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Changes in Biomechanical Dysfunction With Osteopathic Manual Treatment in Patients With Chronic Low Back Pain According to Diabetes Mellitus Status

Journal: The Journal of the American Osteopathic Association Date: 2014/01, 114(1):Pages: e7. doi: Subito , type of study: randomized controlled trial

Full text    (https://www.degruyter.com/document/doi/10.7556/jom_2014_01.0001/html)

Keywords:

biomechanics [63]
chronic pain [295]
diabetes [40]
low back pain [500]
OMT [3746]
osteopathic manipulative treatment [3766]
randomized controlled trial [889]

Abstract:

Introduction and Objective: To assess the relationship between changes in Greenman's “dirty half dozen” biomechanical dysfunctions after osteopathic manual treatment (OMT) in patients with chronic low back pain, with and without diabetes mellitus. Hypothesis: We hypothesized that improvements in chronic low back pain with OMT may be mediated by different factors in patients with and without diabetes mellitus. Consequently, we used changes in Greenman's “dirty half dozen” dysfunctions to test this hypothesis. Methods: This subgroup analysis of data from the OSTEOPATHIC Trial focused on changes over time in Greenman's “dirty half dozen” dysfunctions in patients who received OMT, according to diabetes mellitus status. The OSTEOPATHIC Trial studied OMT and ultrasound therapy (UST) for the treatment of chronic low back pain in 455 patients in the Dallas-Fort Worth metroplex. Subjects who met all eligibility criteria were randomized to 1 of 4 treatment groups based on a 2×2 factorial design with active and sham treatment alternatives. Treatment providers assessed the presence or absence of Greenman's “dirty half dozen” dysfunctions prior to interventions at weeks 0, 1, 2, 4, 6 and 8. Results: Changes in each of the 6 somatic dysfunctions between weeks 0 and 8 were measured in 230 patients who received OMT. There were no significant changes in the status of Greenman's “dirty half dozen” in patients with diabetes mellitus; however, there were significant improvements in patients without diabetes mellitus (decreased psoas tenderpoint P=.003; decreased lumbar non-neutral dysfunction P⩽.001; decreased innominate shear P=.03; and decreased pubic shear P<.001). Conclusion: The OMT effects in patients with chronic low back pain and diabetes mellitus do not appear to be mediated by changes in biomechanical dysfunctions. However, these negative findings may be attributable to inadequate statistical power and other confounders in our subgroup analyses. A subsequent trial is planned to more adequately test this hypothesis.


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