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The DO | Special Coverage | OMED 2013

Promising OMT pilot study points to difficulties with ‘sham’ treatment

A small 2010 feasibility study on the benefits of preventive osteopathic manipulative treatment in nursing home residents showed that residents who received OMT were hospitalized less and took fewer medications than those in the control group, said Karen T. Snider, DO, the study’s lead author, in an OMED session today. However, the “sham” treatment group showed similar results, pointing to a need to refine the mock treatment for clearer results in a larger investigation.

Karen T. Snider, DO

Karen T. Snider, DO, reports on the results of a pilot study of OMT on nursing home residents. (Photo by Patrick Sinco)

In the study, which was published in The Journal of the American Osteopathic Association, eight nursing home residents received OMT twice a month for five months, said Dr. Snider, who is a professor of osteopathic manipulative medicine at the A.T. Still University-Kirksville (Mo.) College of Osteopathic Medicine.

The study included an OMT group, a “light touch” group that received what was meant to be sham OMT, and a control group that received neither treatment. DOs giving light touch were advised to touch the patients in all the same areas they would were they giving OMT and to hold their hands in place.

The light touch protocol proved problematic in part because the study’s osteopathic physicians had trouble not performing OMT, despite their intentions, Dr. Snider noted.

“I recall one [patient] in the light touch group. I had my hands under her back pretending to do paraspinal muscle inhibition … and my mind kind of wandered off,” she said. “So it was very hard.”

The study results were the same for the light touch group and the OMT group—both had fewer hospitalizations and decreased medication use next to the control group, Dr. Snider said. In future studies, the light touch protocol should be completely revamped, she said.

“My husband, who was a co-investigator on the project, called the light touch protocol a ‘diminished forces’ OMT,” Dr. Snider said, to laughter in the room.

Moreover, with the study taking place in Kirksville, the home of osteopathic medicine, some OMT-savvy patients in the light-touch group weren’t convinced that they were receiving OMT, Dr. Snider said.

The challenge is finding a better light touch protocol, Dr. Snider said, and she cited a Swedish massage therapy study led by Mark Rapaport that did show distinctive results in its light touch and massage groups. These researchers used the backs of their hands when performing sham treatments.

Another limitation was the study’s small size of 21 patients. The initial goal was 36 nursing home residents, but Dr. Snider and her team had trouble verifying patient eligibility by the enrollment deadline.

Dr. Snider hopes to assist with larger studies in the future and noted that nursing home residents are highly receptive to participating in research studies involving OMT. After the study started, residents began requesting to be enrolled in it, and patients in the OMT group really enjoyed the treatments.

“At the end of the study we had several people in the OMM group who wanted to continue receiving OMM … so we actually have them come over to the office to be seen,” Dr. Snider said.

Presentation attendee Daniel C. Sacher, OMS II, said he was intrigued to learn more about the benefits OMT has on nursing home residents.

“There’s a problem with polypharmacy in a lot of nursing home patients,” said Sacher, who attends the New York Institute of Technology College of Osteopathic Medicine in Old Westbury. “So if OMT leads to reduced medication use, it can give patients a better quality of life.”

Kevin Camaclang, OMS III, liked listening to Dr. Snider’s descriptions of the various techniques used in the study, such as muscle energy versus myofascial release.

“I plan on going into family medicine,” said Camaclang, who attends the Touro University Nevada College of Osteopathic Medicine in Henderson. “And I see myself using the techniques Dr. Snider spoke about today in the future in my practice.”

rraymond@osteopathic.org

6 Responses

  1. docmorris on Oct. 2, 2013, 9:13 a.m.

    Right on! We are beginning to understand the power of touch in and of itself, especially for those who are seldom touched. The nursing home patients are an excellent example. Touch with the intention to heal is even more powerful and, then, adding techniques that remove obstructions to the body’s ability to heal itself and you have a very powerful paradigm. Osteopathic medicine is an outstanding example of that combination. The problem is finding the appropriate research model. Dr. Snider’s comments are fundamental to any hands-on research.

  2. hardrock95 on Oct. 2, 2013, 2:33 p.m.

    Why did this make the news?

  3. James Highley on Oct. 13, 2013, 9:45 a.m.

    Ok, let me get this straight. The OMT group had the same outcomes as the SHAM treatment group. And the response is “we need a better study that comes up with the results we really wnated in the first place.” Hey there’s real science, and certainly something the Osteopathic profession can hang its’ white coat on. You know a thinking man might draw the conclusion that OMT is the same as a sham. Just sayin’.

  4. Wesley Lockhart on Oct. 14, 2013, 1:11 p.m.

    My interpretation is that light-touch also has beneficial effects. Not surprising as those who understand and utilize a “hands-on” approach know that this is true. All studies have some problems…even evidence-based medicine results can be greatly skewed by which studies are kept and which are omitted. Another point to be made is that DO’s you can’t feel ‘hot rocks in a paper bag” will never understand OMT. Just sayin’.

  5. James on Oct. 16, 2013, 7:17 a.m.

    Mr. Lockhart,

    And entire profession resting on the premise of “light touch”. Remarkable, and how appropriately named…light. In fact, I would feel very comfortable calling it lighter than light, maybe even ephemeral. And as we all know our allopathic counterparts never “touch” their patients. As to evidence based studies, you are correct. At least they give a nod to evidence. Not quit sure what you mean by “hot rocks……”. But I do know that modern science can measure the heat of rocks in a paper bag or in a wooden box or…..well you get my point. After 30 years I still have yet to see an osteopathic lesion be demonstrated/shown to me by any objective, radiologic, electronic, graphic, chemical or otherwise tangible exam or test.

    You are correct, after 30 years I guess I don’t understand and never will.

  6. Joe on Oct. 16, 2013, 8:27 a.m.

    It is interesting the researchers concluded the sham was problematic, rather than concluding the treatment was no more powerful than light touch.

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