Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia: A randomized controlled trial

Donald R. Noll, Brian F. Degenhardt, Thomas F. Morley, Francis X. Blais, Kari A. Hortos, Kendi Hensel, Jane C. Johnson, David J. Pasta, Scott T. Stoll

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Abstract

Background: The Multicenter Osteopathic Pneumonia Study in the Elderly (MOPSE) is a registered, double-blinded, randomized, controlled trial designed to assess the efficacy of osteopathic manipulative treatment (OMT) as an adjunctive treatment in elderly patients with pneumonia.Methods: 406 subjects aged ≥ 50 years hospitalized with pneumonia at 7 community hospitals were randomized using concealed allocation to conventional care only (CCO), light-touch treatment (LT), or OMT groups. All subjects received conventional treatment for pneumonia. OMT and LT groups received group-specific protocols for 15 minutes, twice daily until discharge, cessation of antibiotics, respiratory failure, death, or withdrawal from the study. The primary outcomes were hospital length of stay (LOS), time to clinical stability, and a symptomatic and functional recovery score.Results: Intention-to-treat (ITT) analysis (n = 387) found no significant differences between groups. Per-protocol (PP) analysis (n = 318) found a significant difference between groups (P = 0.01) in LOS. Multiple comparisons indicated a reduction in median LOS (95% confidence interval) for the OMT group (3.5 [3.2-4.0] days) versus the CCO group (4.5 [3.9-4.9] days), but not versus the LT group (3.9 [3.5-4.8] days). Secondary outcomes of duration of intravenous antibiotics and treatment endpoint were also significantly different between groups (P = 0.05 and 0.006, respectively). Duration of intravenous antibiotics and death or respiratory failure were lower for the OMT group versus the CCO group, but not versus the LT group.Conclusions: ITT analysis found no differences between groups. PP analysis found significant reductions in LOS, duration of intravenous antibiotics, and respiratory failure or death when OMT was compared to CCO. Given the prevalence of pneumonia, adjunctive OMT merits further study.

Original languageEnglish
Article number2
JournalOsteopathic Medicine and Primary Care
Volume4
DOIs
StatePublished - 19 Mar 2010

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Osteopathic Manipulation
Pneumonia
Randomized Controlled Trials
Touch
Length of Stay
Respiratory Insufficiency
Anti-Bacterial Agents
Intention to Treat Analysis
Therapeutics
Community Hospital
Confidence Intervals

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Noll, Donald R. ; Degenhardt, Brian F. ; Morley, Thomas F. ; Blais, Francis X. ; Hortos, Kari A. ; Hensel, Kendi ; Johnson, Jane C. ; Pasta, David J. ; Stoll, Scott T. / Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia : A randomized controlled trial. In: Osteopathic Medicine and Primary Care. 2010 ; Vol. 4.
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abstract = "Background: The Multicenter Osteopathic Pneumonia Study in the Elderly (MOPSE) is a registered, double-blinded, randomized, controlled trial designed to assess the efficacy of osteopathic manipulative treatment (OMT) as an adjunctive treatment in elderly patients with pneumonia.Methods: 406 subjects aged ≥ 50 years hospitalized with pneumonia at 7 community hospitals were randomized using concealed allocation to conventional care only (CCO), light-touch treatment (LT), or OMT groups. All subjects received conventional treatment for pneumonia. OMT and LT groups received group-specific protocols for 15 minutes, twice daily until discharge, cessation of antibiotics, respiratory failure, death, or withdrawal from the study. The primary outcomes were hospital length of stay (LOS), time to clinical stability, and a symptomatic and functional recovery score.Results: Intention-to-treat (ITT) analysis (n = 387) found no significant differences between groups. Per-protocol (PP) analysis (n = 318) found a significant difference between groups (P = 0.01) in LOS. Multiple comparisons indicated a reduction in median LOS (95{\%} confidence interval) for the OMT group (3.5 [3.2-4.0] days) versus the CCO group (4.5 [3.9-4.9] days), but not versus the LT group (3.9 [3.5-4.8] days). Secondary outcomes of duration of intravenous antibiotics and treatment endpoint were also significantly different between groups (P = 0.05 and 0.006, respectively). Duration of intravenous antibiotics and death or respiratory failure were lower for the OMT group versus the CCO group, but not versus the LT group.Conclusions: ITT analysis found no differences between groups. PP analysis found significant reductions in LOS, duration of intravenous antibiotics, and respiratory failure or death when OMT was compared to CCO. Given the prevalence of pneumonia, adjunctive OMT merits further study.",
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Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia : A randomized controlled trial. / Noll, Donald R.; Degenhardt, Brian F.; Morley, Thomas F.; Blais, Francis X.; Hortos, Kari A.; Hensel, Kendi; Johnson, Jane C.; Pasta, David J.; Stoll, Scott T.

In: Osteopathic Medicine and Primary Care, Vol. 4, 2, 19.03.2010.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia

T2 - A randomized controlled trial

AU - Noll, Donald R.

AU - Degenhardt, Brian F.

AU - Morley, Thomas F.

AU - Blais, Francis X.

AU - Hortos, Kari A.

AU - Hensel, Kendi

AU - Johnson, Jane C.

AU - Pasta, David J.

AU - Stoll, Scott T.

PY - 2010/3/19

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N2 - Background: The Multicenter Osteopathic Pneumonia Study in the Elderly (MOPSE) is a registered, double-blinded, randomized, controlled trial designed to assess the efficacy of osteopathic manipulative treatment (OMT) as an adjunctive treatment in elderly patients with pneumonia.Methods: 406 subjects aged ≥ 50 years hospitalized with pneumonia at 7 community hospitals were randomized using concealed allocation to conventional care only (CCO), light-touch treatment (LT), or OMT groups. All subjects received conventional treatment for pneumonia. OMT and LT groups received group-specific protocols for 15 minutes, twice daily until discharge, cessation of antibiotics, respiratory failure, death, or withdrawal from the study. The primary outcomes were hospital length of stay (LOS), time to clinical stability, and a symptomatic and functional recovery score.Results: Intention-to-treat (ITT) analysis (n = 387) found no significant differences between groups. Per-protocol (PP) analysis (n = 318) found a significant difference between groups (P = 0.01) in LOS. Multiple comparisons indicated a reduction in median LOS (95% confidence interval) for the OMT group (3.5 [3.2-4.0] days) versus the CCO group (4.5 [3.9-4.9] days), but not versus the LT group (3.9 [3.5-4.8] days). Secondary outcomes of duration of intravenous antibiotics and treatment endpoint were also significantly different between groups (P = 0.05 and 0.006, respectively). Duration of intravenous antibiotics and death or respiratory failure were lower for the OMT group versus the CCO group, but not versus the LT group.Conclusions: ITT analysis found no differences between groups. PP analysis found significant reductions in LOS, duration of intravenous antibiotics, and respiratory failure or death when OMT was compared to CCO. Given the prevalence of pneumonia, adjunctive OMT merits further study.

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