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Osteopathic manipulative treatment including specific diaphragm techniques improves pain and disability in chronic non-specific low back pain: a randomized trial

Mireia Martí-Salvador, Laura Hidalgo-Moreno, Julio Doménech-Fernández, Juan Francisco Lisón, Maria Dolores Arguisuelas
Archives of Physical Medicine and Rehabilitation 2018 May 19

OBJECTIVE: To investigate the effects of an osteopathic manipulative treatment (OMT) which includes a diaphragm intervention compared to the same OMT with a sham-diaphragm intervention in chronic non-specific low back pain (NS-CLBP).

DESIGN: Parallel group randomized controlled trial SETTING: private and institutional health centers.

PARTICIPANTS: Sixty-six subjects (18-60 yrs.) with a diagnosis of NS-CLBP lasting at least 3 months.

INTERVENTIONS: Participants were randomized to receive either an OMT protocol including specific diaphragm techniques (n=33) or the same OMT protocol with a sham-diaphragm intervention (n=33), conducted in five sessions provided during 4 weeks.

MAIN OUTCOME MEASURE: The primary outcomes were pain [evaluated with the Short-Form McGill Pain Questionnaire (SF-MPQ) and the Visual Analogue Scale (VAS)] and disability [assessed with the Roland Morris Questionnaire (RMQ) and the Oswestry Disability Index (ODI)]. Secondary outcomes were fear-avoidance beliefs, level of anxiety and depression, and pain catastrophization. All outcome measures were evaluated at baseline, at week 4, and at week 12.

RESULTS: A statistically significant reduction was observed in the experimental group compared to the sham group, in all variables assessed at week 4 and at week 12 [SF-MPQ (MD -6.2;95%CI: -8.6 to -3.8); VAS (MD -2.7;95%CI: -3.6 to -1.8); RMQ (MD -3.8;95%CI: -5.4 to -2.2); ODI (MD -10.6;95%CI: -14.9 to 6.3]. Moreover, improvements in pain and disability were clinically relevant.

CONCLUSION: An OMT protocol that includes diaphragm techniques produces significant and clinically relevant improvements in pain and disability in patients with NS-CLBP compared to the same OMT protocol using sham diaphragm-techniques.


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