Empfohlene Litteratur | Osteopathische Forschung, Osteopathie auf Master-Niveau | Swiss Osteopathy Science Foundation

Rethinking causation and mechanisms in osteopathy and physical intervention trial design: the positivist-realist continuum

Mon, 06 Apr 2026 00:00:00 +0200

There has been renewed interest in mechanistic theory within osteopathy and the associated musculoskeletal professions, particularly regarding the role mechanisms play in osteopathic, manual and other physical interventions. Evidence-Based Medicine which commits to evidential pluralism (explicit incorporation of mechanistic evidence to inform trial design, through the selection of more meaningful controls and measuring more relevant outcomes) is known as Evidence-Based Medicine Plus (EBM+).

This position paper introduces the concept of EBM+ to the osteopathy and MSK research community, and proposes the evolution of a theory of mechanisms that borrows from both positivist and realist traditions to better account for the mechanistic effects of physical interventions that are described in trials as specific, non-specific and contextual effects, and which have a relevance for clinical practice and education. This position paper contributes an overview of the philosophy of causality, a summary of scientific models of causation, and an account of how different theories of causation can be used to frame mechanisms, contextual factors and both specific and non-specific effects of physical interventions in trial design and clinical practice. What is novel is the positivist-realist continuum as a framework for accounting for different categories of treatment effects within explanatory, pragmatic and mechanistic trial design.

We conclude with recommendations towards refining physical intervention trial design and reporting, encouraging researchers to make explicit the mechanistic theory and causal assumptions that support their methodological choices.

ScienceDirect

An international consensus on gaps in mechanisms of forced-based manipulation research: findings from a nominal group technique

Tue, 12 Dec 2023 00:00:00 +0100

Force-Based Manipulation (FBM) including light touch, pressure, massage, mobilization, thrust manipulation, and needling techniques are utilized across several disciplines to provide clinical analgesia. These commonly used techniques demonstrate the ability to improve pain-related outcomes; however, mechanisms behind why analgesia occurs with these hands-on interven- tions has been understudied. Neurological, neuroimmune, biomechanical, neurovascular, neu- rotransmitter, and contextual factor interactions have been proposed to influence response; however, the specific relationships to clinical pain outcomes has not been well established. The purpose of this study was to identify gaps present within mechanism-based research as it relates to FBM. An international multidisciplinary nominal group technique (NGT) was per- formed and identified 37 proposed gaps across eight domains. Twenty-three of these gaps met consensus across domains supporting the complex multisystem mechanistic response to FBM. The strength of support for gaps within the biomechanical domain had less overall support than the others. Gaps assessing the influence of contextual factors had strong support as did those associating mechanisms with clinical outcomes (translational studies). The importance of literature investigating how FBM differs with individuals of different pain phenotypes (pain mechanism phenotypes and clinical phenotypes) was also presented aligning with other analgesic techniques trending toward patient-specific pain management (precision medicine) through the use of pain phenotyping.

Journal of Manual & Manipulative Therapy

Recommendations for the development, implementation, and reporting of control interventions in efficacy and mechanistic trials of physical, psychological, and self-management therapies: the CoPPS Statement

Wed, 13 Sep 2023 00:00:00 +0200

Control interventions (often called “sham,” “placebo,” or “attention controls”) are essential for studying the efficacy or mechanism of physical, psychological, and self-management interventions in clinical trials. This article presents core recommendations for designing, conducting, and reporting control interventions to establish a quality standard in non-pharmacological intervention research. A framework of additional considerations supports researchers’ decision making in this context. We also provide a reporting checklist for control interventions to enhance research transparency, usefulness, and rigour.

The BMJ

Randomized Trials vs Real-world Evidence How Can Both Inform Decision-making?

Wed, 13 Sep 2023 00:00:00 +0200

Noting that randomized clinical trials (RCTs) “generally yield the strongest inferences about the effects of medical treatments,”1(p984) the AMA Manual of Style instructs that “randomized trials may use terms such as effectand causal relationship,”1(p983) In contrast, the manual claims that observational studies “cannot lead to causal inferences”1(p994) and thus “should be described in terms of association or correlation and should avoid cause-and-effect wording.”1(p983) Nevertheless, analyses of observational data—often consisting of real-world evidence from databases of medical claims and electronic health records—play an increasingly prominent role in health care. Given the well-recognized limitations of observational studies, their growing use to estimate treatment effects is the subject of considerable controversy. Should real-world evidence have a meaningful role in decision-making? In this issue of JAMA, investigators from the RCT DUPLICATE Initiative2 address this controversy by directly comparing the results of published RCTs to analyses of 3 national claims databases that are carefully designed to emulate the original RCTs. The results of their productive line of research warrant careful consideration.

