Osteopathy and Health: Systematic Review with ☸️SAIMSARA.

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Review Stats

Generated: 2025-12-23 13:31:19 CET
Plan: Premium (expanded craft tokens; source: PubMed)
Source: PubMed
Scope: Titles/Abstracts (tiab)
Keyword Gate: Fuzzy (≥60% of required terms, minimum 2 terms matched in title/abstract)
Total Abstracts/Papers: 389
Downloaded Abstracts/Papers: 387
Included original Abstracts/Papers: 141
Total study participants (naïve ΣN): 101767

Outcome-Sentiment Meta-Analysis (OSMA): (LLM-only)
Frame: Effect-of Predictor → Outcome • Source: PubMed
Outcome: Outcome Typical timepoints: 5-y, 3-y. Reported metrics: %, CI, p.
Common endpoints: Common endpoints: qol, complications, seizure.
Predictor: osteopathy and health — exposure/predictor. Typical comparator: those with less experience, males in rural northern, untreated infants, sham….

1) Beneficial for patients — Outcome with osteopathy and health — [2], [8], [9], [11], [19], [20], [21], [22], [23], [26], [27], [28], [29], [31], [34], [35], [38], [39], [43], [44], [45], [48], [51], [59], [62], [64], [68], [71], [75], [76], [77], [80], [82], [85], [86], [89], [92], [94], [95], [96], [99], [103], [113], [118], [123], [124], [125], [129], [131], [133], [134], [135], [141] — ΣN=57530
2) Harmful for patients — Outcome with osteopathy and health — [1], [7], [30], [67], [72], [78], [91], [93], [114], [138] — ΣN=12820
3) No clear effect — Outcome with osteopathy and health — [3], [4], [5], [6], [10], [12], [13], [14], [15], [16], [17], [18], [24], [25], [32], [33], [36], [37], [40], [41], [42], [46], [47], [49], [50], [52], [53], [54], [55], [56], [57], [58], [60], [61], [63], [65], [66], [69], [70], [73], [74], [79], [81], [83], [84], [87], [88], [90], [97], [98], [100], [101], [102], [104], [105], [106], [107], [108], [109], [110], [111], [112], [115], [116], [117], [119], [120], [121], [122], [126], [127], [128], [130], [132], [136], [137], [139], [140] — ΣN=31417

1) Introduction
Osteopathy, a distinct system of medicine, emphasizes the interconnectedness of the body's systems and the body's innate ability to heal. Practitioners, known as osteopaths or Doctors of Osteopathy (DOs), utilize a holistic, patient-centered approach, often employing manual techniques to diagnose and treat a wide range of health conditions. The scope of osteopathic practice extends beyond musculoskeletal complaints to encompass various systemic and chronic health issues, often integrating with conventional medical care. This paper synthesizes recent research to elucidate the current landscape of osteopathic practice, its perceived effectiveness, professional development, and integration within broader healthcare systems, highlighting its evolving role in promoting health.

2) Aim
Systematic review with multilayer AI research agent: keyword normalization, retrieval & structuring, and paper synthesis (see SAIMSARA About section for details).

3) Methods
Systematic review with multilayer AI research agent: keyword normalization, retrieval & structuring, and paper synthesis (see SAIMSARA About section for details).

Bias: Qualitatively inferred from study design fields. The included studies feature a diverse range of designs, from exploratory mixed-methods and cross-sectional surveys to randomized controlled trials (RCTs) and cohort studies, leading to varying levels of evidence strength and potential for selection, reporting, and recall biases, particularly in self-reported data. Case series and retrospective designs inherently carry higher risks of bias compared to prospective RCTs.

4) Results
4.1 Study characteristics
The included studies comprise a wide array of designs, predominantly cross-sectional surveys and mixed-methods studies investigating professional practices, patient perceptions, and educational aspects. Cohort studies and case series explored specific health conditions and occupational exposures, while a few randomized controlled trials and protocols aimed to assess the efficacy of osteopathic manipulative treatment (OMT) for conditions like chronic low back pain (CLBP), depressive symptoms, and infant sucking difficulties. Follow-up periods, when specified, ranged from 5 weeks to 5 years, with many cross-sectional studies having no follow-up.

