Osteopathic manipulative treatment for low back and pelvic girdle pain during and after pregnancy, A systematic review and meta-analysis Una revisione sistematica con meta-analisi

Methods

• Analized articles: 8
• Search string: a combination of the following terms, free or as MeSH: low back pain, back pain, lumbopelvic pain, dorsalgia, osteopathic manipulative treatment, OMT, osteopathic medicine, pregnancy, and postpartum
• Criteria of inclusion:Criteria of inclusion: randomized controlled experimental studies (RCT), in any language, both published in scientific journals and unpublished (gray literature: theses of diploma, congress reports, ongoing trials, etc.); women over the age of 18; postpartum period between 3 and 24 months; non-specific low back pain (ie, pain between the twelfth rib and the lumbo-pelvic area) or pelvic girdle pain (ie, pain in the pubis, hips or buttocks), whether acute, subacute or chronic; studies that evaluated the OMT carried out only by osteopaths and customized to the needs of patients.
• Criteria of exclusion: non-RCT studies; women with pain having a specific cause (eg, fractures, tumors, infections, ankylosing spondylitis); studies evaluating individual techniques.

Characteristics of the studies

• 5 studies on low back pain during pregnancy
• 3 studies on postpartum low back pain
• all studies were considered of a good quality

Participants

• Number in the smallest study: 20 women in the OMT group and 19 women in the control group
• Number in the largest study: 136 women in the OMT group and 133 women in the control group
• Total: 342 women in the OMT groups and 528 women in the control group
• Average age: from 23 to 35 years

Interventions and evaluations

• Evaluation of pain using Visual Analog Scale (VAS), Numeric Rating Scale (NRS) or McGill Pain Questionnaire
• Evaluation of the functional status using Roland-Morris Disability Questionnaire, Oswestry Pain Questionnaire, Pelvic Girdle Pain Questionnaire or other valid questionnaires
• Evaluation of pain and functional status about 8 weeks after the start of the studies and 2 weeks after the last treatment session
• Treatment sessions of 45-60 minutes
• OMT: treatment tailored to meet patients’ needs
• Control: other manual therapies, sham treatment, standard of care, no treatment

Results

• Primary outcomes: Good quality evidence shows that OMT has favored pain reduction and improved functional status in women during pregnancy. Although the evidence is of lower quality, OMT has had positive effects, even of greater magnitude, on pain and functional status in postpartum women. Only 1 study out of 8 reported slightly better effects in the control group.
• Secondary outcomes: Apart from some patients who reported feeling tired after OMT, no mild or severe adverse effect was shown after osteopathic treatment.

Discussion

OMT was particularly effective in reducing back-pelvic pain and improving the ability to move and perform daily activities in pregnant or postpartum women. In general, OMT proved to be significantly more effective than the mere expectation that the disease will resolve itself spontaneously, as well as showing better effects than standard of care. However, it was not always better than the sham control treatments, which, when well done, can induce high expectations of recovery that have a positive effect on health through an important placebo effect.

L’aspetto centrale dello studio è che gli effetti positivi dell’OMT sono risultati clinicamente rilevanti, ossia in grado di effettivamente migliorare la qualità della vita delle donne trattate. Molto probabilmente, questi risultati sono stati dovuti agli effetti analgesici dell’OMT: sentendo meno dolore, le donne hanno potuto sentirsi più sicure nel muoversi e, quindi, nel vivere la quotidianità, fatto che ha può aver poi contribuito ad avere un umore migliore che, a sua volta, può aver favorito la riduzione del dolore percepito.