Reliability of diagnosis and clinical efficacy of visceral osteopathy: a systematic review

Abstract

Background: In 2010, the World Health Organization published benchmarks for training in osteopathy in which osteopathic visceral techniques are included. The purpose of this study was to identify and critically appraise the scientific literature concerning the reliability of diagnosis and the clinical efficacy of techniques used in visceral osteopathy.

Methods: Databases MEDLINE, OSTMED.DR, the Cochrane Library, Osteopathic Research Web, Google Scholar, Journal of American Osteopathic Association (JAOA) website, International Journal of Osteopathic Medicine (IJOM) website, and the catalog of Académie d'ostéopathie de France website were searched through December 2017. Only inter-rater reliability studies including at least two raters or the intra-rater reliability studies including at least two assessments by the same rater were included. For efficacy studies, only randomized-controlled-trials (RCT) or crossover studies on unhealthy subjects (any condition, duration and outcome) were included. Risk of bias was determined using a modified version of the quality appraisal tool for studies of diagnostic reliability (QAREL) in reliability studies. For the efficacy studies, the Cochrane risk of bias tool was used to assess their methodological design. Two authors performed data extraction and analysis.

Results: Eight reliability studies and six efficacy studies were included. The analysis of reliability studies shows that the diagnostic techniques used in visceral osteopathy are unreliable. Regarding efficacy studies, the least biased study shows no significant difference for the main outcome. The main risks of bias found in the included studies were due to the absence of blinding of the examiners, an unsuitable statistical method or an absence of primary study outcome.

Conclusions: The results of the systematic review lead us to conclude that well-conducted and sound evidence on the reliability and the efficacy of techniques in visceral osteopathy is absent.

Trial registration: The review is registered PROSPERO 12th of December 2016. Registration number is CRD4201605286 .

Fig. 1

Flow chart of the study selection process for the systematic review of studies dealing with the reliability of diagnosis in the field of visceral osteopathy

Fig. 2

Assessment of methodological risk of bias for each reliability studies included. Green shading indicates a low risk of bias, yellow an unclear risk of bias and red a high risk. Grey shading color indicates non-applicable items. For general assessment of bias, purple shading and cyan shading indicates a major doubt and a minor doubt as to the overall risk of bias, respectively

Fig. 3

Assessment of methodological risk of bias for the reliability studies taken together. Green shading indicates a low risk of bias, yellow an unclear risk of bias and red a high risk. Grey shading color indicates non-applicable items. For general assessment of bias, purple shading and cyan shading indicates a major doubt and a minor doubt as to the overall risk of bias, respectively

Fig. 4

Selection process for studies dealing with the clinical efficacy of techniques and therapeutic strategies used in visceral osteopathy

Fig. 5

Assessment of methodological risk of bias for each efficacy studies included. Green shading indicates a low risk of bias, yellow an unclear risk of bias and red a high risk. Grey shading color indicates non-applicable items. For general assessment of bias, purple shading and cyan shading indicates a major doubt and a minor doubt as to the overall risk of bias, respectively

Fig. 6

Assessment of methodological risk of bias for the efficacy studies taken together. Green shading indicates a low risk of bias, yellow an unclear risk of bias and red a high risk. Grey shading color indicates non-applicable items. For general assessment of bias, purple shading and cyan shading indicates a major doubt and a minor doubt as to the overall risk of bias, respectively