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Review
. 2024 May 1;16(5):e59439.
doi: 10.7759/cureus.59439. eCollection 2024 May.

Efficacy of Osteopathic Manipulative Treatment for Pain Reduction in Patients With Patellofemoral Pain Syndrome: A Meta-Analysis of Randomized Controlled Trials

Blake E Delgadillo  1 , Audrey Bui  2 , Alyssa M Debski  3 , Brooke Miller  4 , Shan Shan Wu DO  5
Affiliations
Review

Efficacy of Osteopathic Manipulative Treatment for Pain Reduction in Patients With Patellofemoral Pain Syndrome: A Meta-Analysis of Randomized Controlled Trials

Blake E Delgadillo et al. Cureus. .

Abstract

Patellofemoral pain syndrome (PFPS) is among the most common causes of musculoskeletal pain in the United States. It is defined as retropatellar or peripatellar pain that is reproduced with functional activities that load the patellofemoral joint in a flexed position, such as stair climbing or squatting. While it presents in both adolescents and adults, it is commonly found in physically active individuals, such as athletes and military recruits. Exploring the role of osteopathic manipulative treatment (OMT) in PFPS is of particular interest given the absence of a definitive treatment and the poor long-term prognosis associated with PFPS. This meta-analysis includes three studies exploring the use of OMT to reduce pain in patients suffering from PFPS and exploring the efficacy of OMT as a primary intervention. In these studies, pain assessments, pre-treatment, and post-treatment follow-up of at least 30 days were performed using a 10-cm visual analog scale (VAS). The mean difference in pain between OMT and no treatment (NT) groups using the random effects model was -3.95 (-6.39; -1.50) with a p<0.01, suggesting OMT resulted in significant knee pain reduction in those with PFPS. A measure of heterogeneity, known as I2, was found to be high at 97%, which suggests caution should be taken when interpreting the overall results. Given the lack of definitive treatment and the poor long-term prognosis for PFPS, the authors suggest OMT provides an effective option for pain relief in patients with PFPS. Further research is needed to provide results that may be more clinically applicable or valuably interpreted.

Keywords: a meta-analysis; doctor of osteopathic medicine; manual-therapy; orthopedic sports medicine; orthopedics; osteopathic manipulation; osteopathic manipulative medicine (omm); osteopathic manipulative treatment (omt); patellofemoral pain syndrome; randomized controlled trial (rct).

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. A PRISMA flowchart depicting the literature search and selection process
n: number; OMT: osteopathic manipulative treatment; PFPS: patellofemoral pain syndrome; RCT: randomized controlled trial; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Figure 2
Figure 2. Risk of bias for the per-protocol study using the Cochrane Risk of Bias Assessment Tool version 2
Independently completed by two reviewers (AB and BD) using the Cochrane Risk of Bias Assessment Tool version 2, as described by Sterne et al. [24]. Per-protocol study: Tramontano et al. [23] D1: randomization process; D2: deviations from the intended interventions; D3: missing outcome data; D4: measurement of the outcome; D5: selection of the reported result; +: low risk; !: some concerns; -: high risk
Figure 3
Figure 3. Risk of bias for the intention-to-treat studies using the Cochrane Risk of Bias Assessment Tool version 2
Independently completed by two reviewers (AB and BD) using the Cochrane Risk of Bias Assessment Tool Version 2, as described in Sterne et al. [24]. Intention-to-treat studies: Motealleh et al. and Zago et al. [16, 22] D1: randomization process; D2: deviations from the intended interventions; D3: missing outcome data; D4: measurement of the outcome; D5: selection of the reported result; +: low risk; !: some concerns; -: high risk
Figure 4
Figure 4. A forest plot of pain assessment using a visual analog scale compares osteopathic manipulative treatment versus no treatment for all studies included.
OMT: osteopathic manipulative treatment; NT: no treatment; SD: standard deviation; CI: confidence interval Studies included: Motealleh et al., Tramontano et al., and Zago et al. [16,22,23]
Figure 5
Figure 5. A forest plot of pain assessment using a visual analog scale compares osteopathic manipulative treatment versus no treatment for studies focused on generalized body manipulation.
OMT: osteopathic manipulative treatment; NT: no treatment; SD: standard deviation; CI: confidence interval Studies focused on generalized body manipulation: Tramontano et al. and Zago et al. [16,23]
Figure 6
Figure 6. A forest plot of pain assessment using a visual analog scale compares osteopathic manipulative treatment versus no treatment for intention-to-treat studies.
OMT: osteopathic manipulative treatment; NT: no treatment; SD: standard deviation; CI: confidence interval Intention-to-treat studies: Motealleh et al. and Zago et al. [16, 22]
Figure 7
Figure 7. Bland Altman plot for pain measured using a visual analog scale at a follow-up of at least 30 days after osteopathic manipulative treatment versus no treatment.
OMT: osteopathic manipulative treatment; NT: no treatment; upper blue/green line, the upper limit of agreement; lower blue/green line, the lower limit of agreement; middle red line, bias; dots labeled with each study, the difference between OMT versus NT [16,22,23]
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