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.
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.”