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Background Long-term Proton Pump Inhibitor use is associated with low response rates and the risk of adverse events. Objective The objective of this study was to assess the effectiveness of Osteopathic Treatment in patients with Gastroesophageal Reflux Disease (GERD). Methods This study was a randomized controlled trial with a series of osteopathic interventions and an untreated control group. Patients in the osteopathic group (OG) received 4 osteopathic treatments within a time of eight weeks. The control group (CG) did not receive any osteopathic treatment. Primary outcome parameters were gastrointestinal symptoms, assessed by means of the Reflux Disease Questionnaire (RDQ). Secondary outcome parameters were Quality of life with regards to GERD symptoms, assessed by means of the Quality of Life in Reflux and Dyspepsia (QUOLRAD) questionnaire, medication use and osteopathic dysfunctions. Results Seventy patients were randomized. RDQ mean scores decreased statistically significantly in the OG but did not change in the CG; however, these data cannot be interpreted due to a large number of incorrectly completed questionnaires. The between group difference of the changes for the QOLRAD score was statistically significant 0.69 [95%CI = 0.35 to 1.0]. At week 20, changes in the QOLRAD of the OG were sustainable. Medication use decreased substantially in the OG whilst it remained the same in the CG. Conclusion A series of osteopathic treatments might potentially be beneficial for patients suffering from GERD. Future studies should include longer follow-up times and establish the clinical significance of results by introducing a global rating of change measurement.

Zusammenfassung Osteopathische Artikel zur „Spanischen Grippe” oder zur Behandlung von Infektionskrankheiten im Allgemeinen [ 1 ]–[ 7 ] verweisen gerne auf die grosen Behandlungserfolge der Osteopathie in den USA im Vergleich zur medikamentosen Therapie wahrend der grosen Influenzapandemie 1918/19. Da die meisten Erkrankten nicht an der Grippe selbst, sondern an einer Pneumonie verstarben, werden dazu erganzend oft zwei neuere osteopathische Studien zitiert [ 8 ], [ 9 ]. Doch wie zuverlassig sind die angefuhrten Zahlen, die die Erfolge der Osteopathie untermauern sollen, und welche Ergebnisse liefern die Studien zur Pneumonie? Dieser Beitrag stellt viele Fragen und versucht, einige Antworten zu geben.

Shoulder complaints are common in the general population. Typically, the diagnosis of a specific pathology is lacking. The objective of this trial was to evaluate the effectiveness of an osteopathic treatment in patients suffering from shoulder pain.A pragmatic randomized controlled trial was conducted in patients with a history of shoulder pain of 6 weeks to 12 months, and a pain intensity level of at least 40% on the visual analogue scale (VAS). Participants were identified from the general population in Germany and allocated by means of external randomization to an intervention group or a control group. Patients in the intervention group received five osteopathic treatments at intervals of two weeks. Treatment was custom tailored and based on osteopathic principles. Controls received their osteopathic treatment after an 8-week untreated waiting period. Primary outcome parameters were pain intensity and frequency, measured by VAS and Likert Scales. Secondary outcome parameters were shoulder specific pain and disability (Shoulder Pain and Disability Index, SPADI), and quality of life (SF-36).A total of 70 patients aged 25-70 years (average age 45.6 ± 13.4 years) were included, 36 in the intervention group and 34 in the control group. The inter-group comparison of changes revealed clinically relevant improvements in favor of the intervention group for the main outcome parameters maximal pain intensity (VAS: between group difference of means 41.5; 95% CI: 34.6 to 48.3; p 0.005) and average pain intensity (VAS: between group difference of means 40.4; 95% CI: 33.2 to 47.5; p 0.005). The proportion of participants with a low frequency of pain increased in the osteopathic group only (from 7 to 34 vs. 9 to 6 in the control group, p = 0.006), and the number of patients with a high frequency decreased in the osteopathic group only (from 29 to 2 vs. 25 to 28, p 0.0005). Shoulder specific pain and disability also improved. The follow-up assessment in the intervention group showed further improvements.Five osteopathic treatments over a period of eight weeks led to statistically significant and clinically relevant positive changes of pain and disability in patients suffering from shoulder pain.

