John Smartt Osteopath
Bachelor of Applied Science (Osteopathy) Master of Osteopathy (UWS)
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Collected Scientific Research Relating to the Use of Osteopathy with Asthma
1) Osteopathy involves helping people's own self-healing abilities to work better, rather that focussing primarily on particular conditions.
2) Each person is different, and osteopathy treats them differently.
Therefore people respond to osteopathic treatment in different ways. Treatments that work for one person cannot be guaranteed to work for another person in the same way. The fact that there is scientific research supporting a treatment in a group of people does not mean that it will always work in the same way (which is probably true of all research).
A number of things make research into osteopathy challenging. These include the two aspects of osteopathy mentioned above, and also the lack of major commercial interests to provide funding in expectation of financial returns. At the same time, there is an emerging body of research demonstrating the usefulness of osteopathic treatment.
Please note: there is room for debate about the classifications used for these studies. Please let John Smartt know if you believe that any of these classifications are incorrect.
Osteopathy should be seen as something which can be used in addition to other interventions to help people with asthma. It can often lead to an improvement, but the improvement is not always particularly large.
These studies are from peer-reviewed journals
Clinically and statistically significant results Number of studies: 8
Systematic reviews Number of studies: 2
Gleberzon BJ, Arts J, Mei A, McManus EL 2012 The use of spinal manipulative therapy for pediatric health conditions: a systematic review of the literature J Can Chiropr Assoc Jun; 56(2): 128–141 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3364062/
In general, osteopaths would tend to treat children with asthma differently to the way that chirpractors would, but osteopaths are trained to use the same techniques identified here; if they don't use these techniques, that will probably be because they are using something which they believe will work better.
This study had two purposes. These were: (i) to conduct a search of the literature between 2007 and 2011 investigating the use of spinal manipulative therapy (SMT) for pediatric health conditions and (ii) to perform a systematic review of eligible retrieved clinical trials.
The Index of Chiropractic Literature and PubMed were electronically searched using appropriate search words and MeSH terms, respectively, as well as reference tracking of previous reviews. Studies that met the inclusion criteria were evaluated using an instrument that assessed their methodological quality.
Sixteen clinical trials were found that met the inclusion criteria and were scored.
Six clinical trials investigated the effectiveness of SMT on colic, two each on asthma and enuresis, and one each on hip extension, otitis media, suboptimal breastfeeding, autism, idiopathic scoliosis and jet lag. None investigated the effectiveness of SMT on spinal pain.
Studies that monitored both subjective and objective outcome measures of relevance to both patients and parents tended to report the most favorable response to SMT, especially among children with asthma. Many studies reviewed suffered from several methodological limitations. Further research is clearly required in this area of chiropractic health care, especially with respect to the clinical effectiveness of SMT on pediatric back pain."
Pepino VC, Ribeiro JD, Ribeiro MA, de Noronha M, Mezzacappa MA, Schivinski CI. 2013 Manual therapy for childhood respiratory disease: a systematic review. Journal of Manipulative and Physiological Therapeutics Jan;36(1):57-65 http://www.ncbi.nlm.nih.gov/pubmed/23380215
"Of the 8 studies included in the present review, 5 consisted of asthmatic children and the others of children with the following conditions: cystic fibrosis, bronchiolitis, recurrent respiratory infections, among others. Only 2 studies did not identify positive results with the use of manual therapy. The other 6 studies found some benefit, specifically in spirometric parameters, immunologic tests, anxiety questionnaire, or level of salivary cortisol."
"The use of manual techniques on children with respiratory diseases seems to be beneficial. Chiropractic, osteopathic medicine, and massage are the most common interventions. The lack of standardized procedures and limited variety of methods used evidenced the need for more studies on the subject."
Randomised controlled trials Number of studies: 4
López-de-Uralde-Villanueva I,,, Candelas-Fernández P, de-Diego-Cano B, Mínguez-Calzada O, Del Corral T,. 2018 The effectiveness of combining inspiratory muscle training with manual therapy and a therapeutic exercise program on maximum inspiratory pressure in adults with asthma: a randomized clinical trial. Clin Rehabil Jan 1:269215517751587 https://www.ncbi.nlm.nih.gov/pubmed/29318917
The objective of this study was to evaluate whether the addition of manual therapy and therapeutic exercise protocol to inspiratory muscle training was more effective in improving maximum inspiratory pressure than inspiratory muscle training in isolation.
