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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
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). 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/.
College: Faculty of Medicine, Health and Life Sciences
Funders: This research has been funded by The Osteopathic Foundation, grant award number: URNLG010.
Issue: 2
Start Page: e095933

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