Author (Year)	Study Type	Musculoskeletal Care Practice	Population	Outcomes and Limitations
Ernst (2008) [68]	Evaluation of chiropractic practices, focusing on spinal manipulation and subluxation concepts	Chiropractic care	General population	Outcomes:
				Chiropractic care, particularly spinal manipulation, has been associated with frequent mild adverse effects and rare severe complications.
				Subluxation and spinal manipulation lack scientific backing.
				Spinal manipulation has only shown effectiveness for back pain.
				Many chiropractors treat non-musculoskeletal conditions without proven efficacy.
				The therapeutic value of chiropractic remains unproven beyond reasonable doubt.
				Limitations:
				Lack of empirical evidence for effectiveness beyond back pain.
				Incidence of severe complications from spinal manipulation is unknown.
				The review relies on existing literature, lacking new empirical data.
				No evidence for cost-effectiveness of chiropractic care.
Gross et al. (2010) [63]	Systematic review	Cervical manipulation and mobilization for neck pain	Adults with neck pain	Outcomes:
				Moderate quality evidence showed that cervical manipulation and mobilization produced similar effects on pain, function, and patient satisfaction at intermediate-term follow-up.
				Low quality evidence suggested cervical manipulation provided greater short-term pain relief than control.
				Low quality evidence also supported thoracic manipulation for pain reduction and improved function in acute pain and chronic neck pain.
				Optimal technique and dose need to be determined.
				Limitations:
				Low quality evidence for some outcomes.
				Methodological quality of studies varied (33% had low risk of bias).
				Limited evidence on the optimal technique and dose for manipulation and mobilization.
Walker et al. (2010) [64]	Systematic review	Combined chiropractic interventions	Adults with chronic low back pain	Outcomes:
				Chiropractic interventions improved short- and medium-term pain and disability in acute and subacute LBP compared to other therapies.
				No significant difference for long-term pain or disability.
				Small improvements in short-term disability with chiropractic interventions compared to other therapies.
				No difference for chronic LBP.
				Limitations:
				Studies with high risk of bias.
				Small improvements in outcomes, with no clinically meaningful difference compared to other treatments.
				Limited evidence for chronic LBP and mixed populations.
				Need for better quality trials.
Rubinstein et al. (2011) [150]	Systematic review and meta-analysis	Spinal manipulative therapy (SMT) for chronic low back pain	Adults with chronic low back pain	Outcomes:
				High-quality evidence suggests SMT has a small, statistically significant but not clinically relevant effect on pain relief and functional status in the short term compared to other interventions.
				Varying evidence for the effectiveness of SMT when added to other interventions.
				Very low-quality evidence for SMT’s efficacy compared to inert or sham SMT.
				Limitations:
				No evidence of serious complications, but limited data on recovery, return-to-work, quality of life, and costs of care.
				Inconsistent quality of evidence for various outcomes.
				Sparse data on long-term effects and overall cost-effectiveness.
				High heterogeneity and variability in the studies.
Ernst (2012) [67]	Review	Chiropractic spinal manipulation	Patients with musculoskeletal and non-musculoskeletal conditions.	Outcomes:
				Cautiously positive evidence for chiropractic spinal manipulation in treating low back pain and neck pain.
				Negative results for non-spinal conditions such as asthma and dysmenorrhoea.
				Cochrane reviews generally considered reliable but show limited evidence for effectiveness in certain conditions.
				Limitations:
				Clinical and statistical heterogeneity across studies prevented meta-analysis.
				Limited evidence for non-spinal conditions.
				Heterogeneity in the included studies made it difficult to draw definitive conclusions.
Ernst (2012) [52]	Systematic review	Craniosacral therapy (CST)	Various disorders	Outcomes:         The review found that CST showed no substantial evidence of effectiveness for any condition.         While low-quality studies suggested potential positive effects, the high-quality trial did not demonstrate any significant benefits. Limitations:         The review included six studies, most of which had a high risk of bias.         The methodological quality was generally poor, with only one study of higher quality.         The positive effects suggested by low-quality studies were not corroborated by higher-quality trials, leading to doubts about the validity of CST’s clinical benefits.
Ajimsha et al. (2013) [59]	Randomized controlled trial	Myofascial release	Nursing professionals with chronic lower back pain	Outcomes:
				MFR showed greater improvement in pain and disability compared to the control group.