This is a single-blinded, randomized controlled trial.
In total, 43 patients with asthma were included in this study.
The patients were allocated into one of the two groups: (1) inspiratory muscle training ( n = 21; 20-minute session) or (2) inspiratory muscle training (20-minute session) combined with a program of manual therapy (15-minute session) and therapeutic exercise (15-minute session; n = 22). All participants received 12 sessions, two days/week, for six weeks and performed the domiciliary exercises protocol.
The main measures such as maximum inspiratory pressure, spirometric measures, forward head posture, and thoracic kyphosis were recorded at baseline and after the treatment. RESULTS:
For the per-protocol analysis, between-group differences at post-intervention were observed in maximum inspiratory pressure (19.77 cmH2O (11.49-28.04), P < .05; F = 22.436; P < .001; η2p = 0.371) and forward head posture (-1.25 cm (-2.32 to -0.19), P < .05; F = 5.662; P = .022; η2p = 0.13). The intention-to-treat analysis showed the same pattern of findings.
The inspiratory muscle training combined with a manual therapy and therapeutic exercise program is more effective than its application in isolation for producing short-term maximum inspiratory pressure and forward head posture improvements in patients with asthma."
Bockenhauer SE, Julliard KN, Lo KS, Huang E, Sheth AM 2002 Quantifiable effects of osteopathic manipulative techniques on patients with chronic asthma. J Am Osteopath Assoc Jul;102(7):371-5; discussion 375 http://www.ncbi.nlm.nih.gov/pubmed/12138951
"In this pilot study, the authors evaluated the immediate effects of osteopathic manipulative procedures compared with sham procedures on 10 subjects who were diagnosed with chronic asthma. The research followed a pretest-posttest crossover design wherein each subject served as her own control. Blinded examiners recorded respiratory excursion, peak expiratory flow rates, and subjective measures of asthma symptoms. Measurements of both upper thoracic and lower thoracic forced respiratory excursion statistically increased after osteopathic manipulative procedures compared with sham procedures. "
Mehl-Madrona L, Kligler B, Silverman S, Lynton H, Merrell W 2007 The impact of acupuncture and craniosacral therapy interventions on clinical outcomes in adults with asthma. Explore (NY) Jan-Feb;3(1):28-36. http://www.ncbi.nlm.nih.gov/pubmed/17234566
"When treatment was compared with the control group, statistically treatment was significantly better than the control group in improving asthma quality of life, whereas reducing medication use with pulmonary function test results remained the same."
"Acupuncture and/or craniosacral therapy are potentially useful adjuncts to the conventional care of adults with asthma, but the combination of the two does not provide additional benefit over each therapy alone."
"Having a longer, more intensive treatment protocol with a single practitioner was associated with better reductions of anxiety on the BAI [Beck Anxiety Index]."
