Osteopathic Manipulative Treatment Including Specific Diaphragm Techniques Improves Pain and Disability in Chronic Nonspecific Low Back Pain: A Randomized Trial

摘要

ObjectiveTo investigate the effects of an osteopathic manipulative treatment (OMT), which includes a diaphragm intervention compared to the same OMT with a sham diaphragm intervention in chronic nonspecific low back pain (NS-CLBP). DesignParallel group randomized controlled trial. SettingPrivate and institutional health centers. ParticipantsParticipants (N=66) (18-60y) with a diagnosis of NS-CLBP lasting at least 3 months. InterventionsParticipants were randomized to receive either an OMT protocol including specific diaphragm techniques (n=33) or the same OMT protocol with a sham diaphragm intervention (n=33), conducted in 5 sessions provided during 4 weeks. Main Outcome MeasuresThe primary outcomes were pain (evaluated with the Short-Form McGill Pain Questionnaire [SF-MPQ] and the visual analog scale [VAS]) and disability (assessed with the Roland–Morris Questionnaire [RMQ] and the Oswestry Disability Index [ODI]). Secondary outcomes were fear-avoidance beliefs, level of anxiety and depression, and pain catastrophization. All outcome measures were evaluated at baseline, at week 4, and at week?12. ResultsA statistically significant reduction was observed in the experimental group compared to the sham group in all variables assessed at week 4 and at week 12 (SF-MPQ [mean difference ?6.2; 95% confidence interval, ?8.6 to ?3.8]; VAS [mean difference ?2.7; 95% confidence interval, ?3.6 to ?1.8]; RMQ [mean difference ?3.8; 95% confidence interval, ?5.4 to ?2.2]; ODI [mean difference ?10.6; 95% confidence interval, ?14.9 to 6.3]). Moreover, improvements in pain and disability were clinically relevant. ConclusionsAn OMT protocol that includes diaphragm techniques produces significant and clinically relevant improvements in pain and disability in patients with NS-CLBP compared to the same OMT protocol using sham diaphragm techniques.