Table 2 Description of included studies dealing with the clinical efficacy of techniques used in visceral osteopathy

Minor doubt about risk of bias

Panagopoulos [24]

Low back pain: 64

EG “standard physiotherapy + visceral manipulation”/ PG “standard physiotherapy + placebo visceral manipulation”

Pain intensity (0–10 Numerical Pain Rating Scale) at 6 wks. Results show no SSD.

• 8 criteria (3 outcomes after 2 wks, 2 ones after 6 wks and 3 ones after 1 yr).

1. Pain intensity (0–10Numerical Pain Rating Scale).

2. Disability (Rolland-Morris Disability Scale).

3. Function (Patient-Specific Functional Scale).

• Results show no SSD for all criteria with the exception of pain intensity after 1 yr. [PG: 2.17; EG: 3.73].

Haiden [25]

Very low birth weight infant: 41

EG (visceral osteopathy; “protocol adapted from visceral treatment of adults by Barral and Finet”) / untreated G

The time to complete meconium evacuation. Results show no SSD.

4 criteria

1. Introduction of enteral feeding in days.

2. Feeding volume on day 14th.

3. Time of full enteral feeding in days.

4. Hospital stay in days.

• Results show no SSD for all criteria with the exception of time of full enteral feeding, in favor of the untreated G [EG: 34; untreated G: 26]

Tamer [26]

Nonspecific low back pain: 39

One G treated by OMT + physiotherapy (OMT G) / one G treated by OMT + visceral techniques (vOMT)

None

• 12 criteria (12 outcomes immediately after treatment).

1. Pain intensity (Visual Analogic Scale).

2. Function level (Oswestry Function Scale).

3. Physical function (SF-36 for quality of life).

4. Physical role limitation (SF-36 for quality of life).

5. Pain (SF-36 for quality of life).

6. General health (SF-36).

7. Energy (SF-36)

8. Social function (SF-36).

9. Emotional role limitation (SF-36).

10. Mental health (SF-36).

11. Total physical score (SF-36)

12. Total mental score (SF-36)

• Results show SSD for 3 criteria in favor of the vOMT: physical function [OMT G: 30; vOMT: 46]; energy [OMT G: 10; vOMT: 22]; total physical score [OMT G: 10.5; vOMT: 20.6].

High risk of bias

Vigüesca [27]

Sacroiliac pain: 14

EG “ileocecal valve inhibition technique”/ untreated G

None

• 6 criteria (2 outcomes immediately after treatments and 1 wk. and 2 wks later).

1. Pain intensity (Visual Analogic Scale).

2. Functional disabiltity (Oswestry Disability Index).

• Results show difference between pretest and post-test for pain intensity [untreated G: 0; EG: 0.72] and functional disability [untreated G: 0.15; EG: 5.0], and 2 wks later again for pain intensity [untreated G: 0.15; EG: 1.54]. Selective reporting of results.

Attali [28]

Irritable bowel syndrome (IBS): 31

Cross-over range of 10 wks with 2 G (standard therapy + visceral osteopathic manipulation vs. Standard therapy + “placebo manipulation”)

None

45 criteria (21 outcomes 3 wks and 6 wks after treatments, and 3 outcomes 1 yr. later).

1. Constipation (Visual Analogic Scale).

2. Diarrhea (Visual Analogic Scale).

3. Abdominal distension (Visual Analogic Scale).

4. Abdominal pain (Visual Analogic Scale).

5. Colonic transit time: in the right & left colon and the recto-sigmoid (monitoring of ingested radiopaque markers).

6. Rectal sentivity: threshold sensation volume, constant sensation volume and maximum tolerable volume (Anorectal manometry).

7. Pain intensity in 9 abdominal areas (Visual Analogic Scale).

8. Presence or absence of depression (two-question case-finding instrument).

9. Evolution of IBS phenotype (“Standardized questionnaire as defined by the Rome III criteria”).

• Results: selective reporting of results. Number of criteria above 15^a.

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Rosado [29]

Irritable bowel syndrome: 40

EG (Osteopathic visceral manipulation) / “placebo treatment”

None

12 criteria (6 outcomes immediately after treatments and 1 wk. later).

1. Lumbar range of motion (LROM) in flexion (Goniometry)

2. LROM in extension (Goniometry)

3. LROM in right side bending (Goniometry)

4. LROM in left side bending (Goniometry)

5. LROM in flexion (Modified-Modified Schober Test − MMST)

6. LROM in extension (MMST)

• Results: no inter-group statistical comparison; outcomes improve for the two groups apart from the LROM in extension measured by the MMST.