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Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
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Abstract.
BACKGROUND: The efficacy of osteopathic manual therapy (OMT) applications on chronic nonspecific low back pain (LBP)
has been demonstrated. However, visceral applications, which are an important part of OMT techniques, have not been included
in those studies.
OBJECTIVE: The studys objective was to determine the effect of OMT including visceral applications on the function and
quality of life (QoL) in patients with chronic nonspecific LBP.
DESIGN: The study was designed with a simple method of block randomization.
METHODS: Thirty-nine patients with chronic nonspecific LBP were included in the study. OMT group consisted of 19 patients
to whom OMT and exercise methods were applied. The visceral osteopathic manual therapy (vOMT) group consisted of 20
patients to whom visceral applications were applied in addition to the applications carried out in the other group. Ten sessions
were performed over a two-week period. Pain (VAS), function (Oswestry Index) and QoL (SF-36) assessments were carried out
before the treatment and on the sixth week of treatment.
RESULTS: Both of the treatments were found to be effective on pain and function, physical function, pain, general health, social
function of the QoL sub-parameter. vOMT was effective on all sub-QoL parameters (p < 0.05). Comparing the groups, it was
determined that the energy and physical limitations of the QoL scores in vOMT were higher (p < 0.05).
CONCLUSION:Visceral applications on patients with non-specific LBP gave positive results together with OMT and exercise
methods. We believe that visceral fascial limitations, which we think cause limitations and pain in the lumbar segment, should
be taken into consideration.
Keywords: Low back pain, osteopathic manipulative treatment, manual therapy, visceral manipulation
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1. Introduction
Low back pain is a problem faced by individuals
quite often, particularly in developed societies. It negatively affects the quality of life and physical activ Corresponding
author: Seval Tamer, Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey. Tel.: +90 312 3051577; E-mail: ozlemulger
@yahoo.com.
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2. Methods
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S. Tamer et al. / The effect of visceral OMT applications on pain, QoL and function in patients with chronic nonspecific LBP
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S. Tamer et al. / The effect of visceral OMT applications on pain, QoL and function in patients with chronic nonspecific LBP
Table 1
Demographic data of the patients
Age (years)
Height (cm)
Weight (kg)
BMI (kg/m2 )
Gender
Female
Male
Median (%2575)
N (%)
9 (47.4)
10 (52.6)
12 (60)
8 (40)
pa
0.136
0.078
0.899
0.368
0.435b
The Mann-Whitney U a test for median numerical data (25%75%) and Chi -square testb for categorical data were used for data values.
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PASW statistics 18 was used for statistical analysis. The datas compliance with the normal distribution
was examined with visual (histograms and probability
plots) and analytical methods (Kolmogorov-Smirnov,
Shapiro-Wilk tests). Because it was determined that it
was not in accordance with the normal distribution, the
differences between the OMT group and the vOMT
group were determined with the Mann-Whitney U test,
for categorical data Chi-square test (for sex) and the
changes after the treatment were determined with the
Wilcoxon test. The statistical significance level was accepted as p < 0.05.
We used the Gx Power Package Program (Gx power,
version 3.0.10, Franz Faul, Universitat Kiel, GERMAN) to determine the observed power. For SF-36
total physical score 39 patients was enough to obtain
%80 power but other variable was defined as less than
%80. Because there was no similar study in the literature we didnt calculate sample size at the beginning of
the study so we want to show our early first results.
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3. Results
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4. Discussion
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Our study has been the first to apply visceral techniques in non-specific lower back pain patients and determine the effect of vOMT methods on pain, function
and quality of life in comparison with OMT methods.
In our study, it was found that both treatment groups
had an effect on pain and function, and physical function, pain, general health, social function of quality-oflife sub-parameters, while vOMT was effective on all
sub-quality-of-life parameters in patients with chronic
lower back pain.
In non-specific [24] low back pain, which is defined as a symptom characterized by tension and muscle stiffness in the waist region without any pathology, body muscle spasm and normal joint movements
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The function levels of the individuals were evaluated through means of the Oswestry Function Scale,
which was validated for Turkish reliability and validity, by defining their condition consisting of six choices
during activities including personal care, lifting, walking, sitting, standing, sleeping, sex life, social life and
travel. Lower values indicated the high excuse intensity in the function, while the high values indicated a
good functional state [22,23].
All evaluations were conducted before the treatment
and six weeks after the beginning of treatment.
