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.

Gordon, Tom C., Hope-Bell, Josh, Draper-Rodi, Jerry, MacMillan, Andrew, Miller, Danny and Edwards, Darren J 2025. 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. BMJ Open 15 (2) , e095933. 10.1136/bmjopen-2024-095933

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Abstract

To evaluate whether osteopathic and related manual interventions improve adult mental health (depression, anxiety, stress) and psychophysiological measures (eg, heart rate variability, skin conductance). Systematic review and meta-analysis of randomised controlled trials (RCTs). PubMed, MEDLINE (Ovid), Scopus, Cochrane, and AMED, searched through September 2024. 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. 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' (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. 20 RCTs were included. Osteopathic interventions reduced depression (Hedges' =-0.47, 95% CI: -0.86 to -0.09, p=0.02) and increased skin conductance (Hedges' =0.67, 95% CI: 0.00 to 1.34, p=0.05). Depression improvements were greater in pain populations (Hedges' =-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. 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. 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/. [Abstract copyright: © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.]

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Schools > Medicine
Publisher:	BMJ Publishing Group
Date of First Compliant Deposit:	21 February 2025
Date of Acceptance:	16 January 2025
Last Modified:	21 Feb 2025 12:45
URI:	https://orca.cardiff.ac.uk/id/eprint/176379

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