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Effects of manual osteopathic interventions on psychometric and psychophysiological indicators of anxiety, depression and stress in adults: a systematic review and meta-analysis of randomised controlled trials

TOM GORDON, Josh Hope-Bell, Jerry Draper-Rodi Orcid Logo, Andrew MacMillan, Danny Miller, Darren Edwards Orcid Logo

BMJ Open, Volume: 15, Issue: 2, Start page: e095933

Swansea University Authors: TOM GORDON, Darren Edwards Orcid Logo

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DOI (Published version): 10.1136/bmjopen-2024-095933

Abstract

Objectives: To evaluate whether osteopathic and related manual interventions improve adult mental health (depression, anxiety, stress) and psychophysiological measures (eg, heart rate variability, skin conductance). Design: Systematic review and meta-analysis of randomised controlled trials (RCTs)....

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Published in: BMJ Open
ISSN: 2044-6055 2044-6055
Published: BMJ Publishing Group Ltd 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa68722
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Design: Systematic review and meta-analysis of randomised controlled trials (RCTs). Data sources: PubMed, MEDLINE (Ovid), Scopus, Cochrane, and AMED, searched through September 2024. Eligibility criteria: English-language RCTs with &#x2265;30 participants investigating osteopathic or related manual therapies (eg, myofascial release, high-velocity low-amplitude thrusts) delivered by qualified practitioners, compared with no treatment or sham, and reporting immediate postintervention mental health or psychophysiological outcomes. Data extraction and synthesis: Full-text screening, risk-of-bias assessment and data extraction were conducted independently by multiple reviewers using a standardised Joanna Briggs Institute (JBI) Extraction Form. Risk of bias was assessed using the JBI Critical Appraisal Checklist. For meta-analyses, Hedges&#x2019; g (with 95% CIs) was calculated from postintervention means and SD. Random-effects models accounted for heterogeneity, and prediction intervals were calculated to assess uncertainty in effect estimates. Results: 20 RCTs were included. Osteopathic interventions reduced depression (Hedges&#x2019; g=&#x2212;0.47, 95% CI: &#x2212;0.86 to &#x2013;0.09, p=0.02) and increased skin conductance (Hedges&#x2019; g=0.67, 95% CI: 0.00 to 1.34, p=0.05). Depression improvements were greater in pain populations (Hedges&#x2019; g=&#x2212;0.61, 95% CI: &#x2013;1.06 to &#x2013;0.17, p=0.01). However, wide prediction intervals and moderate heterogeneity indicate uncertainty in true effect sizes, and limited studies and sample sizes restrict assessment of publication bias. Conclusions: Osteopathic and related manual therapies may reduce depression and influence certain psychophysiological markers, particularly in pain populations, but uncertainty and heterogeneity limit confidence. More rigorous, larger, and longitudinal RCTs are needed. 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spelling 2025-02-17T14:24:57.2953435 v2 68722 2025-01-21 Effects of manual osteopathic interventions on psychometric and psychophysiological indicators of anxiety, depression and stress in adults: a systematic review and meta-analysis of randomised controlled trials 0a96c2b21758ce41e18c03beb2ff2952 TOM GORDON TOM GORDON true false bee507022c083d875238b7802b96cbeb 0000-0002-2143-1198 Darren Edwards Darren Edwards true false 2025-01-21 Objectives: To evaluate whether osteopathic and related manual interventions improve adult mental health (depression, anxiety, stress) and psychophysiological measures (eg, heart rate variability, skin conductance). Design: Systematic review and meta-analysis of randomised controlled trials (RCTs). Data sources: PubMed, MEDLINE (Ovid), Scopus, Cochrane, and AMED, searched through September 2024. Eligibility criteria: English-language RCTs with ≥30 participants investigating osteopathic or related manual therapies (eg, myofascial release, high-velocity low-amplitude thrusts) delivered by qualified practitioners, compared with no treatment or sham, and reporting immediate postintervention mental health or psychophysiological outcomes. Data extraction and synthesis: Full-text screening, risk-of-bias assessment and data extraction were conducted independently by multiple reviewers using a standardised Joanna Briggs Institute (JBI) Extraction Form. Risk of bias was assessed using the JBI Critical Appraisal Checklist. For meta-analyses, Hedges’ g (with 95% CIs) was calculated from postintervention means and SD. Random-effects models accounted for heterogeneity, and prediction intervals were calculated to assess uncertainty in effect estimates. Results: 20 RCTs were included. Osteopathic interventions reduced depression (Hedges’ g=−0.47, 95% CI: −0.86 to –0.09, p=0.02) and increased skin conductance (Hedges’ g=0.67, 95% CI: 0.00 to 1.34, p=0.05). Depression improvements were greater in pain populations (Hedges’ g=−0.61, 95% CI: –1.06 to –0.17, p=0.01). However, wide prediction intervals and moderate heterogeneity indicate uncertainty in true effect sizes, and limited studies and sample sizes restrict assessment of publication bias. Conclusions: Osteopathic and related manual therapies may reduce depression and influence certain psychophysiological markers, particularly in pain populations, but uncertainty and heterogeneity limit confidence. More rigorous, larger, and longitudinal RCTs are needed. Trial registration number: This meta-analysis was not formally registered, though the protocol and search strategy can be found at Open Science Framework, registration identification: https://osf.io/jrtpx/. Journal Article BMJ Open 15 2 e095933 BMJ Publishing Group Ltd 2044-6055 2044-6055 7 2 2025 2025-02-07 10.1136/bmjopen-2024-095933 COLLEGE NANME COLLEGE CODE Swansea University SU Library paid the OA fee (TA Institutional Deal) This research has been funded by The Osteopathic Foundation, grant award number: URNLG010. 