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Impact of Osteopathic Manipulative Techniques on the Management of Dizziness Caused by Neuro-Otologic Disorders: Systemic Review and Meta-Analysis

Journal: Journal of Osteopathic Medicine Date: 2022/12, 122(12):Pages: A43-A45. doi: Subito , type of study: Meta analysis

Full text    (https://www.degruyter.com/document/doi/10.1515/jom-2022-2000/html)

Keywords:

dizziness [33]
ear [562]
meta analysis [43]
neuro-otologic disorders [1]
OMT [2951]
osteopathic manipulative treatment [2973]

Abstract:

Statement of Significance: Osteopathic manipulative treatment (OMT) has been utilized by osteopathic physicians as a potential primary intervention or adjunctive treatment for dizziness caused by neuro-otologic disorders. Currently, there are no systematic reviews that provide pooled estimates to explore the impact of OMT and/or OMT analogous techniques on the treatment of dizziness caused by neuro-otologic disorders. Research Methods: We performed a literature search in CINAHL, Embase, MEDLINE, Allied and Complementary Medicine Database (AMED), EMCare, Physiotherapy Evidence Database (PEDro), PubMed, PsycINFO, Osteopathic Medicine Digital Repository (OSTMED.DR), and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to March 2021. Included studies were randomized controlled trials (RCTs) and prospective or retrospective observational studies of adult patients experiencing dizziness from neuro-otological disorders which were written in English. Eligible studies compared the effectiveness of OMT and/or OMT analogous techniques with a comparator intervention, such as sham manipulation, a different manual technique, standard of care, or nonpharmacological intervention like exercise or behavioral therapy. Assessed outcomes included: disability associated with dizziness, dizziness severity, dizziness frequency, risk of fall, improvement in quality of life (QOL), and return to work (RTW). Assessed harm outcomes included: all-cause dropout rates (ACD), dropouts due to inefficacy, and adverse events. The meta-analysis was based on the similarities between the OMT and/or OMT analogous technique and the comparator interventions. The risk of bias was assessed using a modified version of the Cochrane risk of bias tool for RCTs and the Cochrane Risk of Bias in Non-randomized Studies – of Interventions (ROBINS-I) for observational studies. The quality of evidence was determined using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. All statistical analyses were performed with the R package meta and reported using a random effect model with P<0.05 being significant. Data Analysis/Results: There were 3,375 studies identified and screened, out of which 12 (11 RCTs1-11, 1 observational study12, n=367 participants) met the inclusion criteria. The median age of participants was 53 years with 60.5% female and 39.5% male.The moderate-quality evidence showed articular OMT was significantly associated with decrease in disability6,8,9 associated with dizziness [n=141; MD (95%CI)= -11.08 (-16.22, -5.94)], dizziness severity6,8,9,11 [n=158; MD (95%CI)= -1.56 (-2.43, -0.68)], and frequency [n=136; MD (95%CI) = -0.64 (-1.06, -0.22)]. In the sensitivity analysis for the disability associated with dizziness4,6-11, any OMT type was associated with a decrease in disability associated with dizziness; however, heterogeneity among studies was high (I2=59%) thus reducing the confidence in the pooled analysis. In the dizziness severity outcomes1,6,8,9,11, any OMT type was also associated with improved outcomes. With the addition of one study1, the heterogeneity was not substantially high. Low-quality evidence showed articular OMT was not significantly associated with ACD rates6,8,9. For the sensitivity analysis, six studies (n=217) were pooled for any OMT technique;4,6-10 however, heterogeneity was high among the pooled studies (I2=46%).Among the non-pooled outcomes, there was improvement in the mental component summary scores (MCS) but not in the physical component summary score (PCS) for articular OMT6. Variable associations were reported for fall risk, and for other OMT techniques for disability, dizziness severity, and frequency. A single observation study12 showed cranial OMT was significantly associated with a reduced fall risk but no RCT2,6 showed significant association of OMT with falls. Six studies1,2,4,6,7,10 explicitly provided statements about adverse events out of which in three studies adverse events occurred in patients2,4,6. Conclusion: The current review is the first systematic review and meta-analysis that reports pooled estimates of the impact of OMT and analogous techniques on outcomes for the treatment of dizziness caused by neuro-otologic disorders. We adjudicated the assessed OMT and analogous techniques according to similarities between OMT technique types. As a result of adjudication and data pooling based on similarities between technique types, heterogeneity in our meta-analyses was low. The review showed moderate-quality evidence that articular OMT was significantly associated with a decrease in disability associated with dizziness, dizziness severity, and frequency. The pooled analysis for ACD rates showed a non-significant association with OMT techniques. For safety outcomes, OMT was well tolerated and was not significantly associated with the ACD. A limitation of the study, due to the limited data, was that we were not able to pool for QOL outcomes and no study reported RTW outcomes. As quality of life can be employed as an indirect measure for RTW, OMT was significantly associated with the improvement in the mental component of the SF-36 scale for the QOL outcome. Secondly, the findings should be interpreted cautiously due to the high risk of bias, and small study sample size in the eligible studies. In the future, good quality RCTs with larger sample sizes should be conducted to better delineate the effectiveness of OMT and analogous techniques for the treatment of dizziness.


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