Table_1_Effectiveness of osteopathic craniosacral techniques: a meta-analysis.XLSX

BackgroundCraniosacral osteopathic manipulative medicine—also known as craniosacral therapy (CST)—is a widely taught and used component of osteopathic medicine. This paper seeks to systematically review and conduct a meta-analysis of randomized controlled trials assessing the clinical effectiveness of CST compared to standard care, sham treatment, or no treatment in adults and children.MethodsA search of Embase, PubMed, and Scopus was conducted on 10/29/2023 and updated on 5/8/2024. There was no restriction placed on the date of publication. A Google Scholar search was conducted to capture grey literature. Backward citation searching was also implemented. All randomized controlled trials employing CST for any clinical outcome were included. Studies not available in English as well as studies that did not report adequate data were excluded. Multiple reviewers were used to assess for inclusions, disagreements were settled by consensus. PRISMA guidelines were followed in the reporting of this meta-analysis. Cochrane’s Risk of Bias 2 tool was used to assess for risk of bias. All data were extracted by multiple independent observers. Effect sizes were calculated using a Hedge’s G value (standardized mean difference) and aggregated using random effects models. The GRADE system was used to assess quality of evidence.ResultsThe primary study outcome was the effectiveness of CST for selected outcomes as applied to non-healthy adults or children and measured by standardized mean difference effect size. Twenty-four RCTs were included in the final meta-analysis with a total of 1,613 participants. When subgroup analyses were performed by primary outcome only, no significant effects were found. When secondary outcomes were included in subgroup analyses, results showed that only Neonate health, structure (g = 0.66, 95% CI [0.30; 1.02], Prediction Interval [−0.73; 2.05]) and Pain, chronic somatic (g = 0.34, 95% CI [0.18; 0.50], Prediction Interval [−0.41; 1.09]) show reliable, statistically significant effect. However, these should not be interpreted as positive results as wide prediction intervals, high bias, and statistical limitations temper the real-world implications of this finding.Conclusions and relevanceCST demonstrated no significant effects in this meta-analysis, indicating a lack of usefulness in patient care for any of the studied indications.Pre-registration available at https://doi.org/10.17605/OSF.IO/54K6G.Systematic Review Registrationhttps://osf.io/54k6g.

背景：颅骶骨整骨疗法，亦称颅骶疗法（CST），是整骨医学中被广泛教授和应用的组成部分。本研究旨在对随机对照试验进行系统回顾和荟萃分析，评估与标准护理、安慰剂治疗或无治疗相比，CST在成人和儿童中的临床有效性。方法：于2023年10月29日对Embase、PubMed和Scopus进行了检索，并于2024年5月8日更新。未对出版日期进行限制。通过Google Scholar检索以获取灰色文献，并实施了反向引用检索。纳入了所有使用CST治疗任何临床结局的随机对照试验。排除非英语文献以及未报告充分数据的文献。多位审稿人用于评估纳入标准，通过共识解决分歧。本荟萃分析的报告遵循了PRISMA指南。使用Cochrane风险偏倚2工具评估偏倚风险。所有数据均由多位独立观察者提取。效应量使用Hedge’s G值（标准化均数差）计算，并使用随机效应模型进行汇总。使用GRADE系统评估证据质量。结果：主要研究结局是CST对于非健康成人或儿童选定结局的有效性，通过标准化均数差效应量进行测量。最终荟萃分析中纳入了24项RCT，共1,613名参与者。仅按主要结局进行亚组分析时，未发现显著效应。当包括次要结局进行亚组分析时，结果显示仅新生儿健康、结构（g=0.66，95%CI[0.30; 1.02]，预测区间[−0.73; 2.05]）和慢性躯体疼痛（g=0.34，95%CI[0.18; 0.50]，预测区间[−0.41; 1.09]）显示出可靠且统计学意义显著的效应。然而，这些结果不应被解读为积极结果，因为宽泛的预测区间、高偏倚和统计局限性限制了这一发现的实际意义。结论与相关性：本荟萃分析中，CST未显示出显著效应，表明对于所研究的任何指征，在患者护理中均缺乏实用性。预注册信息可访问https://doi.org/10.17605/OSF.IO/54K6G。系统评价注册信息https://osf.io/54k6g。