Physical Medicine / OMM

Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/30823

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Determining optimal wearable sensor location for detection of differences in younger versus older adults.
(2022) Panchal, Olivia; Lee, Yein; Moudy, Sarah
Objectives: Previous studies have assessed the efficacy of wearable sensors in detecting differences between younger and older adults or non-fallers and fallers as a means for predicting fall risk in these populations. Numerous combinations of variables (e.g., acceleration, step length, stride duration, and harmonic ratio) have been measured using various sensor locations (e.g., iliac crest, sacrum, dorsal foot, femur, and shin). Currently, there is no consensus among researchers regarding the ideal sensor location for detecting significant differences in these variables between either younger and older adults or non-fallers and fallers. Therefore, the purpose of this study was to determine if common fall risk variables are able to detect differences in relatively healthy younger and older adults as a means for earlier-onset fall risk detection and determine optimal sensor location to make these measurements easier in a clinical setting. We hypothesized that older adults would demonstrate decreased average range of acceleration and the sacrum would be the optimal sensor location for detecting differences in acceleration because of its close proximity to the center of mass. Design: 12 participants voluntarily enrolled and were divided into 2 groups based on age (18-35 and >60 years). Subjects performed a 2-minute treadmill walking task at a self-selected habitual pace. Wearable sensors were placed on the sacrum, lateral femur, and anterior tibia bilaterally. Sensors measured linear acceleration in the anteroposterior (AP), mediolateral (ML), and vertical (V) directions. The average range of acceleration across 10 gait cycles was calculated for each subject. Results: No significant differences in acceleration were found between groups in the AP and V directions for sensors placed at the sacrum (p≥0.317) and lateral femur (p≥0.054) or in any direction for sensors placed at the anterior tibia (p≥0.395). ML acceleration was significantly decreased in the older adults group at the sacrum (Younger=8.83±1.05 m/s2, Older=7.09±1.09 m/s2; p=0.034) and the right lateral femur (Younger=37.58±17.00 m/s2, Older=27.33±4.85 m/s2; p=0.017). Conclusion: With the exception of ML acceleration, acceleration was not found to be significantly different between groups. Significant differences in ML acceleration measured at the sacrum and lateral femur are consistent with previous studies. Compared to AP and V acceleration, hip sway during walking as measured by ML acceleration is more prominent and easier to detect in a clinical setting. Greater side-to-side sway could correlate with instability and thus, an increased risk of falls. Therefore, ML acceleration may be an important variable to focus on in future studies emphasizing earlier fall risk detection in healthy adults. The results suggest sacrum and lateral thigh (rather than anterior tibia) sensors would be more advantageous at detecting differences in acceleration in such studies.
Designing a Sustainable in-Clinic Protocol to Expand Postural Stability Data Collection
(2022) Dinh, Mai; Kennedy, Shawn; Gupta, Sanya; Nayak, Rajesh; Mason, David; Lee, Yein; Patterson, Rita
Purpose: Assessing postural stability may help to predict fall risk and aid in understanding underlying mechanisms of injuries due to falls. Several studies have compared postural stability in different populations of patients; however, the age, gender, race, health conditions, and the number of participants were limited. To answer clinical questions on the relationship between postural stability and fall risk, it is necessary to expand the dataset by including minority and vulnerable populations. The objective of this study is to design a sustainable clinic research data collection protocol to better understand fall risk in the diverse minority populations surrounding the HSC community and provide clinicians with sway information on their patients. Methods: Sustainable data collection protocol: Third-year medical students rotating in OMM clinic collected sway data for one half day during their month-long rotation. Data collectors were presented a video demo of the protocol and a didactic video on balance and falls before collecting data. Medical