IBS, fibromyalgia … A number of very small RCTs with equivocal results, pilot studies, and retrospective reviews have investigated the use of OMT in postsurgical functionality, irritable bowel syndrome, fibromyalgia, infantile torticollis, muscle spasticity, joint pain, labor pain, back pain during pregnancy, adult asthma, chronic obstructive pulmonary disease, and other medical conditions. Results to date have not been meaningful enough to recommend a place for OMT in the management of these disorders.
Limitations of evidence for OMT
Studies of OMT and other forms of spinal manipulation and manual modalities have been criticized for inconsistent quality.22 Sample sizes of published studies tend to be small, rendering statistical analysis problematic.
Pretrial bias of participants may also influence outcome measures. Patients tend to have preformed opinions regarding the efficacy of manual modalities.22
The lack of validation of a placebo control has historically been problematic, and the use of sham treatment is an attempt to overcome this.23 Some studies lack objective parameters for outcomes, relying on subjective patient ratings. Finally, severity of illness in chronic conditions such as back pain varies over time, affecting study results in follow-up.24
CORRESPONDENCE Sarah Cole, DO, 12680 olive Boulevard, Suite 300, St. Louis, MO 63141; sarah.cole@mercy.net
