Preventative osteopathic manipulative treatment and the elderly nursing home resident, a pilot study

Participants

• Number: 21 people (18 female and 3 male, average age 87 years)
• Criteria of inclusion: volunteers, 65 to 100 years old, nursing home residents in Kirksville, Missouri
• Criteria of exclusion: life expectancy less than 6 months, terminal neoplasia, active tuberculosis, inability to collaborate with the attending physician, inability to tolerate OMT, metabolic bone diseases (eg, Paget’s disease and hypoparathyroidism) that could induce the risk of fractures
• Groups of study: three groups obtained by randomization (stratified by nursing home, sex and age)
  • Group 1: OMT, 8 people (10 female and 12 male, mean age 41.9 years)
  • Group 2: light touch, 6 people (11 female and 11 male, mean age 37.7 years)
  • Group 3: standard care, 7 people (13 female and 9 male, mean age 41.7 years)

Interventions and evaluations

• Evaluation via MDS assessment version 2 – mandatory clinical evaluation process for nursing home residents to monitor their functional abilities – throughout the study (on average, from 37 days before the start of recruitment until 79 days after the last intervention, to be precise)
  • amongst the collected data:
    • physical functioning (daily activity level, passive range of motion, voluntary movement and falls)
    • cognition and mood (memory, decision-making, confusion, depression, anxiety, time spent in activity)
    • health (infections, pain, steady-state conditions, change of care services, number of medications)
• Out of these data the following outcomes have been extracted:
  • memory, cognitive skills for daily decision making, infections, falls, steady-state conditions, change in care services, drug use, dependency on daily activities, mental confusion, mood, passive range of motion, voluntary movement, pain, time spent in activity
• The study was conducted in the winter months when mortality from heart attacks, acute cerebrovascular or respiratory diseases in the elderly population is greater. In this way, the preventive capacity of OMT could be better assessed
• Musculoskeletal evaluation of cervical, dorsal and lumbar spine and sacrum, pelvis and ribs for people in the OMT and light touch groups
• Collection of data such as gender, age, BMI, smoking, physical activity, type of work (sedentary or not)
• 2 sessions of OMT or light touch per month, for 5 months
  • OMT had a duration of 10-15 minutes
  • light touch had a duration of 5-10 minutes
• OMT: standardized treatment to act on the autonomic nervous system and lymphatic system, with the opportunity to perform specific techniques based on the somatic dysfunctions found in the evaluation
  • articular, springing, ligamentous tension balancing, cranial, facilitated positional release, high-velocity low-amplitude, muscle energy, myofascial release, soft tissue, Still’s and visceral techniques were used in the treatment
  • the treatment was adjusted taking under consideration the fragility of the people treated
• Light touch: treatment designed to mimic OMT but with much less pressure
• Standard care: person lying on the bed and simply observed (wait)
• OMT performed by 8 osteopaths specialized or in residential training

Results

Primary outcomes: the OMT and light touch groups showed less use of drugs and fewer hospitalizations than the standard care group in a statistically significant way.
No differences were found in respect to the other outcomes.

Discussion

Compared to standard treatments, both OMT and light touch have favored less use of drugs. In addition, people in these two groups showed less hospitalization.

Given the similarity in the results obtained with the OMT and the light touch, probably these positive effects were due more to the touch in itself than to the use of particular techniques.

However, the small sample prevents specific conclusions from being drawn on this point.
In this regard, it was noted that several people acknowledged that they had received the OMT intervention, and some gave a negative assessment as “it was not like what they had received in the past” and expressed a willingness to leave the study.

In addition, the use of simple light touch proved difficult for operators, as they easily tended to treat patients as they were accustomed in their daily clinical practice. As a result, the OMT and the light touch may have been the same type of intervention.

Given that the study has shown the feasibility of using OMT on elderly people in nursing homes, the authors hope for larger and stronger studies, given that, if the OMT was able to have significant preventive clinical effects, health care costs could be considerably reduced.