assistants in the clinic brought patients to students before the appointment time or when the patient's physician was seeing another patient, to avoid delays in clinic schedule. The total time for data collection is approximately two minutes. Postural sway data: Postural sway was evaluated in patients seen in the Osteopathic Manipulated Medicine (OMM) clinic at the University of North Texas Health Science Center between 6/7/2021 and 12/21/2021. Patients who were cane or wheelchair-dependent and children less than 65 lbs. were excluded. Patients took off their shoes and put on shoe covers. Patients then stood on footprints attached to the Bertec Force Plate (Bertec Columbus, Ohio). Patients were asked to stand straight, hands by their sides, body facing toward and looking at a target in front of them for 10 seconds with their eyes open. The same procedure was repeated with their eyes closed. Three trials of each condition were performed. A rest period of three seconds took place between each trial. Measurements of Mean Center of Gravity Sway Velocity were collected. Postural sway data was retrospectively analyzed from the clinic data collection (UNTHSC IRB# 2013-102). Results: 701 postural sway measurements were collected on a total of 511 patients between 06/07/2021 and 12/21/2021. Conclusion: As a result of creating a sustainable data collecting model by incorporating third-year medical students in their rotations as data collectors, 701 postural sway measurements were obtained in approximately seven months. This achievement was possible due to the continuous improvement of the protocol with the collaboration of clinic staff and physicians to ensure data collection incorporates smoothly into the natural flow of the clinic. Future steps: One next step is to allow treatment providers secure access to their patient's data so they can discuss changes in sway during clinic visits. Another is to partner with artificial intelligence experts to form algorithms to analyze the data on diverse patient populations to assist clinicians in clinical assessments/treatments and possibly provide fall prediction alerts.
GUYON'S CANAL SYNDROME AFTER CUBITAL TUNNEL RELEASE: A CASE REPORT
(2022) Yasuda, Tai; Ferguson, Drew; Selod, Omar
Background:Compression of the ulnar nerve typically occurs at the cubital tunnel and less commonly at Guyon's canal. The cubital tunnel is located between the olecranon and the medial epicondyle. A known risk factor for developing cubital tunnel syndrome is repetitive motions at the elbow, commonly found in tennis players and smokers. Guyon's canal is located at the medial wrist between the hook of hamate and pisiform. Compression at Guyon's canal is rare and most commonly occurs in cyclists. In this case, Guyon's canal compression was found after an ulnar nerve decompression and cubital tunnel syndrome in the contralateral extremity. Case Presentation:The patient is a 74-year-old female that presented to the physiatry clinic for bilateral weakness, numbness and tingling in the fourth and fifth fingers. Symptoms in the right hand began approximately eight years ago. She had a right ulnar nerve decompression with persistent numbness since then. Symptoms on the left hand began three months prior to presentation. Social history was significant for an 80-pack year smoking history. Physical exam revealed positive Formant's sign bilaterally and positive Tinel's sign at the right wrist, right elbow, and left wrist. Electrodiagnostic findings were consistent with left sided cubital tunnel syndrome and right sided compression at Guyon's canal. Conclusions:The use of EMG and NCS studies are helpful in diagnosing ulnar nerve lesions. However, if a cubital tunnel syndrome is found, a distal Guyon's canal compression may be masked. In this case, an undiagnosed Guyon's canal compression may have been hidden in the initial EMG study. Additionally, proximal compression of a nerve may contribute to the disruption neurofilament structure, resulting in the distal nerve to be more sensitive to compression.In patients with persistent symptoms of ulnar nerve compression after surgical cubital tunnel release, repeat EMG studies to screen for Guyon's canal compression should be considered.
Candidate gene analysis of 535 "pain genes" and associations with reported intensity of chronic low back pain
(2022) Hurd, Christine A.; Phillips, Nicole R.; Lin, Emily; Broadbent, Dallen; Doederlein, Alexander R.; Dubakula, Vishnu; Licciardone, John C.
