Title: The Effectiveness of Osteopathic Manipulative Treatment for Concussions as Measured by SCAT and HIT-6
Authors: Kiana Jones, MAMSc, Lauren Morgan, CBIS, MAMSc, Atika Singh, MSPH, MAMSc, Angie K Maxson, OMS IV, Ronald Walser, DPT
Introduction
Several studies indicate that some osteopathic manipulative treatment (OMT) techniques may improve TBI symptoms. The Sports Concussion Assessment Tool (SCAT) and Headache Impact Test (HIT-6) are valid and reliable tools used to assess outcomes of OMT on TBI patients. The purpose of this review is to investigate the effectiveness of OMT for treatment of concussion as assessed by SCAT and HIT-6 outcome measures.
Methods
PubMed, CINAHL, TripPro, and Google Scholar were searched using key terms related to 4 separate search categories: 15 terms related to OMT, 11 terms related to TBI, 3 terms for the SCAT search, and 2 terms for HIT-6. Each key term was separated by the Boolean “or” operator, and each of the categories were separated by the Boolean “and” operator. Articles were selected based on the following inclusion criteria: published in English language, subjects with age 18+, and OMT outcomes determined via HIT-6 and/or SCAT. Review articles were excluded.
Results
A total of 2,984 results for the SCAT search and 2,074 results for the HIT-6 search populated across all databases. Five studies (3 SCAT, 2 HIT-6) met inclusion criteria for this review, including 3 randomized clinical trials examining the effect of OMT on concussion and its associated symptoms, a retrospective chart review of patient SCAT data, and a case report. Two of the SCAT studies used the same dataset. One SCAT study showed that patients receiving OMT experienced significant decreases in severity of headache and 9 other symptoms. Both the HIT-6 trial and case study showed reductions in headache severity after OMT. All studies showed improvement for some concussion symptoms after OMT, although not all improvements were statistically significant.
Discussion
The studies included in this review suggest that OMT may be effective for the treatment of concussion. However, the paucity of evidence on this topic does not allow for clear determination of SCAT or HIT-6 as beneficial tools in measuring OMT outcomes with concussion patients. This literature search revealed a lack of uniformity in use of outcome measures on this topic, revealing a need for standardized use of assessment tools. Continued research using SCAT and HIT-6 to assess the effectiveness of OMT techniques to treat concussions should be done, so meta-analyses can be performed for improved clinical decision-making.
Thank you for this important review. As a judge, I have a couple of questions. I noticed that you focused only on the adult population and excluded pediatrics (under 18). I am wondering why?
Also, I know you said some of the OMM techniques were not always defined but was there a technique or group of techniques that appeared more beneficial than others?
Thanks!
Hello Dr. Habecker, thank you for your questions!
We excluded pediatric (younger than 18 years old) studies mainly due to evidence that adult and childhood brain injuries differ significantly in outcomes and common sequalae (see Giza et al. 2007 as an example).
There was not enough data to be able to conclusively distinguish if any techniques were more beneficial than others. However, some of the most common OMT techniques we saw used included: craniosacral therapy, lymphatic drainage, glymphatic drainage, and techniques addressing somatic dysfunctions. We did notice a trend in which these techniques affect the glymphatic system as well, which follows along with current underlying theory of how OMT can alleviate concussion symptoms.
Giza, C. C., Mink, R. B., & Madikians, A. (2007). Pediatric traumatic brain injury: not just little adults. Current Opinion in Critical Care, 13(2). Retrieved from https://journals.lww.com/co-criticalcare/Fulltext/2007/04000/Pediatric_traumatic_brain_injury__not_just_little.6.aspx
Judge: Thank you for sharing your research. I’m curious if your research showed a correlation between the number of OMT treatments patients received and the impact on improving their concussion symptoms? Were there any findings linking the severity of concussion with OMT success rate?
Hello, thank you for your comments and questions. We were not able to conclude if there is direct correlation between the number of OMT treatments patients received and the impact on improving their concussion symptoms. Three studies only looked at the effects of one OMT treatment total (Esterov et al., Yao et al., & Chappell et al.) and the Mazzeo et al. study looked at effects from 2 OMT treatments. Kratz, a case report using HIT-6, was the only one that looked at the effect of multiple OMT treatments on headache outcome, evaluating after the 5th OMT treatment and the 11th OMT treatment. The participant from this case report reported a 70% relief from initial headache level after the 5th OMT treatment and a 90% relief from initial headache level after the 11th OMT treatment. Furthermore, none of the studies discussed the severity of the concussion of the participants and so these could not be linked with OMT success rate. We would love to see more studies that correlate the number of OMT treatments with improvement in concussion symptoms, or severity of concussion with OMT success rate.
Thank you for your presentation. I’m one of the judges evaluating your poster. Would you please explain your exclusion criteria? Thank you.
Thank you for your question, Dr. Smith. Our exclusion criteria were cancer comorbidity, pediatric (younger than 18 years old) studies, review articles, opinion pieces, conference presentations, books, letters, editorials, dissertations/theses or abstracts. We excluded pediatric (younger than 18 years old) studies mainly due to evidence that adult and childhood brain injuries differ significantly in outcomes and common sequelae (see Giza et al. 2007 as an example). Cancer comorbidity was also an exclusion criterion because the history of cancer may have a significant impact on survival and management of treatment. For example, a cancer patient’s headache symptom could be potentially more related to their chemotherapy regimen than the concussion they suffered, which could lead to skewed results in our data. Lastly, we excluded review articles, opinion pieces, conference presentations, books, letters, editorials, dissertations/theses or abstracts because there was no data available within these type of sources to evaluate our assessment tools of interest (SCAT & HIT-6) further.
Every provider offer different techniques , different approach. Every provider has different experience with cervical spine. I am not DO but practice OMT for almost 30 years and see patients with migraine and headaches including concussion symptoms. Most of the time I see it as a mechanical problem in upper neck and often correcting mechanical dysfunction in upper neck will give patient significant result. Brainstem is sensitized by dysfunction in upper neck. Brainstem must be desensitized by correcting upper neck C1-C3. This is my secret. Respectfully , Michael Pys