gms | German Medical Science

Background/research question: Osteopathy aims to holistically improve and support all health aspects. Mainly patients with musculoskeletal pain are treated. Worldwide, osteopathy has no consistent regulation, education and practice standards. However, the question arises whether the public sector should pay for those services in future. This review summarises the evidence on the effectiveness and safety of osteopathy in treating musculoskeletal pain.

Methods: A systematic literature search for RCTs was conducted in five databases. 964 citations were identified and screened by two researchers independently. The best available evidence (n=15) for each body region was selected according to the Cochrane Collaboration's tool. Additionally, we summarised a recent systematic review and meta-analysis for chronic low-back pain, which we critically appraised by the AMSTAR 2 tool.

Results: Statistically significant and some clinically meaningful reductions in pain up to three months in favour of osteopathy were observed for neck pain. For chronic low back pain, osteopathy improved pain for up to three months. It seems that shoulder and foot pain can possibly be reduced by osteopathy. However, for all other body regions and diseases (knee, osteoporosis, fibromyalgia), we cannot make a final statement. No statistically or clinically significant deteriorations occurred due to osteopathy. Osteopathy represents a safe therapeutic choice for the analysed body regions and diseases, as only very few patients reported minor adverse events.

Conclusion: The risk of bias was unclear to high. Serious limitations were given due to a lack of blinding. However, the nature of osteopathy does hardly allow for blinding those who deliver or receive it. The included systematic review was rated with high overall confidence. Heterogeneity (e.g. professions involved, comparison, outcome measurements, treatment period, follow-ups) might have influenced the results. Variations of techniques were observed even inside the same typology of intervention; therefore, a certain degree of variability in manual interventions is predictable.

Osteopathy is safe and effective for neck and low back pain. Regulations regarding education, practice and training are needed before reimbursement. However, a regulation regarding education, practice and training is needed before reimbursement. It is essential to orientate on international standards and adapt those for each country.

Competing interests: The authors report no Conflict of Interest.