Randomized osteopathic manipulation study (ROMANS): pragmatic trial for spinal pain in primary care

Area of Science:

• Evidence-based medicine
• Health services research
• Musculoskeletal disorders

Background:

• Spinal pain is a prevalent and disabling condition.
• Current management guidelines suggest spinal manipulation but lack robust evidence.
• Pragmatic trials and economic evaluations are needed to inform practice.

Purpose of the Study:

• To evaluate the effectiveness of osteopathic manipulative treatment for subacute spinal pain.
• To assess the associated healthcare costs of a primary care-based osteopathy clinic.

Main Methods:

• A pragmatic randomized controlled trial was conducted in a primary care osteopathy setting.
• 201 patients with subacute neck or back pain were randomized to usual GP care or osteopathic manipulation.
• Primary outcome was the Extended Aberdeen Spine Pain Scale (EASPS); secondary outcomes included SF-12 and pain questionnaires.

Main Results:

• The osteopathy group showed greater improvements in EASPS and SF-12 mental scores at 2 months.
• Significant improvements in SF-12 mental scores persisted at 6 months.
• Mean healthcare costs attributed to spinal pain were higher by £65 in the osteopathy group.

Conclusions:

• Primary care osteopathy improved short-term physical and longer-term psychological outcomes for spinal pain.
• The additional healthcare costs associated with osteopathy were minimal.
• Further multicenter studies are required to confirm generalizability.