In Germany in recent years, a growing number of parents are seeking help from osteopaths for the perceived health complaints of their infants and children. However, reliable evidence for the effectiveness of osteopathic interventions for this group of patients is largely lacking.To observe and document changes in the symptoms of certain health disturbances, as perceived by parents, during the course of an osteopathic treatment of their baby, and associated side effects.A single-arm, prospective, multicenter, observational study was chosen as the study design. Parents who contacted an osteopathic practice with any of the following 5 health disturbances were invited to include their baby into the study: idiopathic infant asymmetry (IA), deformational plagiocephaly (DP), feeding disorders (FD), excessive crying (EC), and sleep disorders (SD). Osteopaths performed osteopathic treatment as usual for these conditions, and the parents were asked to rate the perceived severity of symptoms on standardized forms including numerical rating scales (NRS 0-10). In DP, the head circumference of the child's skull was measured with a craniometer, and the cranial vault index (CVAI) was calculated.230 osteopaths agreed to participate, 151 osteopaths returned parental ratings. 1,136 infants were treated 2.8 ± 1.1 times (mean ± SD). IA was the most prevalent disturbance (48%), followed by EC (18%), FD (15%), DP (14%), and SD (4%). In IA, perceived asymmetry as rated on the NRS improved from 6.1 to 1.1, a mean improvement of 82%. In DP, the CVAI improved from 8.0 to 4.0%, a mean improvement of 51%. FD improved by 77%, EC by 70% (from 7.7 to 2.3 on the NRS) and SD by 56%. Adverse reactions with a timely association with osteopathic treatments were reported in 3.5% of all treatments, probably reflecting typical day-to-day variations in symptoms. In a total of 3,212 treatments, there was not a single serious adverse reaction affecting infant health.This is one of the largest studies worldwide to date on the osteopathic treatment of infants. Osteopathic treatment was associated with major positive changes in the severity of perceived health complaints as assessed by parents, which in most cases were resolved as a matter of concern, and was proved to be a safe treatment modality among a large number of therapists. Based on these results, confirmatory intervention studies can and should be planned and conducted.Einleitung: In Deutschland suchen in den letzten Jahren immer mehr Eltern bei Osteopathen Hilfe für die wahr­genommenen gesundheitlichen Beschwerden ihrer Säuglinge und Kinder. Verlässliche Belege für die Wirksamkeit osteopathischer Interventionen für diese Patientengruppe fehlen jedoch weitgehend. Studienziel: Beobachtung und Dokumentation von Veränderungen der Symptome bestimmter, von den Eltern wahrgenommener Gesundheitsstörungen im Verlauf einer osteopathischen Behandlung ihres Babys und der damit verbundenen Nebenwirkungen. Methoden: Als Studiendesign wurde eine einarmige, prospektive, multizentrische Beobachtungsstudie gewählt. Eltern, die sich mit einer der folgenden 5 Gesundheitsstörungen an eine osteopathische Praxis wandten, wurden eingeladen, ihr Baby in die Studie einzubeziehen: idiopathische Säuglingsasymmetrie (IA), Deformations-Plagiozephalie (DP), Fütterungsstörungen (FD), exzessives Schreien (EC) und Schlafstörungen (SD). Osteopathen führten die osteopathische Behandlung wie üblich bei diesen Erkrankungen durch, und die Eltern wurden gebeten, den wahrgenommenen Schweregrad der Symptome auf standardisierten Formularen einschließlich numerischer Bewertungsskalen (NRS 0–10) zu bewerten. Bei der DP wurde der Kopfumfang des Schädels des Kindes mit einem Kraniometer gemessen und der Cranial Vault Index (CVAI) berechnet. Ergebnisse: 230 Osteopathen erklärten sich zur Teilnahme bereit, 151 Osteopathen gaben elterliche Bewertungen zurück. 1’136 Säuglinge wurden 2,8 ± 1,1 Mal behandelt (Mittelwert ± SD). IA war die am häufigsten auftretende Störung (48%), gefolgt von EC (18%), FD (15%), DP (14%) und SD (4%). Bei der IA verbesserte sich die wahrgenommene Asymmetrie, wie sie auf der NRS bewertet wurde, von 6,1 auf 1,1, was einer durchschnittlichen Verbesserung von 82% entspricht. Bei der DP verbesserte sich der CVAI von 8,0 auf 4,0%, was einer durchschnittlichen Verbesserung von 51% entspricht. Die FD verbesserte sich um 77%, die EC um 70% (von 7,7 auf 2,3 auf der NRS) und die SD um 56%. Unerwünschte Reaktionen, die in Verbindung zu gleichzeitigen osteopa­thischen Behandlungen standen, wurden bei 3,5% aller Behandlungen berichtet, spiegeln aber typische alltägliche Symptome wider. Bei insgesamt 3,212 Behandlungen gab es keine einzige schwerwiegende Nebenwirkung, die die Gesundheit des Säuglings beeinträchtigte. Schlussfolgerungen: Dies ist eine der bisher weltweit größten Studien über die osteopathische Behandlung von Säuglingen. Die osteopathische Behandlung ging mit großen positiven Veränderungen in der Schwere der von den Eltern wahr­genommenen Gesundheitsbeschwerden einher und erwies sich als sichere Behandlungsmodalität. Auf der Grund­­lage dieser Ergebnisse können und sollten konfirmatorische Interventionsstudien geplant und durchgeführt werden.