Guiney PA, Chou R, Vianna A, Lovenheim J 2005 Effects of osteopathic manipulative treatment on pediatric patients with asthma: a randomized controlled trial. J Am Osteopath Assoc Jan;105(1):7-12 http://www.ncbi.nlm.nih.gov/pubmed/15710659
"Osteopathic manipulative treatment (OMT) is an underutilized noninvasive treatment method for patients with asthma. The use of OMT may help decrease mortality and morbidity rates among this patient group. The authors conducted a randomized controlled trial attempting to demonstrate the therapeutic relevance of OMT in the pediatric asthma population. With a confidence level of 95%, results for the OMT group showed a statistically significant improvement of 7 L per minute to 9 L per minute for peak expiratory flow rates. These results suggest that OMT has a therapeutic effect among this patient population"
Other controlled clinical trials Number of studies: 2
Lee-Wong M, Karagic M, Gomez S, Wilson A, Resnick D 2008 Adding Osteopathic Intervention to Albuterol Nebulization in Ambulatory Asthma Exacerbations The Internet Journal of Asthma, Allergy and Immunology 7:2 https://ispub.com/IJAAI/7/2/12537
"We conducted this study to describe osteopathic manipulative treatment (OMT) as an adjunct to traditional therapies in acute asthma exacerbation.Methods: A sample of previously diagnosed asthma patients who were having an acute asthma exacerbation were offered to receive OMT treatment as an adjunct to traditional modalities of treatment for acute exacerbation. Each patient was given an albuterol nebulizer treatment followed by an accepted OMT technique known as “rib raising” maneuver for five minutes. Peak flows were obtained before and after each treatment. Each patient was asked to fill out a symptom score diary rating their asthma symptoms before nebulizer treatment, after nebulizer treatment and after OMT. Results: The data showed an average increase in peak flow rates after nebulizer treatment was 36 L/min with a further average increase in peak flow after OMT of 18 L/min with a net increase of 54 L/min (ANOVA, p<0.05). OMT was not associated with any adverse effects or complaints. Study patients reported that the combined nebulizer and OMT treatments made them feel better than in the past when they were offered only traditional albuterol nebulizer treatments. Conclusion: Patients treated for acute asthma exacerbation with nebulizer treatment followed by osteopathic treatment (rib raising maneuver) showed significant improvement in their overall breathing. Unfortunately, lack of a control group in which there would be nebulizer treatment plus no osteopathic treatment makes it uncertain whether this OMT treatment had more than a placebo effect."
Wheatley A, Gosling CM, Gibbons PF 2000 Investigation of the Effects of Using a Rib Raising Technique on FEV1, and FCV Otucomes in People with Asthma: A Clinical Investigation Journal of Osteopathic Medicine 3(2): 60-64
"The aim of this study was to identify whether a manual medicine technique could produce a measurable change in ventilatory function in asthma sufferers."
"Pre- and post-intervention FVC [forced vital capacity] and FEV [forced expiratory volume] measures were recorded for both groups. The rib-raising treatment produced a change in FEV1 of 15.8% for the asthma group and 3.8% for the control group, and a change in FVC of 17.5% and 5.7% respectively."
"These findings indicate that rib raising technique increased lung function in all subjects but showed a trend towards a significantly greater improvement in FEV1 and FVC in asthmatic subjects."
Mixed results (significant for some outcomes, not others)
Kaminskyj A, Frazier M, Johnstone K, Gleberzon BJ. 2010 Chiropractic care for patients with asthma: A systematic review of the literature. J Can Chiropr Assoc Mar;54(1):24-32 https://www.ncbi.nlm.nih.gov/pubmed/20195423
To provide a review of the literature and rate the quality of published studies regarding
chiropractic care, including spinal manipulation, for asthmatic patients.
A multimodal search strategy was conducted, including multiple database searches, along with reference and journal hand-searching. Studies were limited to those published in English and in peer-reviewed journals or conference proceedings between January 1980 and March 2009. All study designs were considered except personal narratives or reviews. Retrieved articles that met the inclusion criteria were rated for quality by using the Downs and Black checklist. A brief summary was also written for each retrieved study.
Eight articles met the inclusion criteria of this review in the form of one case series, one case study, one survey, two randomized controlled trials (RCTs), one randomized patient and observer blinded cross-over trial, one single blind cross study design, and one self-reported impairment questionnaire. Their quality scores ranged from 5 to 22 out of 27.
Results of the eight retrieved studies indicated that chiropractic care showed improvements in subjective measures and, to a lesser degree objective measures, none of which were statistically significant. It is evident that some asthmatic patients may benefit from this treatment approach; however, at this time, the evidence suggests chiropractic care should be used as an adjunct, not a replacement, to traditional medical therapy."