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S. Tamer et al. / The effect of visceral OMT applications on pain, QoL and function in patients with chronic nonspecific LBP
Table 2
OMT and vOMT groups data before and after the treatment
41 (251)
47 (4260)
40 (3550)
50 (3570)
33.3 (069)
Mental health
Total physical
score
56 (4460)
34.5 (29.341)
Total mental
score
39.2 (33.248.2)
50 (0100)
2.020
0.043*
21.5 (068.7)
62 (4174)
67 (4572)
50 (3070)
75 (62.575)
66.7 (0100)
2.200
2.204
1.400
2.849
1.381
0.028*
0.028*
0.162
0.004*
0.167
26.5 (2248)
51 (4060)
38 (26.249.2)
62.5 (37.575)
61.6 (066.7)
68 (5274)
45 (37.850.9)
1.352
2.294
0.176
0.022*
50 (3676)
29.9 (2138.9)
40.5 (33.552.1)
1.288
0.198
38.5 (3551.1)
After treatment
median
(25%75%)
2 (0.23)
16.5 (4.527)
86 (7090)
pc
3,924
3.809
3.928
< 0.001*
< 0.001
< 0.001*
94 (60100)
3.658
< 0.001*
65 (6274)
67 (5775.7)
60 (5077.5)
73.5 (62.587.5)
66.7 (66.7100)
3.921
3.753
3,728
2.706
3.119
< 0.001*
< 0.001*
< 0.001*
0.007*
0.002*
3.486
3.920
< 0.001*
< 0.001*
2.726
0.006*
Pain
General health
Energy
Social function
Emotional role
limitations
3,828
3.704
2.654
vOMT Group
pc
Before treatment
median
(25%75%)
< 0.001*
8 (6.18)
< 0.001*
50 (26.565.5)
0.008*
40 (22.550)
73 (52.584)
50.5 (42.953.2)
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Pain
Oswestry
SF-36 physical
function
Physical role
limitations
OMT Group
Before treatment After treatment
median
median
(25%75%)
(25%75%)
7 (57)
2 (13)
42 (3260)
26 (11.136)
45 (3670)
75 (6582)
50.6 (40.256.9)
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Wilcoxon analysisc results, before and after the treatment, statistical significance *p < 0.05.
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OMT average SD
4.77 1.91
22.60 14.09
22 28.54
31.36 56.15
19.26 34.80
9.63 16.65
7.47 20.76
21.11 23.26
16.74 45.63
6.94 19.30
8.08 14.54
2.02 9.57
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Pain
Oswestry
SF-36 physical function
Physical role limitations
Pain-induced limitations
General health
Energy
Social function
Emotional role limitations
Mental health
Total physical score
Total mental score
Before treatment
Z
pa
1.493
0.136
0.014
0.989
1.368
0,171
1.241
0.215
0.711
0.477
0.409
0.682
0.578
0.563
1.229
0.219
0.173
0.862
0.211
0.833
0.956
0.339
0.422
0.673
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Table 3
Comparison of OMT and vOMT group individuals before and after treatment
BT-AT difference
vOMT average SD
5.65 1.64
28.40 18.19
42.95 23.4
46.00 35.14
34.30 19.21
17.25 13.75
21.10 16.24
16.88 23.48
29.76 33.99
15.20 17.09
17.27 7.96
7.15 9.27
Z
1.424
1.168
2.200
0.642
1.238
1.297
2.115
0.665
1.101
0.837
2.234
1.405
pa
0.154
0.243
0.028*
0.521
0,216
0.195
0.034*
0.506
0.271
0.403
0.025*
0.160
Comparison of before treatment results and changes between before treatment and after the treatment, a Mann-Whitney-U test, *, statistical
significance p < 0.05.
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exercise approaches, provides pain inhibition by reducing the muscle spasms and sympathetic system activation. This result, based on pain and spasm, has affected
the literature in a similar way [12,1416]. In the studies, the mechanism of pain reduction at the spinal and
supraspinal levels with manual therapy techniques has
not been fully revealed [28,29]. It was reported that osteopathic manual therapy, when applied together with
many different methods as the innovation of manual
therapy techniques [30,31], regulates the corticospinal
changes that cause somatic function [32] and pain [33]
by regulating the sensitivity of the 1a reflex pathway
in various segments due to biomechanical loading on
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4.1. Limitations
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5. Conclusion
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Conflict of interest
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