Purpose: Numerous genome-wide association studies have been able to elucidate potential underlying genetic associations with clinical diagnoses. Chronic low back pain (CLBP) is a clinical presentation that has not yet been strongly associated with specific genetic markers. Several studies however have found genetic associations with other various pain disorders, such as the 535 genes identified by Ultsch et al. as "pain genes." Our group aims to find associations between previously identified pain-related genes and clinical reports of the intensity of low back pain using genetic and clinical data collected by the PRECISION Pain Research Registry. Methods: The PRECISION Pain Research Registry is a national registry that has collected demographic, clinical, and genetic information of patients with CLBP. Our analysis is querying associations between these identified "pain genes" and the intensity of low back pain reported by registry participants using a numerical rating scale (NRS). Methods: Participants in the PRECISION Pain Research Registry were genotyped via an Illumina iScan Array Scanner and Global Screening Array. The phenotype of CLBP will be measured by the NRS, which is an 11-point quantifier of pain intensity. The collected genotypes and phenotypic expression of pain will be compared via the Multi-marker Analysis of GenoMic Annotation (MAGMA), which enables candidate gene analysis of the 535 "pain genes" via congregation of single nucleotide polymorphisms (SNPs) and subsequent projection onto principal components in a matrix. Pain intensity will be evaluated as a function of genetic effects accounting for selected covariates-comorbid conditions with a documented relationship to CLBP, smoking status, and genetic ancestry plus residuals, with F-tests to determine the p-values of associations. Results: FN1 and STARD13 were found to be significantly associated with pain intensity in AA registry participants and VEGF-A was found to be significantly associated with widespread pain in NHW registry participants Conclusion: For treatment that is refractory to other strategies, targeted drugs for these protein products can be explored as treatments. These mentioned genes also have significant epigenetic regulation that could be explored in further studies.
Atypical Presentation of Focal Dystonia in Female Bassoonist: A Case Study
(2022) Taqvi, Samar; Lee, Yein
Background: Focal dystonia is a disorder characterized by sustained or intermittent muscle contractions causing abnormal or repetitive movements. Musicians dystonia is focal task-specific dystonia (FTSD) elicited in professional musicians during instrumental playing. Approximately 1% of all professional musicians develop musician's dystonia. Demographically, male musicians tend to be affected more than women, with a male: female ratio of 4:1. Embouchure dystonia falls under the category of FTSD that affects the jaw or tongue in musicians that play woodwind instruments such as oboe, clarinet, bassoon, and flute. The purpose of this case study is to highlight an unusual presentation of focal dystonia. Case Information: We present this case of a 74-year-old female bassoonist with a clinical presentation of jaw weakness and tremor. The patient reported that the symptoms only occurred when she played her instrument. The patient's past medical history includes TMJ and rheumatoid arthritis. Physical exam findings revealed a contraction of the muscles of facial expression accompanied by small tremor-like movements of the chin when playing the bassoon. EMG/NCS studies were ordered along with MRI, which incidentally showed vestibular schwannoma. Although unrelated to the patient's symptoms, a referral was made to otolaryngology. With normal EMG results, a trial of propranolol was initiated with a concern of possible essential tremor, but patient failed to respond to the medicine. Due to the task-specific nature of the patient's symptoms, occurring only when she plays, we initiated a multidisciplinary treatment plan for focal dystonia. The patient was referred to a speech-language pathologist, and we started several home exercises to help with the movement disorder. In addition, the patient was suggested to start movement-based therapies such as the Alexander technique, yoga, and Feldenkrais. The patient was also offered counseling to help her process this serious diagnosis that can dramatically affect a musician's career. The patient also had significant joint and myofascial pain which was treated with osteopathic manipulative treatment and trigger point injections. Conclusions: This case presents an embouchure dystonia that is atypical. Our patient did not fit the typical clinical picture of young, male musician complaining of unwanted movements. While task specific, her movements mimicked essential tremor at times, not to mention other rheumatologic and musculoskeletal conditions such as degenerative joint disease and myofascial pain that contributed to the chief complaint. With the incidental findings of vestibular schwannoma, her diagnostic process was complicated as well. This case highlights the importance of including FTSD on the differential for any musician that presents to the clinic with a complaint of unwanted movements, weakness or tremor regardless of past medical history, age, and gender. Although unclear at initial presentation, with careful history, physical examination, and appropriate diagnostic tests, our team was able to arrive at the correct diagnosis and initiate appropriate treatment.
