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Managing Tremor in Parkinson Disease Using Osteopathic Manipulative Medicine

Journal: Journal of Osteopathic Medicine Date: 2018/11, 118(11):Pages: e166-e167. doi: Subito , type of study: controlled clinical trial

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2018.163/html)

Keywords:

controlled clinical trial [283]
OMT [2951]
osteopathic manipulative treatment [2973]
tremor [5]

Abstract:

Background: Tremor is a common symptom of Parkinson disease (PD), presenting as an obstacle to daily functioning and gradually decreasing quality of life and independence of its patients. PD patients have increased difficulty using objects and decreased writing movement speed. Spiral tracings are effective measurements of tremor and correlate significantly with the unified Parkinson disease rating scale (UPDRS) findings. Tremors during spiral tracing decreased after medication intake, suggesting that spirals/graphical tasks might be more sensitive in diagnosing tremor than the UPDRS. Pharmacologic treatment may control tremors, but short- and long-term use are not without side effects and symptoms may persist. Decreasing the severity of tremors through osteopathic manipulative medicine (OMM) may help reduce medication intake and serve as a safe alternative management option in patients with PD. Hypothesis: OMM will reduce severity of tremors in PD as measured by spiral tracing and hand-drawn straight line tests. Statement of Significance: OMM applied to restricted and stiff regions of PD patients may show improvement in tremor symptoms with little to no side effects. Reduction in tremor may drastically increase quality of life in this population. Methods: This study was approved by the NYIT institutional review board. Six individuals with PD and tremors were equally divided into 2 groups: 1 receiving OMM and the other receiving counseling twice per week for 6 weeks. Both groups performed spiral tracing and straight line drawing tests before and after intervention at visit 1 (week 1), visit 12 (week 6), and at week 10 after a 4-week washout. These tests were evaluated for time (duration of task completion) and accuracy (number of deviations from the tracing outline). The OMM group received a 30-minute OMM session using muscle energy, myofascial, and articulatory techniques targeting the head, spine, thoracic cage, and extremities. The counseling group attended 30-minute 1-on-1 counseling sessions on a variety of topics pertaining to PD. The tests were scored by 2 to 3 graders and the scores were averaged. Data Analysis: Means for number of deviations and length of time were analyzed using a 2×4 mixed ANOVA approach. Results: The week 1 presession loose spiral mean (SE) number of deviations for OMM group and counseling group were 27.7 (5.1) and 20.5 (7), respectively; the mean (SE) times in seconds for OMM group and counseling group were 48.0 (30.0) and 30.5 (5.5) seconds, respectively. The week 1 postsession loose spiral mean (SE) number of deviations for OMM group and counseling group were 27.8 (2.7) and 15 (1.5), respectively. The week 6 presession loose spiral mean (SE) number of deviations for OMM group and counseling group were 18.1 (4.3) and 16.5 (2.4), respectively; the mean (SE) times for OMM group and counseling group were 37.2 (9.4) and 23.9 (4.2) seconds, respectively. The week 10 loose spiral mean (SE) number of deviations for OMM group and counseling group were 21.2 (5.0) and 18.5 (2.3), respectively; the mean (SE)times for OMM group and counseling were 42.3 (27.8) and 27.3 (10.8) seconds. No significant differences were found between the group or weeks for number of deviations (P=0.635) or time (P=0.293). The week 1 presession tight spiral mean (SE) number of deviations for OMM group and counselling group were 35.8 (6.8) and 38.5 (15.5), respectively; the mean times for OMM group and counselling were 66.7 (35.7) and 61.5 (2.5) seconds, respectively. The week 1 postsession tight spiral mean (SE) number of deviations for OMM group and counselling group were 30.1 (5.7) and 31.8 (5.8), respectively. The week 6 presession tight spiral mean (SE) number of deviations for OMM group and counselling group were 26.1 (3.4) and 22.3 (1.0), respectively; the mean (SE) times for OMM group and counselling group were 81.3 (23.8) and 47.7 (8.4) seconds. The week 10 tight spiral mean (SE) number of deviations for OMM group and counselling group were 20.6 (1.1) and 27.0 (5.3). No significance differences were found between the group or weeks for number of deviations (P=0.215) or time (P=0.298). The week 1 presession line mean (SE) times for OMM group and counselling were 67.2 (35) and 25.9 (1.8) seconds, respectively. The week 6 presession line mean (SE) times for OMM group and counselling were 54.2 (25.3) and 21.8 (5.2) seconds, respectively. The week 10 line mean (SE) times for OMM group and counselling were 70 (37) and 28.8 (5.5) seconds, respectively. No significant differences were found between the group or weeks for time (P=.889). Conclusion: OMM did not significantly reduce the severity of tremors in patients with PD. Limitations include human error in grading, small sample size, learning effect, and daily symptom variability. Future studies including a larger sample size should be completed to confirm these findings.


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