Posadzki Pawel, Kyaw Bhone Myint, Dziedzic Arkadiusz, Ernst Edzard
Kleijnen Systematic Reviews, 6 Escrick Business Park, York YO19 6FD, UK.
Lee Kong Chian School of Medicine, Nanyang Technological University, 50 Nanyang Ave, Singapore 639798, Singapore.
J Clin Med. 2022 Jul 30;11(15):4455. doi: 10.3390/jcm11154455.
Osteopathic manipulative treatment (OMT) continues to be used for a range of diseases in children.
The aim of this paper is to update our previous systematic review (SR) initially published in 2013 by critically evaluating the evidence for or against this treatment.
Eleven databases were searched (January 2012 to November 2021).
Only randomized clinical trials (RCTs) of OMT in pediatric patients compared with any type of controls were considered. The Cochrane risk-of-bias tool was used. In addition, the quality of the evidence was rated using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria, as recommended by the Cochrane Collaboration.
Thirteen trials met the eligibility criteria, of which four could be subjected to a meta-analysis. The findings show that, in preterm infants, OMT has little or no effect on reducing the length of hospital stay (standardized mean difference (SMD) -0.03; 95% confidence interval (CI) -0.44 to 0.39; very low certainty of evidence) when compared with usual care alone. Only one study (8.3%) was judged to have a low risk of bias and showed no effects of OMT on improving exclusive breastfeeding at 1 month. The methodological quality of RCTs published since 2013 has improved. However, adverse effects remain poorly reported.
The quality of the primary trials of OMT has improved during recent years. However, the quality of the totality of the evidence remains low or very low. Therefore, the effectiveness of OMT for selected pediatric populations remains unproven.
整骨手法治疗（OMT）仍用于治疗儿童的一系列疾病。
本文旨在通过批判性评估支持或反对这种治疗方法的证据，更新我们先前于2013年首次发表的系统评价（SR）。
检索了11个数据库（2012年1月至2021年11月）。
仅考虑将儿科患者接受OMT的随机临床试验（RCT）与任何类型的对照进行比较。使用Cochrane偏倚风险工具。此外，按照Cochrane协作网的建议，使用推荐分级、评估、制定与评价（GRADE）标准对证据质量进行评级。
13项试验符合纳入标准，其中4项可进行荟萃分析。研究结果表明，在早产儿中，与单纯常规护理相比，OMT在缩短住院时间方面几乎没有效果（标准化均数差（SMD）-0.03；95%置信区间（CI）-0.44至0.39；证据确定性极低）。只有一项研究（8.3%）被判定偏倚风险低，且显示OMT对1个月时纯母乳喂养的改善无影响。2013年以来发表的RCT的方法学质量有所提高。然而，不良反应的报告仍然很少。
近年来，OMT的主要试验质量有所提高。然而，总体证据质量仍然很低或极低。因此，OMT对特定儿科人群的有效性仍未得到证实。