OMT as an Effective Treatment for Patients with Long-Term Postoperative Complications: A Case Study
(2022) Ta, Khanh; Malla, Trishangi; Hadley, Lesca
Background: Prior studies have shown how Osteopathic Manipulative Treatment (OMT) performed on patients with non-emergent, undifferentiated chest pain can offer relief as a supplement to allopathic medicine. Previous surgery or trauma to the chest, abdominal, or pelvic regions commonly produces somatic dysfunction which can worsen existing cardiovascular conditions. However, little information exists regarding the effect of OMT in the long-term postoperative recovery of these patients. In 2021, medical students at a mobile clinic in Sanderson, TX provided healthcare screenings and OMT to patients in underserved rural communities. Case Information: A 71-year-old Caucasian female presented to the clinic with 1 week of dyspnea and chest heaviness, worsening within 24 hours prior to her visit. The patient reported progressive epigastric pain that radiated upwards, generalized myalgia, bilateral lower extremity paresthesias, and decreased urination. Her past medical history was significant for coronary artery disease, hypertension, GERD, chronic kidney infections, sinus infections, dural hematoma, hypothyroidism, osteoarthritis, and nose carcinoma. She has a history of two previous stent placements in 2019, a dural hematoma surgery in 2021, a tonsillectomy, and a tubal ligation. Current medication use included baby aspirin, lisinopril, metoprolol, levothyroxine, rosuvastatin, and Zyrtec. The epigastric pain did not improve with pain medications. On admission, vital signs showed a HR of 61bpm, BP of 142/78, and temp of 97.8F. Physical exam revealed regular rate and rhythm without bruits, gallops, or murmurs. PMI was displaced laterally indicating possible ventricular dysfunction. Radial, Dorsalis Pedis, and posterior tibial pulses 2+ bilaterally, extremities were warm to touch. Lungs were CTA bilaterally. Additional physical exam findings include severe RUQ pain with no visible masses or abdominal distension. Gallbladder ultrasound was negative for gallstones, with some wall thickening. Cardiac ultrasound was performed which revealed ventricular and septal hypertrophy, reduced LV function by 50%, and reduced ejection fraction by 50%. Given her chest discomfort and potential causative somatic dysfunctions, an osteopathic exam was performed, and anterior thoracic tender points were found at AT3 and AT8. Rib examination revealed a significant right ribs 8-10 inhalation dysfunction which was then treated with OMT, specifically Muscle Energy. The patient had immediate relief of symptoms after the treatment and reported nearly complete resolution of her pain. Conclusions: This report illustrates the use of OMT to beneficially alleviate symptoms of dyspnea and severe epigastric pain in a patient with a history of coronary artery disease and multiple invasive surgeries, including coronary revascularization. Somatic dysfunction of the thoracic cage can significantly worsen existing cardiac symptoms and present very similarly to acute myocardial infarction. This case suggests that OMT should be considered in the management of future patients who are experiencing complications in the years following their surgery to improve patient outcomes.
How "in tune" are musicians to their musculoskeletal problems? A survey of dancers, instrumentalists, and vocal performers.