JAMA Network

Blinding and sham control methods in trials of physical, psychological, and self-management interventions for pain (article I): a systematic review and description of methods

Tue, 28 Mar 2023 00:00:00 +0200

Blinding is challenging in randomised controlled trials of physical, psychological, and self-management therapies for pain, mainly because of their complex and participatory nature. To develop standards for the design, implementation, and reporting of control interventions in efficacy and mechanistic trials, a systematic overview of currently used sham interventions and other blinding methods was required.

Journal of the International Association for the study of Pain

A Randomized Controlled Trial of Osteopathic Manipulative Therapy to Reduce Cranial Asymmetries in Young Infants with Nonsynostotic Plagiocephaly

Sat, 31 Dec 2022 00:00:00 +0100

This study aimed to compare the efficacy of osteopathic manipulative therapy (OMTh) versus light touch therapy (LTT) in reducing cranial asymmetries in infants with nonsynostotic plagiocephaly (NSP).

National Library of Medicine

Avoiding nocebo and other undesirable effects in chiropractic, osteopathy and physiotherapy: An invitation to reflect

Sat, 31 Dec 2022 00:00:00 +0100

While the placebo effect is increasingly recognised as a contributor to treatment effects in clinical practice, the nocebo and other undesirable effects are less well explored and likely underestimated. In the chiropractic, osteopathy and physiotherapy professions, some aspects of historical models of care may arguably increase the risk of nocebo effects.

ScienceDirect

Manual therapy prevents onset of nociceptor activity, sensorimotor dysfunction, and neural fibrosis induced by a volitional repetitive task.

Tue, 06 Dec 2022 00:00:00 +0100

Painful and disabling musculoskeletal disorders remain prevalent. In rats trained to perform repetitive tasks leading to signs and dysfunction similar to those in humans, we tested whether manual therapy would prevent the development of the pathologies and symptoms. We collected behavioral, electrophysiological, and histological data from control rats, rats that trained for 5 weeks before performing a high-repetition high-force (HRHF) task for 3 weeks untreated, and trained rats that performed the task for 3 weeks while being treated 3x/week using modeled manual therapy (MMT) to the forearm (HRHF + MMT). (...)

We conclude that the performance of the task for 3 weeks leads to increased ongoing activity in nociceptors, in parallel with behavioral and histological signs of neuritis and nerve injury, and that these pathophysiologies are largely prevented by MMT.

National Library of Medicine

Effect of osteopathic techniques on human resting muscle tone in healthy subjects using myotonometry: a factorial randomized trial

Sun, 27 Nov 2022 00:00:00 +0100

Musculoskeletal disorders (MSDs) are highly prevalent, burdensome, and putatively associated with an altered human resting muscle tone (HRMT). Osteopathic manipulative treatment (OMT) is commonly and effectively applied to treat MSDs and reputedly influences the HRMT. Arguably, OMT may modulate alterations in HRMT underlying MSDs. However, there is sparse evidence even for the effect of OMT on HRMT in healthy subjects. A 3 × 3 factorial randomised trial was performed to investigate the effect of myofascial release (MRT), muscle energy (MET), and soft tissue techniques (STT) on the HRMT of the corrugator supercilii (CS), superficial masseter (SM), and upper trapezius muscles (UT) in healthy subjects in Hamburg, Germany.

National Library of Medicine

4 M’s to make sense of evidence – Avoiding the propagation of mistakes, misinterpretation, misrepresentation and misinformation

Thu, 25 Aug 2022 00:00:00 +0200

This Masterclass helps osteopaths to make sense of research.

It helps osteopaths decide how/when to apply research findings in their clinical practice.

A simple framework to assess the literature is provided.

Case reports, clinical trials, qualitative research, and reviews are detailed specifically.

ScienceDirect

Quantitative investigation of ligament strains during physical tests for sacroiliac joint pain using finite element analysis.

Thu, 25 Aug 2022 00:00:00 +0200

In this study, a three-dimensional finite element model of the sacroiliac joint was developed and the biomechanical conditions for six typical physical tests such as the compression test, distraction test, sacral apex pressure test, thigh thrust test, Patrick's test, and Gaenslen's test were modelled.

ScienceDirect

Blinding, Sham and Treatment Effects in Randomized Controlled Trials for Back Pain in 2000–2019: A Review and Meta-analytic Approach

Thu, 25 Aug 2022 00:00:00 +0200

Blinding aims to minimize biases from what participants and investigators know or believe. Randomized controlled trials, despite being the gold standard to evaluate treatment effect, do not generally assess the success of blinding. We investigated the extent of blinding in back pain trials and the associations between participant guesses and treatment effects.

