediatric disorders, gynecological disorders, obstetric disorders, metabolic disorders, psychological disorders, the side effects of AM, and animal experiments accounted for 49.53%, 14.02%, 7.48%, 7.48%, 4.67%, 4.67%, 5.61%, and 6.54% of all these papers, respectively, with most reports focusing on clinical studies.

CONCLUSION

The variety of diseases treated with AM is gradually increasing, and the treatment programs of AM for many diseases are being gradually optimized. Different forms of AM, especially mechanical AM, have been widely studied; the side effects of AM have also been considered; and the possible mechanisms of AM therapy continue to be discovered. In general, AM is an effective and safe therapy and can be widely used in various diseases, but further studies are necessary to clarify the mechanism of AM for different diseases. In the future, AM could become an even safer, more popular, and more modern therapy.

Effects of manual therapy on body posture: Systematic review and meta-analysis

BACKGROUND

Several clinical trials investigated the effectiveness of MT on body posture, but a systematic review grouping the results of these studies was not found in the literature.

RESEARCH QUESTION

Does manual therapy (MT) cause postural changes?

METHODS

Inclusion criteria were: randomized controlled trials in any population; studies in which the primary intervention was the use of any MT technique; studies that evaluated the immediate, short, medium, or long-term effects of interventions on body posture; and studies published in peer-reviewed scientific journals in any year and language. In March 2022, we conducted a search in the PUBMED, Cinahl, Embase, PEDro, and Cochrane Central databases that yielded 6627 articles, of which 38 including 1597 participants were eligible; of these, 35 could be grouped into 12 meta-analyses. The risk of bias was assessed using the PEDro scale and the certainty in the scientific evidence rated through the GRADE system.

RESULTS

The results allowed us to conclude with moderate certainty in the evidence that, when compared to no intervention or sham, in the short and medium term, MT reduced the forward head posture (14 studies, 584 individuals, 95%CI 0.38, 1.06), reduced thoracic kyphosis (5 studies, 217 individuals, 95%CI 0.37, 0.94), improved lateral pelvic tilt (5 studies, 211 individuals, 95%CI 0.11, 0.67) and pelvic torsion (2 studies, 120 individuals, 95%CI 0.44, 1.19) and increased plantar area (3 studies, 134 individuals, 95%CI 0.04, 0.74). With moderate certainty, there was no significant effect on shoulder protrusion (5 studies, 176 individuals, 95%CI -0.11, 0.61), shoulder alignment in the frontal plane (3 studies, 160 individuals, 95%CI -0.15, 0.52), scoliosis (2 studies, 26 individuals, 95%CI -1.57, 2.19), and pelvic anteversion (5 studies, 233 individuals, 95%CI -0.02, 0.51). With low certainty, MT had no effect on scapular upward rotation (2 studies, 74 individuals, 95%CI -0.76, 2.17). With low to very low certainty, it is possible to conclude that MT was not superior to other interventions in the short or medium term regarding the improvement of forward head posture (5 studies, 170 individuals, 95%CI -1.39, 0.67) and shoulder protrusion (3 studies, 94 individuals, 95%CI -4.04, 0.97).

SIGNIFICANCE

MT can be recommended to improve forward head posture, thoracic kyphosis and pelvic alignment in the short and medium term, but not shoulder posture and scoliosis. MT reduces the height of the plantar arch and this must be taken into account in physical therapy planning. PROSPERO registration number: CRD42021244423.

Results of a feasibility randomised controlled trial of osteopathy on neck-shoulder pain in computer users

BACKGROUND

Computer use is a well-known source of chronic pain, leading to absenteeism and reduced productivity and well-being. This study evaluated the feasibility of conducting a full-scale randomised controlled trial. Several methodological variables defined trial feasibility.

MATERIALS AND METHODS

Thirty adults, daily computer users reporting pain, were recruited. Data collection took place at LABIOMEP. Participants were randomised into 1 of 3 parallel groups and received either osteopathic, sham or no treatment. Only the volunteers were blind to group assignments. The primary objective was to study the feasibility and acceptability of the protocol.

RESULTS

Of 77 participants interested, 30 were included and randomised into three groups of ten. All participants concluded the study, and all the data was analysed. The feasibility outcomes were deemed appropriate. No adverse events or severe side effects were reported or identified.

CONCLUSION

Studying the efficacy of osteopathic consultation on computer users by conducting an RCT is feasible and safe. With adjustments, a full-scale study can be designed.

TRIAL REGISTRATION

ClinicalTrials.gov with the identifier: NCT04501575. Date registered August 06, 2020.

Effects of Osteopathic Visceral Treatment in Patients with Gastroesophageal Reflux: A Randomized Controlled Trial

Osteopathic manual treatment has been recommended as a non-pharmacological therapy for Gastroesophageal Reflux Disease (GERD). However, to date, no study has supported the effectiveness of this intervention with respect to the symptoms of the disease. Our goal was to assess the effect of an osteopathic manual technique for the lower esophageal sphincter on GERD symptoms, cervical mobility and on the C4 spinous process pressure pain threshold (PPTs).

METHODS

A randomized, double-blind placebo-controlled trial was performed. Sixty subjects suffering from GERD participated in this study and were randomly assigned to either an experimental group (EG) (n = 29), who received the osteopathic technique for the lower esophageal sphincter, or to a control group (CG) (n = 31), who received a manual contact, which mimicked the osteopathic technique without exerting any therapeutic force. Randomization was computer-generated, with allocation concealed by sequentially numbered, opaque, sealed envelopes. The GerdQ questionnaire was used to assess symptom changes the week after intervention. Cervical Range of Motion (CROM) and algometer were used to evaluate cervical mobility and PPTs before and after both treatments. Before-after between groups comparison (t-test) was used for statistical analysis of the outcome, with two measurement points (GerdQ), while repeated-measures ANOVA was used for those outcomes with four measurement points (CROM and PPT).

RESULTS

The application of the osteopathic manual treatment in subjects with GERD produced a significant improvement in symptoms one week after the intervention (p = 0.005) with a between-groups difference of 1.49 points in GerdQ score (95% CI: 0.47-2.49). PPT C4 improved in the EG after the treatment (p = 0.034; η² = 0.048) (between-groups difference 8.78 Newton/cm²; 95% CI: 0.48-17.09). CROM also increased in the EG compared to the CG (p < 0.001; η² = 0.108) (between-groups difference 33.89 degrees; 95% CI: 15.17-52.61).

CONCLUSIONS

The manual osteopathic technique produces an improvement in GERD symptoms one week after treatment, cervical mobility, and PPTs. This may mean that osteopathic treatment is useful for improving symptoms of GERD.