Background In Germany, more parents have been seeking help from osteopaths for their infants and children in recent years. This implies an increasing demand of reliable evidence regarding the effectiveness of osteopathic intervention for this group. Objective To identify the ‘typical’ (most common) health concerns of parents when presenting their infants (age 0–12 months) in pediatric osteopathic practices. Methods For the purpose of this survey, well-trained osteopaths who specialize in the treatment of children and infants were selected. A documentation form containing a list of the likely most common infant health problems, developed by means of systematic literature analyses, was provided to experienced osteopaths to assess which health problems were seen most frequently. Results Eighty-one osteopaths were contacted, of which 64 (79 %) responded and returned the documentation form. Nine documentation forms could not be evaluated. The remaining 55 documentation forms included information on 2833 health concerns. Quantitatively, there was no dominant health problem, but five problems were found to be common: 21 % of the cases were idiopathic infant asymmetry, 17 % were plagiocephaly, 16 % were excessive crying, and 14 % were feeding and sleep disorders. All other problems were observed as far less frequent. In addition, osteopaths reported 423 other health concerns that were not specified in the documentation form. Conclusions In this survey, infants that were presented in osteopathic practices often had one or more of those five health problems mentioned above. A large observational trial is currently underway to document changes observed during osteopathic treatment of these health problems.

Context: Persistent low back pain (LBP) is a common complaint among women during and after pregnancy, and its effects on quality of life can be disabling. Objective: To evaluate the effectiveness of osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) in women with persistent LBP and functional disability after childbirth. Methods: A pragmatic randomized controlled trial was conducted among a sample of women with a history of pregnancy-related LBP for at least 3 months after delivery. Participants were identified from the general population in Germany. By means of external randomization, women were allocated to an OMTh group and a waitlist control group. Osteopathic manipulative therapy was provided 4 times at intervals of 2 weeks, with a follow-up after 12 weeks. The OMTh was tailored to each participant and based on osteopathic principles. The participants allocated to the control group did not receive OMTh during the 8-week study; rather, they were put on a waiting list to receive OMTh on completion of the study. Further, they were not allowed to receive any additional treatment (ie, medication, physical therapy, or other sources of pain relief) during the study period. The main outcome measures were pain intensity as measured by a visual analog scale and the effect of LBP on daily activities as assessed by the Oswestry Disability Index (ODI). Results: A total of 80 women aged between 23 and 42 years (mean [SD], 33.6 [4.5] years) were included in the study, with 40 in the OMTh group and 40 in the control group. Pain intensity decreased in the OMTh group from 7.3 to 2.0 (95% CI, 4.8-5.9; PP=.005). The between-group comparison of changes revealed a statistically significant improvement in pain intensity in the OMTh group (between-group difference of means, 4.8; 95% CI, 4.1-5.4; PP Conclusion: During 8 weeks, OMTh applied 4 times led to clinically relevant positive changes in pain intensity and functional disability in women with postpartum LBP. Further studies that include prolonged follow-up periods are warranted. (German Clinical Trials Register: DRKS00006280.)

The clinical sequelae and manifestation resulting from whiplash injury are defined as late whiplash syndrome (LWS). The objective of this study was to investigate whether a series of osteopathic treatments of patients with LWS may improve their symptoms.The study was designed as a two-phase (pre-post) clinical intervention study. In phase one, the patients received no treatment for 6 weeks; in phase two, they received five test-dependent osteopathic treatments.Forty-two (42) patients (mean age 39 years) suffering from LWS due to car rear-end collisions were included.Five (5) individualized and custom-tailored osteopathic treatments at 1-week intervals were performed.Main outcome parameters were the neck-related pain and disability (determined by the Neck Pain and Disability Scale [NPAD]) and the quality of life (assessed on the SF-36). The presence of a post-traumatic stress disorder (PTSD) was diagnosed.A direct comparison between the untreated period and the treatment period revealed clinically relevant and statistically significant improvements in the osteopathic treatment period for the NPAD. In the intervention phase, the NPAD dropped from 41.5 to 26.0 points, which corresponds to an improvement of 37% (95% confidence interval=11.1-19.8; p0.0005). For the SF-36, both the physical and the mental component summary showed a significant and substantial improvement during treatment phase (p=0.009 versus p=0.02). Prior to treatment, 17 patients (43.6%) were diagnosed with a positive PTSD; this number fell to only 6 (15.4%) during observation.Five (5) osteopathic treatments had a beneficial effect on the physical as well as the mental aspects of LWS and lives up to its claim of being a complementary modality in the treatment regimen of this condition. Based on these preliminary findings, rigorous randomized controlled studies are warranted.