PubMed

From Alpha Diversity to Zzz: Interactions among sleep, the brain, and gut microbiota in the first year of life

Thu, 31 Mar 2022 00:00:00 +0200

Infant sleep habits and neurophysiology are associated with their gut microbiome.

This sleep-brain-gut link is important for infant development.

Sleep and gut microbiota are promising targets for early interventions.

ScienceDirect

Quality of life in patients referring to private osteopathic clinical practice: A prospective observational study

Fri, 03 Sep 2021 00:00:00 +0200

A large clinical practice-based osteopathic research was performed in Central–Southern Italy.

4 OMT sessions improved quality of life in self-referred patients.

OMT reduced the relative risk of using drug.

ScienceDirect

Effect of soft tissue mobilization techniques on adhesion-related pain and function in the abdomen: A systematic review

Wed, 30 Jun 2021 00:00:00 +0200

To systematically review the effects of soft tissue mobilization (STM) on both surgical and non-surgical abdominal adhesion-related symptoms.

ScienceDirect

Effect of Osteopathic Manipulative Treatment vs Sham Treatment on Activity Limitations in Patients With Nonspecific Subacute and Chronic Low Back Pain

Tue, 27 Apr 2021 00:00:00 +0200

Osteopathic manipulative treatment (OMT) is frequently offered to people with nonspecific low back pain (LBP) but never compared with sham OMT for reducing LBP-specific activity limitations.

Effect of Osteopathic Manipulative Treatment vs Sham Treatment on Activity Limitations in Patients With Nonspecific Subacute and Chronic Low Back Pain: A Randomized Clinical Trial

A Perceptual Framework for Conservative Treatment and Rehabilitation of Ankle Sprains: An Evidence- Based Paradigm Shift

Mon, 29 Jun 2020 00:00:00 +0200

Journal of Athletic Training

Spinal manipulation therapy: Is it all about the brain? A current review of the neurophysiological effects of manipulation

Wed, 09 Oct 2019 00:00:00 +0200

Weitere Infos auf ScienceDirect

Médecines complémentaires et lombalgies : que dit la littérature scientifique ?

Sun, 07 Jul 2019 00:00:00 +0200

Weitere Infos auf Revmed

Reliability of Diagnosis and Clinical Efficacy of Cranial Osteopathy: A Systematic Review

Sun, 05 May 2019 00:00:00 +0200

Weitere Infos auf Pubmed Central

Osteopathic decapitation: Why do we consider the head differently from the rest of the body? New perspectives for an evidence-informed osteopathic approach to the head

Sun, 05 May 2019 00:00:00 +0200

Weitere Infos auf ScienceDirect

Adverse events and manual therapy: A systematic review

Sun, 05 May 2019 00:00:00 +0200

Weitere Infos auf Pubmed

Defining adverse events in manual therapy: An exploratory qualitative analysis of the patient perspective

Sun, 05 May 2019 00:00:00 +0200

Weitere Infos auf Pubmed

Clinical reasoning in osteopathy - More than just principles?

Mon, 25 Feb 2019 00:00:00 +0100

Weitere Infos auf der Seite International Journal of Osteopathic Medicine

Understanding clinical reasoning in osteopathy: a qualitative research approach

Mon, 25 Feb 2019 00:00:00 +0100

Weitere Infos auf "Chiropractic & Manual Therapies"

Teaching critical thinking in osteopathy – Integrating craft knowledge and evidence-informed approaches

Fri, 30 Nov 2018 00:00:00 +0100

Weitere Infos auf "Journal of Osteopathic Medicine"

Quantitative investigation of ligament strains during physical tests for sacroiliac joint pain using finite element analysis.

Fri, 30 Nov 2018 00:00:00 +0100

Weitere Infos auf Pubmed

Making evidence based medicine work for individual patients

Fri, 30 Nov 2018 00:00:00 +0100

Weitere Infos auf "British Medical Journal"

Primary care physicians’ attitude and reported prescribing behavior for chronic low back pain: An exploratory cross-sectional study

Sat, 13 Oct 2018 00:00:00 +0200

Weitere Infos auf Plos ONE

Recent guidelines for chronic or recurrent low back pain recommend non-pharmacologic treatments as first-line options. The objective of this study was thus to explore the perceived usefulness of several conventional and complementary medicine treatments for chronic or recurrent low back pain by primary care physicians and their reported prescribing behavior.

Osteosurvey. The role of osteopathy in the Swiss primary health care system: a practice review

Sat, 13 Oct 2018 00:00:00 +0200

Weitere Infos auf "British Medical Journal"

The aim of this study was to describe osteopathic activity and scope of practice to understand the current and future role of osteopathy in the Swiss healthcare system.