Efficacy of osteopathic manipulative treatment in patients with Parkinson’s disease, a narrative review

Methods

• Articles analyzed: 5
• Search strings: a combination of the following terms: OMM (osteopathic manipulative medicine), OMT, osteopathic, Parkinson Disease, manual therapy, physical therapy, training, autonomics, gait, balance
• Criteria of inclusion: studies published between 2010 and 2021; studies evaluating OMT and other forms of manual therapies ascribable to osteopathic techniques on people with Parkinson’s disease.
• Criteria of exclusion: descriptive studies of single cases; conference abstracts; articles not in English; studies where OMT and manual therapies have not been applied on people with Parkinson’s disease.

Characteristics of the studies

• 1 OMT study and lifestyle-related counseling (nutrition, stress management, exercise, etc.)
• 1 study on manual therapies
• 1 study on manual therapies with coordination exercises
• 1 study on cranial therapy and exercises
• 1 studio on OM and intestinal health

Participants

• Number in the smallest study: 6 people in the control group for 4 weeks and the same 6 people in the OMT group for a further 4 weeks
• Number in the biggest group: 22 people in the group with OMT and 14 people in the control group
• Total: 28 people in the groups with OMT or other kind of manual therapies, 29 in the control groups and 35 people who received both interventions deferred over time (e.g. first OMT and then control intervention, or vice versa)

Interventions and evaluations

• From a 2-day study to assess immediate effects, to a 1-year study
• Personalized OMT according to the patient’s needs
• Manual techniques similar to osteopathic techniques
• Coordination and relaxation exercises
  in the control groups: no intervention, physical exercises, other manual therapies, same interventions as the treatment group but reversed over time (eg, if the intervention group first received the OMT and then the counseling, the control group first received the counseling and then the OMT)

Results

Outcome primari: improvement in motor functions and, partially, in balance and gait.

Techniques similar to myofascial release have decreased fatigue, pain, stiffness and difficulty in moving, improving gait (speed and stride length) and shoulder mobility. They also favored a reduction in the severity of the disease measured with the Unified Parkinson’s Disease Rating Scale and an improvement in balance.

Cranial osteopathy appears to improve gait in the immediate.
The OMT directed at the visceral level and through techniques aimed at improving the functionality of the autonomic nervous system has favored a better intestinal health (less constipation and changes in the composition of the microbiota), improving the quality of life.

Discussion

OMT and similar manual techniques have shown to improve movement control and balance in people with Parkinson’s disease, while at the same time reducing their perception of fatigue, stress and pain and also improving their mood and quality of sleep.

Unfortunately, the low quality of the studies makes it difficult to draw solid conclusions. However, this study may be the starting point for more targeted and better organized clinical trials.

Moreover, since Parkinson’s disease is considered incurable and, therefore, is addressed through a symptomatic approach, interventions that show their effectiveness on symptoms and potentially reduce the progression of the disease can become an important help for patients.