Helge Franke, Klaus Hoesele | Year 2013

Osteopathic manipulative treatment (OMT) for lower urinary tract symptoms (LUTS) in women

Pathology:

Incontinence

Type of study:

Systematic review with meta-analysis

Date of publication of the study’:

2013/Jan/17

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Purpose of the study

  • Objective: to evaluate the efficacy of OMT in women with lower urinary tract disorders
  • Measured outcomes:
    • Primary: any outcome concerning lower urinary tract symptoms

Methods

  • Articles analyzed: 5
  • Search string: a combination of the following terms: “low urinary tract symptoms”, “urinary incontinence”, “urinary retention”, “voiding dysfunction”, “osteopathy”, and “osteopathic medicine”
  • Criteria of inclusion: studies on women of at least 18 years of age, diagnosed with urinary tract disorders; randomized controlled trials (RCT) and clinical controlled trials (CCT) where the effect size (the relevance of the actual result) was attributable to the OMT; other interventions implemented in the OMT group had to also be present in the control group
  • Criteria of exclusion: neurologic disorders. tumors, urinary tract infections, antibiotic therapy, interventions implemented in the OMT group but not in the control group.

Characteristics of the studies

  • 3 studies with diagnosis of stress urinary incontinence or overactive bladder
  • 2 studies with diagnosis of bladder voiding dysfunction
  • The studies ranged from low to high risk of bias (according to the Cochrane’s risk of bias – RoB – assessment method)
  • Substantial heterogeneity

Participants

  • Numbers in the smallest study: 25 women, who represented both the OMT group and the control group
  • Number in the biggest study: 60 women, of which 30 women in the OMT group and 30 in the control group
  • Total: 233 women

Interventions and evaluations

  • In the OMT groups:
    • individualized treatment based on the clinical conditions of the patients and the somatic dysfunctions detected
  • In the control groups:
    • 2 studies with pelvic floor training
    • 3 studies without treatment
  • OMT practiced by osteopaths

Results

  • Primary outcomes: OMT reported positive results on lower urinary tract symptoms in 4 out of 5 studies. In 1 study OMT showed results comparable to pelvic floor training.
    Considering all the studies, the meta-analysis defined a statistically significant effect size in favor of OMT compared to control interventions (no surgery or pelvic floor training). By carrying out a subgroup analysis, the meta-analysis revealed OMT to be better than waiting (ie, not following any treatment) and equivalent to pelvic floor training.
  • Further analysis: the somatic dysfunctions detected were mainly at the level of the urinary bladder and related ligaments, of the uterus, pelvic floor, obturator foramen (foramen obturatum), pubic symphysis, neurocranium and different parts of the spine (in particular, dorsal and sacral areas).

Discussion

OMT seems able to help women manage and reduce urinary tract symptoms on par with pelvic floor training, considered by Cochrane reviews as one of the first-line interventions for women with urinary incontinence problems.

The studies were found very heterogeneous compared to each other, most likely due to the lack of methodological standards for organizing studies on OMT. In fact, different measuring instruments were used, as well as interventions were applied according to different frequencies and durations.

Given the significant impact that urinary tract symptoms have on quality of life and given the need for conservative and well-tolerated treatments, the results of this meta-analysis show how OMT merits further investigation.

The review of Osteopedia

By Marco Chiera

Strengths: meta-analysis with evaluation of the effect size, useful as a basis for defining the sample size (how many people to recruit) of future studies; description of the main somatic dysfunctions found; analysis of studies where OMT was practiced on the basis of patients’ needs, as in its daily clinical practice.

Limits: lack of a detailed description of which outcomes were evaluated, how they were evaluated and the interventions carried out (duration, frequency, operators) in the various studies analyzed; although the aim was to carry out a meta-analysis, excluding studies other than RCT and CCT may have limited the analysis of the effectiveness of OMT on female urinary symptoms.

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