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Comparing the Effect of Osteopathic Manipulative Medicine Versus Concussion Education for the Acute Treatment of Mild Concussion Symptoms
Angelo, N. [8]
Zwibel, H. [10]
Leder, A. [15]
Mancini, J. [25]
Yao, S. C. [54]

Journal: Journal of Osteopathic Medicine Date: 2017/11, 117(11):Pages: e102-e104. doi: Subito , type of study: randomized controlled trial

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2017.141/html)

Keywords:

concussion [29]
OMT [2951]
osteopathic manipulative treatment [2973]
randomized controlled trial [710]

Abstract:

Introduction/Objectives: The prevalence of concussion, a form of mild traumatic brain injury, is continually rising in conjunction with increasing numbers of student athletes. Head injury leads to inflammation and the accumulation of toxic mediators, such as reactive oxygen species, postulated to be the source of concussion symptoms. Symptoms can be difficult to recognize, ranging from dizziness and imbalance to emotional changes and neurocognitive deficits. Treatment includes physical and cognitive rest until asymptomatic followed by a gradual return-to-play progression. While widely accepted, complete rest can lead to deconditioning in athletes. Studies have shown that reappearance of symptoms can also occur when activity is resumed. Osteopathic manipulative medicine (OMM) uses techniques addressing somatic dysfunctions (SDs) of the musculoskeletal system that can arise after injury. OMM could potentially aid in the clearance of toxic mediators present after concussion by removing musculoskeletal restrictions and thus improving glymphatic drainage. Past research found OMM to be effective in improving concussion symptoms, including tinnitus, dizziness, and nausea, in both adolescent and adult case studies. Small pilot studies have also demonstrated improvement of concussionlike symptoms, including dizziness and imbalance, in both the acute and subacute setting. OMM has the potential to address the causes of concussion symptoms and, through randomized controlled trial, could become a valuable alternative to rest in the management of concussion. Research Question/Hypotheses: To determine the effectiveness of OMM compared with a control group receiving concussion education in addressing acute concussion symptoms as measured by the Symptom Concussion Assessment Test – 3 (SCAT-3). Methods: This study is NYIT Institutional Review Board approved, BHS-1139, and is registered at ClinicalTrials.gov (NCT02750566). This randomized controlled trial investigated the effectiveness of OMM in managing mild concussion symptoms over a 1-week period after diagnosis. Participants presenting at the NYITCOM Academic Health Care Center for concussion evaluation were recruited for this study. Participants aged 18-50 years with a diagnosis of concussion cleared of life-threatening injuries by a neurologist were included in the study. Exclusion criteria included participants with contraindications to OMM, history or current diagnosis of spinal cord injury, a neurodegenerative condition, pregnancy, inability to complete assessments, as well as loss of consciousness for greater than 2 minutes, witnessed seizures, or intractable vomiting following head injury. After informed consent, participants were randomized to an OMM or control group receiving concussion education. All participants received the intervention on the initial visit (visit 1) after enrollment and at follow-up 48-72 hours later during visit 2. Participants in the OMM group received physician-directed osteopathic manipulative treatment. Physicians were directed to assess and treat SD potentially contributing to concussion symptoms, with focus on the cranium, thoracic and lumbar spine, ribs, and pelvis/sacrum. The OMM group received key techniques to decrease craniocervical restriction and improve lymph drainage in the head and neck. Control participants received concussion education, standardizing 30 minutes of face-to-face time with a physician between groups. Data collected included pre- and postintervention SCAT-3 performed on the initial visit and follow-up visit. One week after the initial visit, SCAT-3 was repeated a final time during visit 3. SCAT-3 includes a symptom evaluation portion during which participants self-report 22 common concussion symptoms on a 0-6 severity scale, from which total symptom number and symptom severity can be summated. Data Analysis: Analysis included 22 participants, 11 who received OMM and 11 controls. One participant was not included in the analysis owing to inability to complete assessments during visit 2. Statistics were performed on IBM SPSS Statistics 24, and α was set at .05. Independent t tests were performed to determine any differences in initial concussion symptom number and severity values between groups. Mann Whitney U testing was performed to analyze mean differences between pre- and postintervention SCAT-3 symptom number and severity scores over visits 1, 2, and 3. Results: No significant differences in initial SCAT-3 symptom number and SCAT-3 symptom severity were found between the OMM and control groups. On visit 1, a statistically significant decrease in concussion symptom number (P=.005) and symptom severity (P=.003) was found from before the intervention to after the intervention in participants receiving OMM compared with controls receiving concussion education. Participants in the OMM group had a mean decrease of 3.64 in symptom number vs a 0.82 decrease in the control group. An average decrease of 12.36 in symptom severity was also seen in the OMM group vs a 4.09 decrease in the control group. On visit 2, no significant difference was found between pre and postintervention symptom number (P=.332) and severity (P=.652) for those receiving OMM vs control. Additionally, no significant difference was found between intervention groups in the change in symptom number and severity from preintervention visit 1 to preintervention visit 2 (P=.438 and P=.519, respectively) and from preintervention visit 1 to visit 3 (P=.546 and P=.436, respectively). Conclusion: The results of this study demonstrate the potential of OMM as acute treatment for mild concussion symptoms. OMM was shown to significantly decrease symptom number and severity when participants were treated at the time of their initial concussion diagnosis. Limitations of this study include a small participant population of student athletes with mild concussions, in whom symptoms usually resolved within 72 hours. OMM did not demonstrate a significant difference vs control between visit 1 and visit 2, as well as acutely from before to after the intervention during visit 2, because both groups’ symptoms resolved in the 48-72-hour follow-up period. Over the 1-week period between visit 1 and visit 3, a similar symptom resolution trend was again seen in both groups. Because of these results, further study with larger populations including moderate and severe concussions due to a variety of mechanisms is warranted. Standardization between time of concussion to treatment with OMM and the treatment techniques used by physicians should also be implemented. Through this process, OMM can be validated as an alternative treatment, supplementing the body's capacity to heal itself, to provide relief to concussion patients acutely, as well as decreasing recovery time overall.

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