2025-02-17T14:24:57.2953435 2025-01-21T11:08:41.4163832 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Public Health TOM GORDON 1 Josh Hope-Bell 2 Jerry Draper-Rodi 0000-0002-1900-6141 3 Andrew MacMillan 4 Danny Miller 5 Darren Edwards 0000-0002-2143-1198 6 68722__33603__651502b7fd884e43ae6a23dea1497bab.pdf 68722.VOR.pdf 2025-02-17T14:18:54.1888175 Output 1800715 application/pdf Version of Record true © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. true eng http://creativecommons.org/licenses/by-nc/4.0/
title Effects of manual osteopathic interventions on psychometric and psychophysiological indicators of anxiety, depression and stress in adults: a systematic review and meta-analysis of randomised controlled trials
spellingShingle Effects of manual osteopathic interventions on psychometric and psychophysiological indicators of anxiety, depression and stress in adults: a systematic review and meta-analysis of randomised controlled trials
TOM GORDON
Darren Edwards
title_short Effects of manual osteopathic interventions on psychometric and psychophysiological indicators of anxiety, depression and stress in adults: a systematic review and meta-analysis of randomised controlled trials
title_full Effects of manual osteopathic interventions on psychometric and psychophysiological indicators of anxiety, depression and stress in adults: a systematic review and meta-analysis of randomised controlled trials
title_fullStr Effects of manual osteopathic interventions on psychometric and psychophysiological indicators of anxiety, depression and stress in adults: a systematic review and meta-analysis of randomised controlled trials
title_full_unstemmed Effects of manual osteopathic interventions on psychometric and psychophysiological indicators of anxiety, depression and stress in adults: a systematic review and meta-analysis of randomised controlled trials
title_sort Effects of manual osteopathic interventions on psychometric and psychophysiological indicators of anxiety, depression and stress in adults: a systematic review and meta-analysis of randomised controlled trials
author_id_str_mv 0a96c2b21758ce41e18c03beb2ff2952
bee507022c083d875238b7802b96cbeb
author_id_fullname_str_mv 0a96c2b21758ce41e18c03beb2ff2952_***_TOM GORDON
bee507022c083d875238b7802b96cbeb_***_Darren Edwards
author TOM GORDON
Darren Edwards
author2 TOM GORDON
Josh Hope-Bell
Jerry Draper-Rodi
Andrew MacMillan
Danny Miller
Darren Edwards
format Journal article
container_title BMJ Open
container_volume 15
container_issue 2
container_start_page e095933
publishDate 2025
institution Swansea University
issn 2044-6055
2044-6055
doi_str_mv 10.1136/bmjopen-2024-095933
publisher BMJ Publishing Group Ltd
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care - Public Health{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Public Health
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description Objectives: To evaluate whether osteopathic and related manual interventions improve adult mental health (depression, anxiety, stress) and psychophysiological measures (eg, heart rate variability, skin conductance). Design: Systematic review and meta-analysis of randomised controlled trials (RCTs). Data sources: PubMed, MEDLINE (Ovid), Scopus, Cochrane, and AMED, searched through September 2024. Eligibility criteria: English-language RCTs with ≥30 participants investigating osteopathic or related manual therapies (eg, myofascial release, high-velocity low-amplitude thrusts) delivered by qualified practitioners, compared with no treatment or sham, and reporting immediate postintervention mental health or psychophysiological outcomes. Data extraction and synthesis: Full-text screening, risk-of-bias assessment and data extraction were conducted independently by multiple reviewers using a standardised Joanna Briggs Institute (JBI) Extraction Form. Risk of bias was assessed using the JBI Critical Appraisal Checklist. For meta-analyses, Hedges’ g (with 95% CIs) was calculated from postintervention means and SD. Random-effects models accounted for heterogeneity, and prediction intervals were calculated to assess uncertainty in effect estimates. Results: 20 RCTs were included. Osteopathic interventions reduced depression (Hedges’ g=−0.47, 95% CI: −0.86 to –0.09, p=0.02) and increased skin conductance (Hedges’ g=0.67, 95% CI: 0.00 to 1.34, p=0.05). Depression improvements were greater in pain populations (Hedges’ g=−0.61, 95% CI: –1.06 to –0.17, p=0.01). However, wide prediction intervals and moderate heterogeneity indicate uncertainty in true effect sizes, and limited studies and sample sizes restrict assessment of publication bias. Conclusions: Osteopathic and related manual therapies may reduce depression and influence certain psychophysiological markers, particularly in pain populations, but uncertainty and heterogeneity limit confidence. More rigorous, larger, and longitudinal RCTs are needed. Trial registration number: This meta-analysis was not formally registered, though the protocol and search strategy can be found at Open Science Framework, registration identification: https://osf.io/jrtpx/.
published_date 2025-02-07T05:25:03Z
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