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The Effect of Facial Effleurage on Acute Rhinosinusitis

Journal: Journal of Osteopathic Medicine Date: 2019/12, 119(12):Pages: e106-e108. doi: Subito , type of study: randomized controlled trial

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2019.128/html)

Keywords:

facial effleurage [2]
randomized controlled trial [710]
rhinosinusitis [5]

Abstract:

Statement of Significance: Physicians prescribe antibiotics to 85-98% of patients presenting with rhinosinusitis, even though 90-98% of the patients with rhinosinusitis would spontaneously resolve without intervention. Physicians are aware of this growing issue; however, due to patient expectations, the physicians still prescribe antibiotics. Facial Effleurage (FE) might allow physicians an avenue to directly help patients without prescribing antibiotics. While many Osteopathic physicians express anecdotal evidence of the therapeutic power of FE, there exists a substantial lack of scientifically based explorations into the efficacy of FE. Providing evidence to support the use of FE is critical to encourage physicians to utilize this Osteopathic Manipulative Therapy. Research Methods: This study design is a parallel-arm, randomized, placebo-controlled clinical trial evaluating the efficacy of Facial Effleurage. Patients presenting to 2 outpatient, direct primary care clinics in a mid-sized manufacturing town are asked to participate. After informed consent is given, the patient is screened for enrollment. Samples of the nasal mucus secretions, WBCs, serum, and bacterial nasal swab are collected. Patients answer surveys asking the patient how bad their current symptoms are. Then, patients are randomized into 1 of 8 treatment groups. Facial Effleurage treatment is administered by a board-certified Osteopathic physician. The Physical Touch Control Protocol attempts to address the placebo effect without allowing true Osteopathic Manipulation to be performed. The antibiotic treatment is a prescription of antibiotics, usually amoxicillin, as determined by the physician. One hour after the beginning of treatment, the patients provide the samples listed above. Then the patients record the severity of their symptoms every 12 hours for the next 7 days. The patients report to the clinic for a follow-up appointment. The samples are taken, and the patient is asked about adverse events, and the resolution of symptoms. Data Analysis: Serum cytokine and antibody levels are measured by ELISA. Mucosal cytokine levels are measured by cytometric bead array. Bacterial pathogen isolation is performed on a swab of the middle turbinate, and growth on various selective agars and biochemical tests are performed for the identification of species. A power analysis revealed that a sample size of 40 is needed for the minimal effect needed. Descriptive statistics, 2-tailed Fisher Exact Tests, ANOVA analysis, were performed using GraphPad Prism software as needed. P<.05 was considered significant. Results: So far, 86/200 patients have been enrolled in our study. Facial Effleurage significantly decreases the patient-reported symptom severity 1 hour after treatment and at the follow-up appointment 7 days after treatment. Patients receiving the sham treatment did not report significant decreases in symptom severity, nor did patients who only received antibiotics. Serum levels of total IgG and total IgE are significantly decreased 1 hour after treatment. Serum levels of IL-6 are significantly decreased 1 hour after treatment and that decrease continues 7 days after treatment. Serum levels of TNF-a are significantly increased 1 hour after treatment. Conclusion: Our data suggest that Facial Effleurage has a significant benefit in decreasing the severity of symptoms for patients suffering from acute rhinosinusitis. This benefit seems to be uniquely associated with the methods during facial effleurage and not patient expectations or placebo effect as this benefit was not consistently found in patients treated with the sham treatment. The benefit of facial effleurage is also not only associated with patient-reported symptoms but is also found in immunological parameters like cytokines, white blood cells, antibodies, complement proteins, and other effector molecules. This suggests that facial effleurage has the ability to remove any obstruction to the nasal tissues, refreshes the immunological environment within the tissues, allows for the effective removal of any pathogens, and causes the healing of the symptoms of acute rhinosinusitis.


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