key: cord-0723315-8047ndsd
authors: Marin, Thibault; Maxel, Xuan; Robin, Alexandra; Stubbe, Laurent
title: The importance of epistemological consideration in the reporting of evidence for osteopathic care in Covid-19 papers
date: 2021-02-25
journal: Explore (NY)
DOI: 10.1016/j.explore.2021.02.011
sha: 6ba8a08ce505686c05adeebc7608ce97ba9c1b2f
doc_id: 723315
cord_uid: 8047ndsd

nan

Apart from the health crisis, the COVID-19 pandemic has also led to an unprecedented amount of communications and controversial opinions in several fields, even amongst esteemed physicians, scientists and journals. Osteopathic medicine is a somewhat young discipline and even though osteopathic research takes place in several countries, evidencebased protocols are often difficult to apply to this alternative holistic manual therapy. This factual situation can explain a tendency of mistrust from scientists and medical practitioners, and emphasizes necessary caution for osteopathic communication. It is within this context of reservation that we published a review entitled "Evidence-based assessment of potential therapeutic effects of adjunct osteopathic medicine for multidisciplinary care of acute and convalescent COVID-19 patients" [1] . On completion of this review, the available evidence led us to limit our conclusions to the two very careful following statements: i) there are multiple arguments supporting potential therapeutic benefits from adjunct osteopathic care, and ii) "more clinical evidence -through rigorous controlled trials -is necessary, especially regarding a new and highly-infectious disease such as COVID-19" [1] .

As expected, the initial reception of this work was divided -especially on social media -and we were pleased to see that Draper-Rodi et al. deemed our work of sufficient interest to interact through the proper scientific methods of communication [2] . They made it clear that they share our concern for cautious osteopathic approaches and communication. However, they consider that our work "contains many scientific errors and overinterpretation" [2] , in a rhetorical form that leaves very little room for dispute. Since they are familiar with the rigorous exercise of peer reviewing [3, 4] , we value their input and will gladly examine their suggestions of reading materials and methodological improvements. Nevertheless, as encouraged by the editor -whom we wish to thank for this opportunity to respond -we believe it necessary to address their comments below and will try to clarify all misunderstandings and inaccuracies.

On several occasions, Draper-Rodi et al. state that our review contains "many misrepresentations and overstatements" and "big claims with small or no data" [2] . Since (only) three references were specifically challenged, we will briefly address each of them: i) Bordoni et al. [5] is indeed a "clinical commentary/unsystematic review"; we opted for this reference to introduce the principles of mechanotransduction, a biological field still relatively new and complex to experiment with in vivo human subjects. This explains scarce literature thus far, even though its theoretical implications are substantial for manual therapy such as osteopathic manipulative treatment (OMT) (Chaitow et al. [6] ). ii) Engel et al. is a robust randomized controlled trial with valid methodology; they identified a significant increase of the forced vital capacity in the manual therapy group (+0.40L, 98.33% CI: 0.02, 0.79; p=0.03). [7] . To discard their consequential findings solely because of it being a "pilot study" [2] is hardly tenable. iii) A few "animal studies" [2] were used -and introduced as such -amongst which Hodge et al.'s considerable work regarding in vivo immune processes and OMT. Through multiple publications including the one singled-out by Draper-Rodi et al. [8] , they have laid the necessary foundations for the implementation of human clinical research -such as Walkowski et al.'s pilot RCT, also utilized in our review [1, 9] . Moreover, the subsection of our review which is the main focus of their concerns actually lead to a very cautious and conditional conclusion: "All of the above suggests that mastered specific OMT could contribute to modulate immunity, inflammatory processes and fibroblast proliferation that result from an infection such as SARS" [1] . In the end, Draper-Rodi et al.'s assertions are bolstered by erroneous generalization and exemplification of our work, whilst resulting in strongly detrimental appreciations.

Draper-Rodi et al. rightly recommended to "follow the lead taken by the chiropractic profession in rejecting pseudoscientific claims of benefits of manual therapy care" [2] . This statement was referring to a dubious unreviewed online report published by the International Chiropractors Association [10] which led to a strong collective rebuttal [11] . We agree in the peer-review process and as such have gone through the proper avenues to make this work available for the scientific community following peer evaluation. We are appreciative that Draper-Rodi et al. pointed out the absence of primary data preventing us to conduct a systematic review. Their suggestion for a scoping review is relevant and could constitute a step forward; it does not however detract from the value of the work already done and the hypotheses that emerged from it. Moreover, sharing Draper-Rodi et al.'s legitimate concerns for "misleading messages, poor practice, public mistrust and harm" [2] , we were careful not to put forward any guidelines to individual osteopathic practitioners nor did we encourage in any way COVID patients to seek osteopathic care, as this was never the objective of this review. Our original intent -to which we are committed -was to gather sufficient theoretical evidence to support the development of a clinical trial including OMT as an adjunct therapy to conventional hospital care, this process being the standard promoted by the World Health Organization for clinical research implementation [12] .

As stated by Draper-Rodi et al. in their concluding paragraph, "theorising about potential mechanisms, and formulating hypotheses are the foundations of scientific enquiry" [2] . As all of the concerned authors are both clinicians and researchers, it seems opportune to recall the assertions of Archibald Cochrane, one of the fathers of modern evidence-based medicine [13] :

'Rational scientific and methodological principles are not sufficient for securing rational and humane health care. A philosophy reminding us of both our limited scientific possibilities-limited in principle-and our personal responsibility is needed. It is one of Cochrane's great merits to have provided just that. It is to be regretted that many more people seem to have adopted his more technical advice concerning effectiveness and efficiency than have grasped the philosophical framework within which these standards are situated'.

The guidelines of the Osteopathic International Alliance are consistent with this rationale; our review was carried out accordingly. Clinical researchers have a bridging responsibility between the requirements of systematic and rigorous laboratory processes and the practical and human realities of patient care. Both fields are complementary and should lead to mutually beneficial progress. Albeit challenging, this dual role is essential for enabling both innovative research and advancing healthcare.

Evidence-based assessment of potential therapeutic effects of adjunct osteopathic medicine for multidisciplinary care of acute and convalescent COVID-19 patients

The importance of rigour in the reporting of evidence for osteopathic care in Covid-19 papers

The ghost in the machine'-But whose ghost is it and what machine? A response to Wallden and Chek's editorials

An investigation of cranial motion through a review of biomechanically based skull deformation literature

Understanding fibroblasts in order to comprehend the osteopathic treatment of the fascia. Evid-Based Complement Altern Med

Fascial well-being: Mechanotransduction in manual and movement therapies

Medium term effects of including manual therapy in a pulmonary rehabilitation program for chronic obstructive pulmonary disease (COPD): a randomized controlled pilot trial

Lymphatic pump treatment mobilizes leukocytes from the gut associated lymphoid tissue into lymph

Osteopathic manipulative therapy induces early plasma cytokine release and mobilization of a population of blood dendritic cells

International Chiropractors Association. Immune function and chiropractic what does the evidence provide?

A united statement of the global chiropractic research community against the pseudoscientific claim that chiropractic care boosts immunity

Implementation research in health: a practical guide. Alliance for Health Policy and Systems Research, World Health Organization

Who cares? The lost legacy of Archie Cochrane