It is unclear whether the following journals are peer-reviewed
Clinically and statistically significant results Number of studies: 3
Randomised controlled trial
Williams K, Gosling C 2008 An investigation of the lasting effects of thoracic manipulation and rib raising on spirometric measurements of asymptomatic participants Victoria University Research Repository 04 Sep 2008 23:13 http://vuir.vu.edu.au/933/
"Although research has been undertaken into the effects of manual intervention on common respiratory conditions, very little research has been undertaken into whether manual therapy can produce a significant improvement in the respiratory function of asymptomatic volunteers one week after the manual intervention. To test whether a relationship exists between the effects of thoracic HVLA and rib raising (RR) on the pulmonary function of asymptomatic volunteers one week after the manual intervention, 38 participants (males = 25, females = 13) were randomly assigned to either a HVLA (n=11), RR (n=14) or a HVLA + RR group (n=13). Statistically significant increases were observed in both FVC (p=0.005) and FEV1 (p=0.002) within each of the three groups over time (pre-test, post-test, 1 week). However, no significant increases were found neither in the chest diameter values within the three treatment groups with respect to time nor between the three groups at any of the three time periods. The greatest increases in percentage change occurred in FEV1 and FVC values at the 1 week time period, particularly for the HVLA + RR and the RR group in which respective FEV1 increases of 10.5% and 7.41% occurred. The results of this study suggest that HVLA and rib raising ought to be equally effective in improving the pulmonary function of asymptomatic individuals , given that no statistically significant difference was found between the mean FEV1 and FVC values within the 3 groups over time. Since previous research shows that rib raising produces within subject increases in both FEV1 and FVC over time that are statistically significant in asthmatics, it may be possible to infer that HVLA may be as useful an adjunct as rib raising in the long-term management of stable asthma. This minor thesis was written by a post-graduate student as part of the requirements of the Master of Health Science (Osteopathy) program."
Case reports Number of studies: 2
Esnouf E, Gosling C 2004 The Effect of Osteopathic Treatment on Lung Function in Children with Asthma: A Case Study Victoria University http://vuir.vu.edu.au/794/1/Esnouf_et.al_2005. pdf
"Lung function improved in the treatment participant with spirometry values (FVC, FEV1, FEV1/FVC, PEF and F25-75) improving overall, compared to minimal improvements in the control participant for FVC and FEV1. All other values for the control participant showed either no change or a decline in lung function. The participant in the treatment group had an improvement of 58.85% in FEV1 at the end of the second treatment session compared to a 10.06% improvement in the control participant. FEV1/FVC improved by 22.19% on average for the treatment participant compared to a decline of 8.80% in the control participant. A marked improvement was found in functional capacity as determined by the asthma control questionnaire, with medication usage decreasing by half in the participant who received osteopathic treatment. Conclusion: This case study suggests that osteopathic treatment may improve lung function in the children with asthma when compared to a sham control treatment."
Albones E, Gosling C, Cornall D 2005 The Short and Intermediate Term Effect of Rib Raising on Lung Function on a Child with Asthma: A Comparison Case Study Osteopathic Medicine, School of Health Sciences, Victoria University, Melbourne (unpublished thesis) http://vuir.vu.edu.au/740/1/Albones_et.al_2005.pdf
This was a very limited study with only two subjects. At the same time, it did include a control (one of the subjects). It is not published in a peer-reviewed journal.
"Objective: The aim of this study was to determine whether the use of a specific manual therapy technique, rib raising, could produce short and intermediate term improvements in the lung function in children with chronic asthma.
Clinical Features: A comparative single case study was carried out between two asthmatic children aged 16-17, both with a long history of mild asthma requiring the use of ventolin up to five times a week.
Intervention: One received the rib raising technique and the other a sham technique. Pre and post treatment FEV1 and FVC were recorded for both participants over the short and intermediate term.
Outcomes: The rib raising participant showed, in the short term (20 minutes post treatment), up to a 13.81% increase in FVC and up to an 18.37% increase in FEV1 compared to the sham technique of 3.48% and 8.28%, respectively. In the intermediate term (one week post treatment) the rib raising improved FVC by 10.49% and FEV1 by 24.90%, while the sham yielded FVC improvements of 0.87% and FEV1 of 5.73%. Overall FEV1/FVC increased by 8% in the rib raising compared to only 3% in the sham technique.
Conclusions: These results demonstrate that rib raising produce an increase in the lung function of an asthmatic child in the short and intermediate term."