title: A randomized control trial on the effectiveness of osteopathic manipulative treatment in reducing pain and improving the quality of life in elderly patients affected by osteoporosis.
abstract: BACKGROUND
  In the elderly population, a decrease in bone mineral density (osteoporosis) is often associated with a decrease in quality of life and an increase in self reported body pain. This pain originates from the musculoskeletal system and can potentially affect different areas of the body.
  
  
  OBJECTIVE
  The aim of this study was to investigate the effect of osteopathic manipulative treatment (OMT) on self reported pain and quality of life in an elderly population.
  
  
  METHODS
  Randomized placebo controlled trial.
  
  
  METHODS
  Patients were recruited from the Geriatric Department, Bassini Hospital (Milan, Italy). Patients were randomly assigned to either 6 sessions of OMT (n = 37 patients) or an equivalent number of sham manipulative treatment (SMT) (n = 35 patients). The main outcome variables were QOL measured by QUALEFFO -41 and overall bodily pain measured using a visual analog scale (VAS). Data were analyzed using a two factor ANOVA (treatment × time) for repeated measurements with an α level set at p ≤ 0.05.
  
  
  RESULTS
  Main result of this study was that OMT compared to SMT showed a significant decreased of disability. This effect was demonstrated by a significant interaction in the overall disability score (p =0.001) and the Mental wellbeing (p =0.058), Health perception (p =0.005) and Pain (p =0.003) QUALEFFO -41 subscales, while no significant difference (no interaction) for pain as measured by VAS and for the Daily activities, Walking, Household cleaning and Leisure time activities QUALEFFO -41 subscales (p > 0.05) was found. No adverse effects were recorded during the study.
  
  
  CONCLUSIONS
  This study demonstrated that, in a group of elderly subjects affected by osteoporosis OMT was able to increase self reported QOL while the effect on body pain perception is unclear. This overall improvement in QOL appears to be caused by an improvement in psychological factors (i.e Mental wellbeing and Health perception) rather than physical factors. In fact, all QUALEFFO -41 subscales related to physical function demonstrated no significant interaction. The effect of OMT on Pain perception is less clear. In fact, there was no effect on pain as assessed by VAS while a significant improvement was observed when the QUALEFFO -41 subscale was used. This could be due to the metric properties of the two pain measurement methods; an alternative explanation could be that VAS measures mainly pain quantity while QUA-LEFFO -41 subscales measures mainly pain quality. The lack of effect of OMT on physical function needs to be confirmed by more direct measurements of this variable.
authors.affiliation: International College of Osteopathic Medicine, Cinisello Balsamo, Milan, Italy.
authors.forename: Liria
authors.initials: L
authors.lastname: Papa
authors.forename: Alfonso
authors.initials: A
authors.lastname: Mandara
authors.forename: Michele
authors.initials: M
authors.lastname: Bottali
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Gulisano
authors.forename: Stefano
authors.initials: S
authors.lastname: Orfei
keywords: osteopathic treatment; osteoporosis; pain; quality of life