Methods and Results

We piloted a prospective patient-completed online questionnaire rating (‘none’/‘mild’/‘moderate’/‘severe’/‘don't know’) 14 symptoms (e.g. ‘pain’, ‘headaches’, ‘dizziness’, ‘nausea’, ‘tingling’) at five time-points within one week post-treatment. We recruited patients presenting with a new complaint. Additional data on concomitant symptoms, demographics, and treatment approach were obtained. Using logistic regression we explored associations between reporting an event at 24 hours and age, gender, high-velocity-low-amplitude-thrust and smoking status.

‘Pain’ (82%), ‘stiffness’ (40%) and ‘lack of mobility’ (28%) were the main presenting complaints, and ‘lower back’ (39%), ‘head/neck’ (26%) and ‘upper limb’ (14%) the commonest regions affected. AEs were reported by 83% of patients; ‘pain’ (74%), ‘stiffness’ (58%) and ‘unexpected tiredness’ (10%) were the most frequently reported. These peaked at 24, 48 and 24 hours respectively and were commonly rated as ‘mild’. There was no evidence for age, gender, HVLAT in crude or adjusted models; there were very weak/weak suggestions smoking cessation may be associated with reporting AEs; adjusted OR for ex-smokers versus never-smokers was 3.50 (0.66–18.40; P=0.14); ex-smokers versus smokers was 5.67 (0.85–37.80; P=0.07)).

Methods and results

A survey was sent to all UK practising osteopaths. Another survey was sent to patients recruited by osteopaths. Patients were surveyed before treatment, one day and two days after treatment and at six weeks. 1,082 (27.8%) osteopaths completed the practitioner survey. 2,057 patients, recruited from 212 osteopaths, completed questionnaires before, and directly after their treatment. 1,387 patients provided data six weeks after treatment.

Between 10% and 20% of patients experienced increased symptoms/pain related to their main complaint in the days directly following treatment. This was highest for new patients. At 6 weeks, 4% of patients reported temporary disability, which they attributed to osteopathic treatment. 10% of patients reported seeking further consultation for worsening symptoms associated with osteopathic care. The comparison between those that received manipulation and those that did not suggests that manipulation was not linked to worsening outcomes.

In the preceding year, 4% of osteopaths reported that they had patients who experienced a range of serious events. The most common event described was the occurrence of peripheral neurological symptoms. There were also 7 reports of stroke-like symptoms.

Summary of methods used and results

We adopted a multi-strand search of electronic databases, and citation and reference tracking. Two researchers identified qualitative investigations relating to low back pain. Data were abstracted and synthesised using meta-ethnographic processes. Provisional results, based on 41 studies, indicate few studies have directly addressed this issue, but that data regarding experience and expectations may be useful. Whilst results suggest that practically, patients are concerned with (re-)engagement in meaningful activities, the more experientially focused literature suggests that patients want to be believed and have validated their experiences and identity as someone ‘doing battle’ with pain. Patients seek not only diagnoses, treatment and cure, but simultaneously reassurance of the absence of pathology. In the absence of tenable diagnoses, some feel they must not adopt a ‘sick role’. Some struggle, but manage to meet others' expectations; thereby undermining the credibility of their pain/disability claims. Others withdraw, fearful of disapprobation and unable or unwilling to accommodate social demands. Patients generally seek to regain their pre-pain healthy, and emotionally robust state.