(2022) Colucci, Patricia; Lee, Yein; Roop, Katrina; Passmore, Cynthia
RAD Abstract Submission How "in tune" are musicians to their musculoskeletal problems? A survey of dancers, instrumentalists, and vocal performers. Purpose This is an ongoing survey of dancers, instrumentalists, and vocal performers connected with University of North Texas Health Science Center Performing Arts Medicine Clinic (UNTHSC PAMC.) The study's goal was to study the injuries, illnesses, prior treatments, self-care habits, and the effectiveness of osteopathic manipulative treatment (OMT) when addressing the musculoskeletal injuries of the performers. Methods A survey consisting of 33 quantitative and qualitative questions was created using Qualtrics and granted IRB approval (IRB 1504435-3.) The survey gathered information about the duration and frequency of practices and performances for dancers, vocal performers, brass, string, percussion, and woodwind instrumentalists. Surveys were distributed and collected through the internet and a mobile platform. Information regarding the survey was disseminated through social media and word of mouth. Data was gathered from Qualtrics and analyzed. Performers were asked specifics of their practice schedule, if break time is allotted, and about performer injuries and treatments pursued. If a participant received OMT, he or she was asked about its impact on their return to performance. Those surveyed also reported the amount of cardiovascular exercise and resistance and flexibility training they do in a week. Every person surveyed was asked about the impact coronavirus disease 2019 (COVID-19) has made on their performance. Results At this time, of 58 respondents, and 42 instrumentalists were selected for initial analysis. These instrumentalists are primarily White, highly educated, 30 years of age, and have typically played 13 years (range 5 - 66 years). Preliminary results revealed that 75% of instrumentalists report practicing 5 hours or more per week. Additionally, 66% of instrumentalists play with pain, most reportedly in the jaw, anterior neck, and upper/middle back. The instrumentalist demonstrated a high level of technical language when describing their injuries. The survey reported frequent break times and using a variety of at-home modalities to treat their pain, while 78% reported less than four hours of cardiovascular activity per week. There were eight subjects who responded to questions regarding OMT. Of those responses, three responded that OMT has decreased or improved pain, four responded that OMT had reduced time away from performances, and three reported OMT had enhanced sound quality. Conclusions The current findings support the already known high prevalence of musculoskeletal injuries amongst instrumentalists. Many musicians were significantly aware of their medical problems, as evidenced by the highly technical description of their various musculoskeletal diagnoses. While they demonstrated trying many different self-care and treatment modalities for their injuries and illnesses, the survey shows musicians dedicate little time to physical activity. Due to a lack of responses, the significance of OMT on musculoskeletal injuries of the performers remains to be seen.
The Role of Osteopathic Cranial Manipulation in a 7-Year Old Male with Attention Deficit Hyperactivity Disorder
(2022) Rashik, Mohammad Imran; Surve, Sajid
Background: Attention Deficit Hyperactivity Disorder (ADHD) is a disease process that involves mismanagement of the executive functions of the brain. Typical symptoms of ADHD may include aggression, attention loss with hyperactivity, anger, impulsivity, anxiety and even depression. ADHD is known to affect children with a prevalence of up to 9%, with symptoms being manifested in males more often than females. ADHD diminishes the quality of the lives of children and their families due to poor schoolwork and unacceptable social behavior. Osteopathic Cranial Manipulation (OCM) is a technique that can be used as a supplemental therapy for patients with ADHD. It has shown to provide significantly sustained improvements in attention and intellectual performance in pediatric patients. Case Presentation: A 7-year-old Caucasian male patient with a past medical history of strabismus and nocturia was presented to the Osteopathic Manipulative Medicine (OMM) clinic at the University of North Texas Health Science Center (UNTHSC) by his mother with the chief complaint of attention problems at home and school. The mother complained that the patient lacked attention at school, inappropriately touched his teachers at school, as well as friends and family members at home. The patient had trouble reading, writing and speech difficulties. For the academic term of 2020-2021, the patient had complaints of disruptive behavior from teachers every day. During late 2021, he also was officially diagnosed with ADHD. Over a period of 3 visits, osteopathic examination revealed restrictions in the right ethmoid bone, dural strain, sacroiliac joint restrictions, occipitomastoid suture restriction, right temporal bone external rotation and bladder restrictions in the pelvic area. The mother preferred medications to be a last resort of treatment. So, osteopathic cranial manipulative medicine (OCMM) was used with the intention of addressing underlying structural dysfunction. The treatments led to subjective relief of symptoms which led to increased attention span, better grades, acceptable social behavior and an overall increase in quality of life in the patient. In order to assess treatment outcomes objectively, the Vanderbilt Assessment Scale was used over a period of three months. The post treatment symptom score from the mother decreased by 8 points in comparison to pre-treatment symptom score and the cognitive performance score decreased by 1.28 points. However, post treatment symptom score from the teacher increased by 1 point compared to pre-treatment and the cognitive performance score stayed the same. Conclusion: This case sheds light to the potential use of OCMM as a stand-alone therapy for patients who refuse to use stimulant medications and may be of use for osteopathic physicians in an outpatient setting. Due to conflicted scoring on the assessment scale from the mother and the teacher, it is difficult to conclude whether OCMM was of significant benefit to this patient. Therefore, a better solution would be to conduct clinical trials with stand-alone OCMM and a bigger sample size and then calculating the assessment scale results over a longer period of time.
