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Osteopathic Manipulative Treatment Reduces Oxidative Stress Levels and Improves Relative Stiffness and Quality of Life in Parkinson Disease
Moriarty, S. A. [1]
Lu, V. [1]
Oommen, C. [1]
Bellavia, L. M. [1]
Lee, J. M. [2]
Leder, A. [15]
Cheriyan, G. [6]
DiFrancisco-Donoghue, J. [9]
Mancini, J. [25]
Leheste, J. [5]
Yao, S. C. [54]

Journal: Journal of Osteopathic Medicine Date: 2017/11, 117(11):Pages: e89-e91. doi: Subito , type of study: randomized controlled trial

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

Keywords:

OMT [2951]
osteopathic manipulative treatment [2973]
oxidative stress [5]
quality of life [86]
randomized controlled trial [710]
stiffness [18]

Abstract:

Introduction: Parkinson disease (PD) is a neurodegenerative disorder involving the hallmark features of stiffness, bradykinesia, postural instability, and tremor caused by a decreased production of dopamine. Research demonstrates that neurodegeneration is commonly associated with an increase in inflammation and oxidative stress, demonstrated by higher systemic levels of reactive oxidative species (ROS) thought to originate from mitochondria in underused skeletal muscle tissue. High levels of oxidative stress, especially over a prolonged time, significantly exacerbate somatic and neuronal dysfunction. ROS are known to cause widespread damage to nucleic acids (DNA, RNA), lipids, and proteins. Specifically, damage to DNA can have severe consequences if not properly repaired, and there is evidence that this damage may contribute to the pathogenesis of PD, as well as certain cancers. Further, PD has a considerable effect on quality of life that progresses along with disease manifestation. The goal of osteopathic manipulative treatment (OMT) is to decrease musculoskeletal restrictions and improve circulation of fluids in an effort to decrease stiffness, reduce inflammation, and improve quality of life in individuals with PD. Hypothesis: We hypothesized that biweekly OMT over a 6-week period using a predefined protocol (PARK-OMM) will lead to decreased oxidative stress on DNA, reduced relative stiffness, and improved quality of life in PD compared with a 6-week controlled counseling period. Statement of Significance: By directly managing mechanical restrictions with OMT, symptoms of PD such as stiffness can be decreased, leading to an improved quality of life. Additionally, OMT can alleviate oxidative stress to DNA in PD. Methods: The study was approved by the NYIT institutional review board (BHS 975). Participants were recruited through flyer distribution and direct inquiry to patients of the NYITCOM Adele Smither's Parkinson's Center. Inclusion criteria included scores on the Movement Disorder Society's Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS) for motor function, sensory organization test (SOT) for balance, and/or the Balance Evaluation Systems Test (Mini-BESTest) for balance and gait analysis. Once included and consented, participants were randomly assigned in blocks of 2 to receive either the OMT or counseling intervention. Both groups received 6 weeks of biweekly interventions with either a 30-minute session of OMT protocol aimed to increase joint range of motion of the spine and extremities and decrease stiffness by a physician board certified in neuromusculoskeletal medicine/osteopathic manipulative medicine (NMM/OMM) or a 30-minute counseling session by a health care professional addressing a specific aspect of PD. Counseling topics included PD history and risk factors, trauma history, falls prevention, transfer and gait, balance and freezing, nutrition, exercise and stretching, depression and mental health, genetics, meditation and stress reduction, PD nonmotor symptoms, medication side effects, and sleep. Each session, both OMT and counseling, started with taking an updated history on self-reported stiffness using a 10-point scale. Additional outcome measures conducted at weeks 1, 3, and 6 included the PD Questionnaire-39 (PDQ-39) for quality of life and blood and urine samples. Additional blood and urine sample were obtained after the participants’ first intervention to assess for potential acute changes. Blood plasma and urine samples were stored at -80°C after collection until analysis. Data Analysis: Preclinical and clinical differences in study variables were compared using unpaired t test, analysis of variance, and post-hoc analysis for continuous measures, as well as χ2 tests and Fisher exact tests for categorical variables. To assess the relationship between continuous variables, correlation and linear regression analyses were used. Results: The average relative stiffness scores on the 10-point scale at week 1, week 3, and week 6 were calculated and graphed. Five of the 6 participants in the OMT group had a negative slope, with an average improvement of 3.25 points from week 1 to week 6, indicating a relative improvement in stiffness. One OMT participant had a 1-point increase in stiffness. Two of the counseling participants (n=4) had no change in stiffness from week 1 to week 6, and 1 participant showed an increase in stiffness by 2 points. One counseling participant (n=1) did not report any stiffness. PDQ-39 scores at week 1 and week 6 were analyzed for the OMT group (n=6) and the counseling group (n=4). The average change was -14 for the OMT group and 3 for the counseling group, with a lower score demonstrating an improvement in quality of life. One participant in the OMT group showed a slightly increased PDQ-39 score at week 6. Only 1 participant in the counseling group had decreased PDQ-39 scores, and the remaining 3 participants showed slightly increased PDQ-39 scores at week 6. A t test showed the trend was not statistically significant (P=.141). Blood and urine samples of the same participants were analyzed in duplicate for oxidative damage on an enzyme-linked immunosorbent assay (ELISA) platform for 8-hydroxy-2'-deoxyguanosine (8-OHdG), a critical DNA biomarker of oxidative stress and carcinogenesis. Creatinine levels were measured to determine relative kidney function to be considered with urinary measurements of 8-OHdG. Urinalysis of 8-OHdG indicated a statistically significant 37% (P=.03) reduction in oxidative damage to DNA in PD participants receiving OMT (n=6) vs counseling (n=4). Conclusion: Our pilot data demonstrating that OMT can be a useful modality in improving stiffness, a key manifestation of PD. By addressing the biomechanical restrictions of joints to improve range of motion and encouraging circulation of fluids by removing fascial restrictions, there was an improvement in participant-rated sensations of stiffness. Further, the majority of participants receiving OMT reported an improvement in quality of life compared with counseling, as measured by the PDQ-39. Decreased stiffness in PD can potentially allow for more independence and a better quality of life. Hand-in-hand with those behavioral findings, OMT-related alleviation of systemic oxidative stress levels likely affects morbidity and mortality associated with PD, which will need to be investigated further. We hope to strengthen these results as the study continues and our sample size increases.

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