4.2 Main numerical result aligned to the query
A significant proportion of patients seeking osteopathic care do so for musculoskeletal (MSK) conditions. The use of osteopathy for MSK problems was reported to be a median of 73% (range: 61.9% to 81.1%) across various populations and settings, including patients in Quebec [110], England [76], and the UK [33, 136]. While other specific conditions showed promising results, such as a mean effectiveness of 7.3 for pain reduction in endometriosis [9] and a mean reduction of 1.20 hours in infant crying time [125], these metrics were not directly comparable across multiple studies to derive a central value.

4.3 Topic synthesis

Musculoskeletal and Chronic Pain Management — Osteopathy is frequently sought for musculoskeletal conditions, with 61.9% to 81.1% of patients consulting for spinal, thoracic, pelvic, or limb pain [33, 76, 110, 136]. It demonstrated significant effectiveness for chronic low back pain [29, 135], chronic neck pain [48], and temporomandibular disorders [95], and was rated with a mean effectiveness of 7.3 for pain reduction in endometriosis [9].
Addressing Non-Musculoskeletal Complaints — Over one in ten Australian and New Zealand osteopaths (13.5%) often treat non-musculoskeletal (non-MSK) complaints, particularly using visceral techniques (ORa 3.54) and Osteopathy in the Cranial Field (OCF) (ORa 2.05) [5]. This includes conditions like chronic prostatitis (48-58% improvement in symptoms) [131], infant sucking difficulties [23, 96], and excessive crying in infants [26].
Public Awareness and Accessibility — A substantial gap in public awareness of osteopathic manipulative medicine (OMM) exists, with 72% unaware of its distinction from allopathic medicine in Fresno County [2]. Despite this, there is strong openness to osteopathic care (83% in Fresno County [2], 61.5% among people experiencing homelessness [8]), and osteopathy is a popular complementary medicine (CM) method in Switzerland (30.5% of women, 15.2% of men) [127].
Professional Identity and Practice Heterogeneity — Osteopathic practice exhibits fragmentation in diagnostic frameworks and treatment rationales, often driven by tradition rather than empirical evidence [4]. Conceptions of practice range from technical rationality to professional artistry [10, 16, 119], and experienced osteopaths are more likely to use cranial osteopathy daily (37.3% vs 18.5%) [3].
Interprofessional Collaboration and Integration — Osteopaths frequently engage in referral relationships with other health practitioners [83], and general practitioners (GPs) often recommend osteopathic treatment for spinal and musculoskeletal complaints [39, 122]. Interprofessional education activities significantly improved collaborative competency among osteopathic, pharmacy, and physician assistant students [19].
Osteopathy in Vulnerable Populations — Osteopathy is utilized by specific vulnerable groups, including people experiencing homelessness [8], women with endometriosis [9], cancer patients in palliative care [85, 94], and parents of children with excessive crying [26] or epilepsy [118]. It is also associated with skeletal issues in conditions like autoimmune pancreatitis (35.6-38.1% with skeletal muscle loss/sarcopenia) [7], thalassemia intermedia (76% osteopathy) [93], and chronic occupational cadmium exposure [1].
Educational and Ethical Considerations — Osteopathy students show high prevalence of spinal musculoskeletal diseases (98.4%) during training [67]. While largely supportive of evidence-based practice (EBP), Spanish osteopaths report low to moderate skills and infrequent engagement [52]. Undergraduate osteopaths in the UK did not engage in competent Shared Decision Making (SDM) behaviors, scoring significantly lower than NHS physiotherapists [70].

5) Discussion
5.1 Principal finding
The central finding indicates that osteopathy is predominantly utilized for musculoskeletal conditions, with a median of 73% of patients seeking care for such complaints across various international settings [33, 76, 110, 136]. This underscores its established role in addressing physical pain and dysfunction.

5.2 Clinical implications

Osteopathic manipulative treatment (OMT) should be considered as an effective intervention for chronic low back pain, showing improvements in pain intensity, physical function, and quality of life [29].
Osteopaths are well-positioned for health promotion, with many already discussing lifestyle factors such as physical activity, stress management, and diet with patients [44, 75].
Given the high interest in osteopathic care among underserved populations like people experiencing homelessness, strategies to improve accessibility and awareness in these communities could mitigate health and social issues [8].
For infants with biomechanical sucking difficulties or excessive crying, osteopathic treatment, particularly myofascial release, can be a beneficial and safe adjunct to conventional care, improving sucking skills and reducing crying time [23, 26, 96, 125].
Clinicians should be aware of the potential for osteopathy to assist with symptom management in palliative care and for cancer-related complaints like pain and fatigue, offering a non-pharmacological, holistic approach [59, 85].

