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