Altered Balance in those with Back Pain
(2022) Doederlein, Alexander R.; Kennedy, Shawn; Patterson, Rita
Purpose: Numerous studies have attempted to find an association between back pain (BP) and altered standing balance. These quiet standing (QS) studies measure a subject's center of pressure (COP) via a force plate system. From the COP data, variables such as COP area and COP velocity are calculated to measure the amount of sway a subject had while attempting to stand still during the QS trial. In reviewing previous research, most studies had relatively small sample sizes, and while some were able to achieve statistically significant differences in sway variables between subjects with BP and healthy controls, most were too underpowered to achieve clinical statistical significance. Also, what is concerning is that some studies with shared variables had inconsistent results of whether BP or healthy control participants had greater values. Our study sought to test potential associations with a much larger sample size (greater than 10-fold larger than many other studies) to find clinically meaningful relationships. Methods: This research is built from the results of previous QS studies and an ongoing QS project at UNTHSC. A Bertec force plate (Bertec, Columbus, Ohio) was used to collect data from participants standing quietly on it for a period of 30 seconds with their eyes open (EO), and then 30 seconds with their eyes closed (EC). Each 30 second period was collected as three 10 second trials for each condition. This study's data was collected from people suffering from BP and healthy controls. Results: COP area was statistically significantly greater for BP subjects, however, only during EC trials. In contrast, during EO trials, the COP area was not statistically different between the two groups. Furthermore, in distinction from previous studies, velocity was statistically significantly greater for healthy controls regardless of the trial's eye condition. Conclusions: These results led us to hypothesize that during the EC trials, BP subjects cover a greater COP area than the controls due to decreased proprioception, in which they sway further from their balance point before being able to detect they are moving. However, in EO trials, this area is not statistically different, likely because BP subjects have learned to compensate for their decreased proprioception by relying more on their vision for positional sense. Furthermore, since the healthy controls exhibited a greater velocity than the BP subjects, this could mean that the BP subjects are taking longer to regain their balance due to decreased reflexes. In conclusion, we suggest that future QS studies screen subjects for delays in reflexes, a lesser sense of proprioception, and whether lighting conditions create altered sway outcomes. This study contributes precautionary information to help prevent falls in those with BP.
Parsonage Turner syndrome following COVID19 vaccination in a cancer patient: A case report
(2022) Ferguson, Drew; Yasuda, Tai; Selod, Omar
Background: Parsonage Turner syndrome (PTS) is a rare condition involving inflammation of the brachial plexus. Causes of PTS include inflammatory processes following infections, vaccinations, and surgery. PTS following COVID19 infections and COVID19 vaccinations have been reported. In this case, the patient presented with severe shoulder pain and weakness in the left upper extremity following the second dose of the COVID19 vaccine. This case is complicated by a history of recent chemotherapy and positive COVID19 infection. Case Description: The patient is a 56-year-old male presenting to the physiatry clinic with severe left shoulder pain and weakness for five months beginning approximately twenty-four hours after the second dose of the COVID19 vaccination. Symptoms were exacerbated with abduction and external rotation. He has a history of renal cell carcinoma with metastasis treated with chemotherapy and a history of COVID19 infection prior to the vaccine. Physical exam revealed left deltoid atrophy with limited abduction and external rotation. Electrodiagnostic evidence of left sided brachial plexopathy involving the upper, middle, and lower trunks was found on EMG/NCS. MRI of the left shoulder showed edematous signal in proximal and infraspinatus muscles, consistent with PTS. Conclusions: Although the etiology of PTS is largely unclear, there is a large immune component in the development of PTS considering most cases occur after infections and vaccinations. Dysregulation of the immune system following chemotherapy may have contributed to the development of PTS in this case. COVID19 infection prior to the vaccine series may have also contributed to a heightened immune response. Risk factors for PTS include recent infections, vaccinations, and surgery. Considering the role of the immune system in developing PTS, immunocompromised conditions should also be considered as possible risk factors. It is important to identify patients at increased risk for PTS and discuss PTS as a potential adverse effect of the COVID19 infection and vaccine.
