(OMT) for Patients with Low Back Pain - American Academy of ...

2a2b3aSystematic review with homogeneity ofcohort studiesIndividual cohort study or low-qualityrandomized controlled trialSystematic review with homogeneity ofcase-control studiesIndividual studies should be freeof substantial variations in thedirections and magnitudes ofOMT effectsLow quality may be indicated bysuch factors as importantdifferences in baselinecharacteristics between groups,lack of concealment of treatmentallocation, and excessive lossesto follow-upIndividual studies should be freeof substantial variations in thedirections and magnitudes ofOMT effects3b Individual case-control study These should be free ofsubstantialevidence of selection bias,information bias, orconfounding variables4 Case series and low quality cohort andcase-control studies5 Expert opinion without explicit criticalappraisal, or based on physiology,bench research, or "first principles"Low quality of cohort and casecontrol studies may be indicatedby such factors as importantsources of selection bias,information bias, orconfounding variablesThese generally will have limitedempirical data relevant to OMTeffects in human populations*Adapted from Straus SE, Richardson WS, Glasziou P, and Haynes RB, Evidence-Based Medicine.How to Practice and Teach EBM (3rd ed), 200515. Potential benefits and harms: Describe anticipated benefits and potential risks associated withimplementation of guideline recommendations.Potential benefits include but are not limited to improved care for patients seeing osteopathicphysicians or practitioners for somatic dysfunctions causing low back pain. Harms have not beenidentified in randomized clinical trials on OMT for patients with low back pain. OMT for somaticdysfunction has not demonstrated harm in any clinical trials to date.16. Patient preferences: Describe the role of patient preferences when a recommendation involves asubstantial element of personal choice or values.Patients have a choice of provider and services when they suffer from low back pain. OMT offersanother option for care for low back pain from somatic dysfunction and can be provided by9