title: A randomized controlled trial of the effectiveness of osteopathy-based manual physical therapy in treating pediatric dysfunctional voiding.
abstract: OBJECTIVE
  Pediatric dysfunctional voiding (DV) presents physical and emotional challenges as well as risk of progression to renal disease. Manual physical therapy and osteopathic treatment have been successfully used to treat DV in adult women; a pediatric trial of manual physical therapy based on an osteopathic approach (MPT-OA) has not been reported. The aim of this study was to determine whether MPT-OA added to standard treatment (ST) improves DV more effectively than ST alone.
  
  
  METHODS
  Twenty-one children (aged 4-11 years) with DV were randomly assigned to receive MPT-OA plus standard treatment (treatment group) or standard treatment alone (control group). Pre-treatment and post-treatment evaluations of DV symptoms, MPT-OA evaluations and inter-rater reliability of DV symptom resolution were completed.
  
  
  RESULTS
  The treatment group exhibited greater improvement in DV symptoms than did the control group (Z=-2.63, p=0.008, Mann-Whitney U-test). Improved or resolution of vesicoureteral reflux and elimination of post-void urine residuals were more prominent in the treatment group.
  
  
  CONCLUSIONS
  Results suggest that MPT-OA treatment can improve short-term outcomes in children with DV, beyond improvements observed with standard treatments, and is well liked by children and parents. Based on these results, a multi-center randomized clinical trial of MPT-OA in children with vesicoureteral reflux and/or post-void urinary retention is warranted.
authors.affiliation: Kennedy Krieger Institute, Physical Therapy Department, 707 North Broadway, Baltimore, MD, USA. nemett@kennedykrieger.org
authors.forename: Diane R
authors.initials: DR
authors.lastname: Nemett
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Fivush
authors.forename: Ranjiv
authors.initials: R
authors.lastname: Mathews
authors.forename: Nathalie
authors.initials: N
authors.lastname: Camirand
authors.forename: Marlo A
authors.initials: MA
authors.lastname: Eldridge
authors.forename: Kathy
authors.initials: K
authors.lastname: Finney
authors.forename: Arlene C
authors.initials: AC
authors.lastname: Gerson
mesh_terms: D001676:Biofeedback, Psychology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D010021:Osteopathic Medicine / Q000379:methods*; D010352:Patient Dropouts; D026741:Physical Therapy Modalities; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000628:therapy; D014552:Urinary Tract Infections / Q000628:therapy; D014554:Urination; D014555:Urination Disorders / Q000628:therapy*; D014718:Vesico-Ureteral Reflux / Q000628:therapy