title: Osteopathic manipulative treatment: A systematic review and critical appraisal of comparative effectiveness and health economics research.
abstract: In recent years, evidence has emerged regarding the effectiveness of osteopathic manipulative treatments (OMT). Despite growing evidence in this field, there is need for appropriate research designs that effectively reflect the person-centred system of care promoted in osteopathy and provide data which can inform policy decisions within the healthcare system. The purpose of this systematic review is to identify, appraise and synthesise the evidence from comparative effectiveness and economic evaluation research involving OMT. A database search was conducted using CINAHL, PubMed, PEDro, AMED, SCOPUS and OSTMED.DR, from their inception to May 2015. Two separate searches were undertaken to identify original research articles encompassing the economic evaluation and comparative effectiveness of OMT. Identified comparative effectives studies were evaluated using the Cochrane risk of bias tool and appraised using the Good Reporting of Comparative Effectiveness (GRACE) principles. Identified economic studies were assessed with the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines. Sixteen studies reporting the findings of comparative effectiveness (n = 9) and economic evaluation (n = 7) research were included. The comparative effectiveness studies reported outcomes for varied health conditions and the majority (n = 6) demonstrated a high risk of bias. The economic evaluations included a range of analyses and considerable differences in the quality of reporting were evident. Despite some positive findings, published comparative effectiveness and health economic studies in OMT are of insufficient quality and quantity to inform policy and practice. High quality, well-designed, research that aligns with international best practice is greatly needed to build a pragmatic evidence base for OMT.
authors.affiliation: Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Endeavour College of Natural Health, Level 2, 269 Wickham St, Fortitude Valley, QLD, 4006, Australia. Electronic address: amie.steel@uts.edu.au.
authors.forename: Amie
authors.initials: A
authors.lastname: Steel
authors.affiliation: Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Research Unit for Studies of Integrative Health Care, Karolinska Institutet (NVS/OMV), Alfred Nobels Alle 23, 141 83, Stockholm, Sweden.
authors.forename: Tobias
authors.initials: T
authors.lastname: Sundberg
authors.affiliation: Endeavour College of Natural Health, Level 2, 269 Wickham St, Fortitude Valley, QLD, 4006, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Reid
authors.affiliation: Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), B4495, Oxford, OX3 7LD, University of Oxford, Oxford, United Kingdom.
authors.forename: Lesley
authors.initials: L
authors.lastname: Ward
authors.affiliation: Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Centre for Applications of Health Psychology, Faculty of Social Human and Mathematical Sciences, Building 44 Highfield Campus, University of Southampton, Southampton, SO17 1BJ, United Kingdom.
authors.forename: Felicity L
authors.initials: FL
authors.lastname: Bishop
authors.affiliation: Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; School of Nursing & Midwifery, Health Economics & Social Policy Group, University of South Australia, 101 Currie St, Adelaide, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Leach
authors.affiliation: Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45141, Duisburg, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Cramer
authors.affiliation: Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.
authors.forename: Jon
authors.initials: J
authors.lastname: Wardle
authors.affiliation: Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.
authors.forename: Jon
authors.initials: J
authors.lastname: Adams
mesh_terms: D057186:Comparative Effectiveness Research / Q000379:methods*; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data*; D004470:Economics, Medical / Q000706:statistics & numerical data*; D006801:Humans; D026301:Manipulation, Osteopathic / Q000191:economics* / Q000379:methods*; D016896:Treatment Outcome
keywords: Comparative effectiveness research; Economic evaluation; Osteopathic manipulative treatment; Osteopathy; Pragmatic research