Chronic non-specific neck pain (CNP) is a common, often disabling condition which still lacks a reliable therapeutic standard. Empiric evidence suggests that osteopathic interventions might be effective in alleviating CNP symptoms. A randomized controlled clinical trial of efficacy was performed to test this hypothesis.135 CNP sufferers were identified through advertisements, and 41 patients who met all relevant predefined criteria were recruited. All participants received a 12-min session of sham ultrasound once a week for an average of 10 weeks. In addition, a test-dependent osteopathic intervention of 45 min was given to 24 participants every other week. 40 participants could be followed up for 12 weeks after the end of therapy. The main outcome parameter was pain intensity measured on a numeric rating scale (NRS, range: 0-10).There were 2 dropouts in the intervention group and 2 in the control group. Average pain intensity decreased from 4.7 to 2.2 in the osteopathic group (p0.0005), and from 4.8 to 4.0 in the control group (p = 0.09). The intergroup difference of longitudinal changes was clearly significant, too (p = 0.02). Further slight but comparable reductions were observed at follow-up (0.3 and 0.4 NRS points, respectively). These changes seem to have a positive impact on quality of life, as assessed by generic and specific instruments such as the MOS SF-36 and the Northwick Park Pain Questionnaire.A series of test-dependent osteopathic interventions may be a promising therapeutic regimen for CNP sufferers. Further studies will have to demonstrate a) whether these findings are reproducible, and b) whether positive long-term outcomes can be achieved.

Introduction: Chronic Low Back Pain (CLBP) is a very common complaint in the general population and it is often managed by physicians by conservative means. Osteopathic manipulative treatment (OMT) has been recently been demonstrated to be an effective method to reduce pain in patients suffering with CLBP. The objective of this study was to compare the effects of OMT with sham manipulative treatment (SMT) on patient’s self reported pain and disability. Design: This was a randomized controlled investigation Methods: For this study ninety-four patients were recruited from the Orthopedic Department, Bassini Hospital (Italy) in the period between September 2006 and March 2008. Patients were randomly assigned to either usual care plus OMT (n 1⁄4 44) or usual care plus SMT (n 1⁄4 50). The main outcome variables were the Oswestry Disability Index and a 10-cm visual analog scale (VAS) for overall back pain. Data were analyzed using a two-factor ANOVA for repeated measures with an a level set at 0.05. Results: Overall, OMT significantly decreased pain and disability compared to SMT on this study. The change in VAS was -2.8 1.4 for OMT and 0 0.9 for SMT. The change in Oswestry Disability Index -8.4 8.5 for OMT and 0.3 7.2 for SMT). There was a significant interaction (group x time) for both visual analog scale (p

Die chronische Sinusitis: Eine Ubersicht Die in der Praxis haufige chronische Sinusitis wird leicht unterschatzt, da die Symptomatik medizinisch nicht “bedrohlich” ist. Nicht selten ist aber die Lebensqualitat der Betroffenen nachhaltig beeintrachtigt, wie die Ubersichtsarbeit von Karl-Ludwig Resch et al. belegt. Dazu konnen ggf. auch medikamentose und/oder invasive Masnahmen beitragen, die in der Regel das Problem nicht ursachlich therapieren. Positive praktische Erfahrungen mit osteopathischen Behandlungen lassen sich plausibel begrunden, sind aktuell aber noch nicht durch valide klinische Studien bestatigt.

Objective Chronic non-specific neck pain (CNP) is a common, often disabling condition, which still lacks a reliable therapeutic standard. Empiric evidence suggests that osteopathic interventions might be effective in alleviating CNP symptoms. A randomized sham-controlled clinical trial was performed to test this hypothesis. Materials and methods One hundred and thirty-five CNP sufferers were identified through advertisements, and 49 patients meeting all relevant predefined criteria were recruited. All participants received a 12 min session of sham ultrasound once a week for an average of 10 weeks. In addition, 45 min of a test-dependent osteopathic intervention was given to 24 participants every other week. Forty participants could be followed up 12 weeks after the end of therapy. Results There was one dropout in the intervention group and 6 in the sham group. On a numeric rating scale (NRS, range: 0–10) average pain intensity decreased from 4.7 to 2.2 in the osteopathic group (P Conclusions A series of osteopathic interventions seems a promising therapeutic regimen for CNP sufferers. Further studies will have to demonstrate whether (a) these findings are reproducible and (b) positive long term outcomes can be achieved.