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Osteopathic Manipulative Treatment as Adjuvant Therapy in Peripheral Arterial Disease.

Date: 2023, , type of study: randomized controlled trial

Free full text   (file:///C:/Users/helge/Downloads/OSTEOPATHIC_MANIPULATIVE_TREATMENT_AS_AD-1.pdf)

Keywords:

intermittent claudication [3]
osteopathic manipulative treatment [2973]
endothelial function [2]
OMT [2951]
pilot study [104]
randomized controlled trial [710]

Abstract:

Introduction: Peripheral arterial disease (PAD) is a manifestation of systemic atherosclerosis. Intermittent claudication, the predominant clinical symptom, is characterized by cramping, aching or fatigue, which typically involves the calf muscles, thighs and buttocks. PAD is associated with impaired endothelial function and by an increased expression of adhesion molecules. Conservative treatment includes dietary and pharmacological risk factor modification and exercise training. The osteopathic manipulative treatment (OMT) may allow for a normalization of imbalances between the sympathetic and parasympathetic nervous systems and improved vascular motion which would result in a more balanced homeostatic mechanism. Recent study used their own findings in the area of nitric oxide (NO) research to explain the therapeutic vascular effects of OMT. Purpose/Aim of the Study: The present pilot study investigated whether OMT, when combined with lifestyle modifications and pharmacological therapy, could be of benefit to patients with intermittent claudication.Materials and Methods: Thirty male PAD patients (Fontaine stage II)(mean age 69±8 years) were recruited to the study. 15 patients were assigned to osteopathic treatment (OMT group) and the others, were considered controls. Groups were matched for age and medical treatment. The study lasted for 6 months. The monitored parameters were: blood tests (lipid and inflammatory parameters, brachial artery flow-mediated vasodilation-FMV, ankle-brachial artery index-ABI, treadmill test). All replied to a self-administered questionnaire (HRQoL SF-36) at the start and end of the 6-month study. The OMT protocol included one session every 2 weeks for 2 months, a one month resting interval and then an OMT session every 3 weeks for 2 months. OMT technique: myofascial release, strain/counterstrain, muscle energy, soft tissue, high-velocity low-amplitude (thoracolumbar region, typically T10–L1), lymphatic pump and craniosacral manipulation. Results: Compared to the control group, the OMT group had a significant increase in FMV, ABI, treadmill testing and physical health component of life quality (all p < 0.05) from the beginning to the end of the study. At univariate analysis in the OMT group there was a negative correlation between changes in brachial flow-mediated vasodilation and Interleukin-6 levels (r= - 0.30; p= -0.04) and a positive one between claudication pain time and physical function score (r= 0.50; p= 0.05). Relevance: OMT was associated with longer walking times in our patients such as were achieved in other cohorts with supervised exercise training programmes. Conclusions: OMT significantly improves endothelial function and functional performance in intermittent claudication patients along with benefits in quality of life. This novel treatment combined with drug and lifestyle modification might be an effective alternative to traditional training based on exercise. Discussion: Improvements in brachial FMV, serum inflammatory markers and clinical parameters suggest OMT may promote NO release and consequently increase blood flow in peripheral vascular tissue. This effect may exert profound physiological consequences in PAD patients. Implications: The OMT programme has the potential advantage to be cost-effective and logistically viable, since frequency and intensity are reduced and OMT does not necessarily need to be performed in a hospital out-patients setting.


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