Outcomes in Subgroups of Patients with Chronic Low Back Pain Treated With and Without Osteopathic Manipulative Treatment: A Retrospective Cohort Study
(2022) Moore, Samuel; Fix, Kassidy; Blair, Lillian; Ta, Khanh; Licciardone, John C.
Purpose: Chronic low back pain (CLBP) is a public health issue that often causes disability and yields high societal costs due to lost productivity. Clinical practice guidelines in the United States recommend spinal manipulation as a first-line treatment for CLBP. Recent evidence demonstrates that osteopathic manipulative treatment (OMT) may reduce low back pain intensity and back-related disability in patients with CLBP. However, it is unclear if patient subgroups respond differently to OMT. This study aims to determine if OMT effects in patients with CLBP differ according to patient characteristics. Methods: This study was conducted within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation between April 2016 and December 2021. A total of 1243 registry participants reported data on sociodemographic characteristics, psychological variables, and clinical status at enrollment, and 788 provided complete data over 12 months of follow-up. Participants were classified as OMT users or non-users at enrollment. The primary outcomes were low back pain intensity measured with a numerical rating scale (NRS) from 0 to 10, back-related functioning measured with the Roland-Morris Disability Questionnaire (RMDQ), and pain impact derived from the Patient-Reported Outcomes Measurement Information System. Repeated measures analysis of variance was used to assess longitudinal outcomes according to OMT use. Subgroup analyses were then performed using 14 pre-specified variables to identify interaction effects relating to OMT use. Results: At enrollment, 177 (14.2%) participants reported ever using OMT for CLBP. Osteopathic manipulative treatment use was less likely to be reported by Blacks (P< .001) and participants currently using NSAIDs for low back pain (P=.003). Overall, over 12 months, OMT users reported lower scores than non-users for low back pain intensity (NRS score mean difference, -0.54; 95% CI, -0.87 to -0.21; P=.001); back-related disability (RMDQ score mean difference, -2.10; 95% CI, -3.24 to -0.96; P< .001); and pain impact (mean difference, -2.67; 95% CI, -4.39 to -0.95; P=.002). Subgroup analyses showed that the only interaction effect involved gender. Male OMT users reported better outcomes (as compared with male non-users) than did female OMT users (as compared with female non-users) for all primary outcomes (NRS score mean difference for males, -1.12, 95% CI, -1.76 to -0.47 vs. -0.34; 95% CI, -0.72 to 0.04 for females; P=.04; RMDQ score mean difference for males, -4.29, 95% CI, 6.51 to -2.07 vs. -1.33, 95% CI, -2.65 to -0.01 for females; P=.02; pain impact score mean difference for males, -5.75, 95% CI, -9.10 to -2.40 vs. -1.58, 95% CI, -3.57 to 0.40 for females; P=.04). Conclusion: Patients who were current or former users of OMT reported better longitudinal outcomes over 12 months relating to low back pain intensity, back-related disability, and pain impact. Subgroup analyses found that OMT use (vs. non-use) consistently yielded better longitudinal outcomes in males than in females. However, none of the other 13 pre-specified variables was associated with a significant interaction for OMT effect.

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