Cheri Lotfi, Jesse Blair, Angela Jumrukovska, Mackenzie Grubb, Emily Glidden, James Toldi | Year 2023

Effectiveness of Osteopathic Manipulative Treatment in Treating Symptoms of Irritable Bowel Syndrome: A Literature Review

Pathology:

Irritable bowel syndrome (IBS)

Type of study:

Literature review

Date of publication of the study’:

2023/Jul/24

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Purpose of the study

  • Objective: To evaluate the efficacy and safety of OMT in reducing the severity and symptoms of IBS
  • Measured outcomes: evaluation of the improvement of IBS symptoms after OMT by comparing statistical significance (p-value).

Methods

  • Articles analyzed: 16
  • Search string:
    • use of the following terms “osteopathic visceral techniques” and “Irritable Bowel Syndrome”.
  • Criteria of inclusion: primary studies or meta-analyses; studies that used the Rome III Criteria for the diagnosis of IBS; studies containing a minimum of 5 participants.
  • Criteria of exclusion: case reports, articles published in languages other than English, studies on IBS not related to OMT.

Characteristics of the studies

  • 4 randomized controlled studies
  • 1 meta-analysis

Participants

  • Number in the smaller study: 8 people
  • Number in the biggest study: 61 people
  • Total number: 150 people

Interventions and evaluations

  • Assessment of IBS symptoms by different instruments and questionnaires, including symptom severity, Likert scale, Visual Analog Scale (VAS), Irritable Bowel Syndrome Quality of Life Instrument (IBS-QOL) questionnaire, IBS symptom severity (IBS-SS) questionnaire.
  • OMT:
    • different for each study, including visceral techniques, indirect and direct techniques, personalized treatment.
  • Control: sham treatment

Results

Primary outcomes: in 3 studies, OMT improved IBS symptoms statistically significantly with a p-value < 0.01. One of the 3 studies showed a reduction in symptoms measured by VAS 4 times greater in the OMT group than in the sham treatment control group. In a fourth study, OMT showed positive effects on IBS-QOL with a p-value = 0.015 and on IBS-SS with a p-value = 0.02 in the improvement of daily symptoms and a p-value = 0.015 in the improvement of more severe symptoms. In the last study, OMT improved IBS symptoms with a p-value < 0.006.

Studies also found short- and long-term (1 year) improvements in abdominal distension and pain, reduced rectal tenderness and constipation.

Discussion

OMT has the potential to reduce the symptoms of IBS, including constipation, diarrhea, abdominal distension, rectal hypersensitivity and abdominal pain, both in the short and long term. As a result, the quality of life of people with IBS can improve through OMT. From the analysis of one study, it can be possible to assume that at least 1 OMT session a month could have a good clinical benefit.

Visceral manipulation can improve symptoms in patients with IBS thanks to its effects on the autonomic nervous system, on fluid and nutrient influx to the tissues, on the relaxation of the smooth muscles of fascia and ligaments, and on blood and lymph flow, particularly if manipulation is performed on multiple body areas.

While 2 studies did not evaluate the safety of OMT, 3 studies reported no adverse effects. Therefore, OMT can be considered a safe treatment that can be included in standard therapy.

However, it is difficult to generalize the results presented here because the included studies considered different techniques, sessions of different duration and frequency, different questionnaires, and small samples.

The review of Osteopedia

By Marco Chiera

Strengths: both the efficacy and the adverse effects of OMT were assessed.

Limits: the introduction is lacking some further explanation as to why OMT may be useful in IBS; since this is a review, the search string should have been more articulate, and should have involved other databases (eg, PubMed); an analysis of the limits of the review is missing (only the limits of the studies analyzed were included).

Comparing the results of studies by p-value without making any methodological considerations really serves little purpose, as it favor a purely mathematical aspect and leaves out what matters in a study: sample size, inclusion and exclusion criteria, methodology adopted to avoid bias, etc. In fact, a methodologically well-structured study but with a p-value that is not statistically significant is worth much more than a methodologically deficient study but with very small p-values.

Moreover, clinical significance, which is far more important than statistical significance, is left out.

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