Optimising the psychological benefits of osteopathy

Abstract 

Osteopaths practise a physical method of treatment within a biopsychosocial model of illness. The most important risk factors for back and neck pain are psychosocial. Psychological treatments such as cognitive behavioural therapy, multidisciplinary rehabilitation and educational booklets have been successfully used to address these risk factors. Although osteopathy is a physical treatment, any reduction in distressing symptoms may have psychological benefits. To assess whether spinal manipulation was effective in improving psychological outcomes a systematic review of randomised controlled trials (RCTs) was carried out. The review identified 129 RCTs, 12 of which adequately reported psychological outcomes. The control interventions in these RCTs were grouped into either verbal or physical treatments. Six RCTs with a verbal comparator were combined in a meta-analysis and found that spinal manipulation improved psychological outcomes, with a mean benefit equivalent to 0.34 of the population standard deviation (SD) at 1–5months; 0.27 of the SD at 6–12months. Eight RCTs with a physical treatment comparator were combined in a meta-analysis and found a much smaller mean benefit of 0.13 of the SD in favour of manipulation at 1–5months; 0.11 of the SD at 6–12months. The nature of this psychological benefit was explored in one of these RCTs, which found that spinal manipulation improved back pain beliefs but not fear avoidance beliefs. The nature of this psychological benefit had also been explored previously in a qualitative study, which found that osteopathy patients reported improved understanding, reduced fear and a positive approach that encouraged exercise rather than rest. The psychological benefit could also be due to the placebo effect due to increased clinical contact, treatment preference, or the caring effect of the therapist. However, some authors argue that such effects are better described as part of the characteristic treatment effect of a complex intervention. If so, then the psychological benefits of spinal manipulation could be optimised by integrating cognitive behavioural principles into routine osteopathic practice. The benefits of such integrated care could be tested in future RCTs.

Keywords: Back pain, Neck pain, Spinal manipulation, Osteopathic medicine, Psychosocial aspects, Placebo effect