5.3 Research implications / key gaps

Standardize Visceral Practice — Future research should focus on developing empirically-supported diagnostic frameworks and treatment rationales for visceral osteopathic practice to reduce current fragmentation [4].
OMT for Depressive Symptoms — A randomized controlled trial is needed to investigate the effect of osteopathic manipulative treatment (OMT) on depressive symptoms in patients with chronic low back pain, with follow-up at 3 months [6].
OMM in Neurosurgery — Further research is warranted to demonstrate the clinical benefits of osteopathic manipulative medicine (OMM) applications in neurosurgery, facilitating its integration into this specialty [22].
Shared Decision Making Outcomes — Studies should evaluate the impact of educational strategies designed to improve Shared Decision Making (SDM) competencies in osteopathic students on patient outcomes and satisfaction [70].
Long-term Efficacy in Specific Conditions — More prospective, long-term randomized controlled trials are needed to confirm the efficacy of osteopathic treatment for conditions such as pediatric otitis media [121] and chronic fatigue syndrome (CFS/ME) in children [115].

5.4 Limitations

Methodological Heterogeneity — The wide variety of study designs, from case series to RCTs, limits the ability to draw definitive, generalizable conclusions about osteopathic efficacy.
Awareness Gaps — Low public awareness of osteopathic manipulative medicine (OMM) may affect patient self-selection and the generalizability of studies on patient perceptions and access.
Diagnostic Inconsistency — Fragmentation in diagnostic frameworks and treatment rationales within specialized osteopathic practices, particularly visceral osteopathy, introduces variability that can confound research outcomes.
Evidence-Based Practice Skill Deficit — Self-reported low to moderate skills and infrequent engagement in evidence-based practice (EBP) among osteopaths may impact the quality and consistency of care provided.
GP Referral Bias — Unfavorable attitudes of general practitioners towards osteopaths could limit referrals and interprofessional collaboration, potentially underrepresenting osteopathy's role in integrated care.

5.5 Future directions

Standardize Diagnostic Frameworks — Develop and validate standardized, empirically-supported diagnostic frameworks for specialized osteopathic practices, such as visceral osteopathy.
Enhance EBP Training — Implement and evaluate targeted educational programs to improve evidence-based practice skills and integration among practicing osteopaths.
Improve SDM Education — Integrate specific, competency-based educational modules on Shared Decision Making (SDM) into osteopathic curricula and assess their impact on student performance.
Investigate OMT for Depression — Conduct a large-scale randomized controlled trial to assess the effectiveness of osteopathic manipulative treatment on depressive symptoms in patients with chronic low back pain.
Address Public Awareness — Develop and implement public health campaigns to increase general public awareness and understanding of osteopathic manipulative medicine.

6) Conclusion
Osteopathy is predominantly utilized for musculoskeletal conditions, with a median of 73% of patients seeking care for such complaints across various international settings [33, 76, 110, 136]. This highlights its established role in addressing physical pain, although its application extends to a broad spectrum of non-musculoskeletal conditions, from infant crying to palliative care. The methodological heterogeneity of current research, encompassing diverse study designs, remains the single limitation that most affects certainty in drawing broad conclusions. Clinicians should recognize osteopathy's potential as an effective adjunctive therapy for chronic pain and specific pediatric conditions, while future research should prioritize large-scale, high-quality randomized controlled trials to further validate its efficacy across a wider range of health issues and standardize diagnostic approaches.

References
SAIMSARA Session Index — session.json

Figure 1. Publication-year distribution of included originals

Figure 1. Publication-year distribution of included originals

Figure 2. Study-design distribution of included originals

Figure 2. Study-design distribution

Figure 3. Study-type (directionality) distribution of included originals
Figure 3. Directionality distribution

Figure 3. Directionality distribution

Figure 4. Main extracted research topics

Figure 4. Main extracted research topics (Results)

Figure 5. Limitations of current studies (topics)

Figure 5. Limitations of current studies (topics)

Figure 6. Future research directions (topics)

Figure 6. Future research directions (topics)