PRP014: Adjunctive osteopathic treatment to improve outcomes in hospitalized COVID-19 patients: A chart review with matched controls

David Rabago, MD; Anne Darby; Robert Lennon, MD, FAAFP, JD, JD; Theodore Demetriou, DO; ; Megan Mendez Miller, DO


Context: Acute respiratory distress is the most common cause of death from the novel coronavirus (SARS-CoV-2) in the COVID-19 pandemic. Care is supportive. Osteopathic manipulative treatment (OMT) has been used for over 100 years for a variety of conditions including respiratory distress. Evidence supporting its use includes mortality data during the 1918 Spanish Influenza pandemic and a contemporary randomized controlled trial reporting decreased length of hospital stay compared with usual care. OMT has not been assessed in the COVID-19 pandemic. Objective: To assess feasibility, patient- and disease-oriented outcomes of adjunctive OMT in hospitalized COVID-19 patients. Study Design: Retrospective chart review (N=60) comparing patients receiving usual care and adjunctive OMT (N=30) to age/gender/disease severity matched control patients receiving usual care alone (N=30). Setting: Academic medical center, COVID-19 hospital ward (not intensive care ward). Population: Adults with test-positive or presumed-positive COVID-19. Intervention: While on the ward, patients were offered a 10-minute, standardized, 4-part OMT procedure once daily which included rib raising, abdominal diaphragm doming, thoracic pump and pedal pump.
Outcome Measures: Primary: Feasibility: rates of procedural acceptance, satisfaction (-2 “very unsatisfied” to +2 “very satisfied” 5-point ordinal response scale) side effects and adverse events. Secondary: Patient Oriented: self-reported clinical change after therapy (-3 “very much worse” to +3 “very much improved” 7-point ordinal response scale), days in COVID unit, disposition. Tertiary: Disease Oriented: findings on routinely obtained labs and imaging studies.
Results: Study recruitment is ongoing; 6 patients were offered 18 OMT procedures during their hospital stay; 15 procedures were accepted (83%); satisfaction score per procedure was 1.53±0.52 points; side effects were 1 episode of non-cardiac chest tightness and 1 episode of reflux, both self-limited; there were no adverse events. Self-reported clinical change score was 1.07±0.93 points per procedure. Data collection/analysis are ongoing. Expected Outcomes: Early results suggest feasibility of procedural and overall study conduct including high data capture rate. Self-report data suggest OMT for COVID-related respiratory distress is satisfactory to patients and potentially effective. We anticipate full enrollment and high data capture rate in active and matched control groups
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Lauren Piper, DO 11/21/2020

Love this project! Hope you publish final results when all your data is tallied. Will share with my resident team (MD program with Osteopathic Recognition and OR track available for MD and DO).

Megan Mendez Miller 11/21/2020

Lauren- Yes, Dr. Rabago is excellently leading us towards hopeful publication! Thanks for viewing our poster and positive feedback! Please feel free to reach out to Dr. Darby ( if you want to discuss any further developing osteopathic /OR curriculum at our institutions (residency, faculty, and MD students) -Megan

Tim Riley 11/22/2020

Excellent work!  A no-side effect treatment to improve outcomes for COVID patients in the hospital - such a valuable contribution to the literature.  It seems that clinician time and related cost would be an important metric to include.  Thanks for this work!

Susan Veldheer 11/22/2020

Looking forward to seeing the comparative results. Something like this makes such logical sense. I wonder about dose... perhaps that is something you are planning on addressing in the future?

Emily Godfrey 11/23/2020

Great work David! Very interesting. I am curious if this treatment has ever been used for cystic fibrosis patients? Are you considering the etiology within the outcome of "work of breathing?" --meaning is there a better response to OMT when the pathology is upper airway vs. lower airway?

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