				MFR group had a 53.3% reduction in pain and 29.7% reduction in disability at week 8, with continued improvement at week 12.
				73% of MFR group had ≥50% pain reduction.
				Limitations:
				Single-blind design could introduce bias.
				No placebo for control group, only sham MFR.
				Small sample size (80 participants).
				The study did not address long-term effects beyond 12 weeks.
				The control group received sham MFR, which may not fully mimic the standard care.
Franke et al. (2014) [47]	Systematic review and meta-analysis	Osteopathic manipulative treatment (OMT)	Adults with non-specific low back pain	Outcomes:         Moderate-quality evidence showed OMT significantly improved pain and functional status in acute and chronic nonspecific LBP. Limitations:         Low evidence quality limits generalizability.         The small number of included trials limits robustness. Future research requires larger, high-quality randomized controlled trials (RCTs) with robust control groups.
Guillaud et al. (2016) [53]	Systematic review	Craniosacral therapy (CST)	Various disorders	Outcomes:
				Diagnostic procedures used in cranial osteopathy are unreliable in many cases.
				For efficacy, the review found that the studies had significant methodological flaws, with only three studies showing low risk of bias.
				These studies failed to rule out non-specific effects, and no strong evidence supported the efficacy of cranial osteopathy.
				Limitations:
				Diagnostic reliability, there was inconsistency in the results, indicating a lack of reliability in cranial osteopathy diagnostics. The methodological quality of the included studies was generally low.
				High risk of bias.
				Low quality of the studies.
				The heterogeneity in study designs and methodologies may limit the generalizability of the findings.
Arguisuelas et al. (2017) [60]	Randomized controlled trial	Myofascial release	Adults with nonspecific chronic low back pain	Outcomes:
				Significant improvements in pain (SF-MPQ) and sensory subscale, compared to sham MFR.
				Disability and fear-avoidance beliefs significantly decreased in the MFR group compared to the control.
				No differences in VAS scores between groups.
				Limitations:
				The clinical relevance of the improvements is uncertain due to the 95% CI overlapping the minimal clinically important differences.
				The study was limited to a small sample size (54 participants).
				Short duration of the intervention (4 sessions).
				Lack of long-term follow-up data.
Kranenburg HA et al. (2018) [69]	Systematic review	Cervical spine manipulation (CSM) and mobilization	Patients with neck pain and headache	Outcomes:
				Identified characteristics of patients, practitioners, treatment process, and adverse events (AE).
				Cervical arterial dissection (CAD) reported in 57% of cases, with women more at risk.
				Limitations:
				Poor description of patient characteristics and under-reporting of cases.
				Further research needed for uniform AE registration using standardized terminology.
Rubinstein SM et al. (2019) [65]	Systematic review and meta-analysis	Spinal manipulative therapy (SMT)	Patients with chronic low back pain	Outcomes:
				SMT produces similar effects to recommended therapies for short-term pain relief and moderate improvement in function.
				Compared to non-recommended therapies, SMT shows a small to moderate improvement in function but minimal pain relief.
				Evidence for sham SMT is of low quality, suggesting uncertain effects.
				Musculoskeletal adverse events were transient and mild to moderate in severity.
				Limitations:
				High heterogeneity between studies made it difficult to interpret some findings.
				Evidence for the effectiveness of sham SMT was of very low quality.
				Most studies did not systematically report adverse events.
				Some results were not clinically relevant despite statistical significance. comparisons, heterogeneity in comparison treatments.
Rehman et al. (2020) [48]	Systematic review and meta-analysis	Osteopathic manual therapy (OMT)	Patients with chronic pain	Outcomes:
				Some improvement in pain and functional outcomes findings limited by inconsistent methodologies.
				OMT demonstrated no significant impact compared to physiotherapy or gabapentin for any measured outcomes.
				Limitations:
				Small sample sizes.
				Variability in techniques and outcomes.
				Heterogeneity among comparator treatments and outcome measures reduces generalizability.
Farra et al. (2021) [49]	Systematic review and meta-analysis	Osteopathic interventions (OMT, MFR, CST, OVM)	Patients with chronic non-specific low back pain	Outcomes:
				Osteopathic interventions are more effective than control treatments in reducing pain and improving functional status.
				Myofascial release (MFR) showed the most effective results for pain reduction, with moderate-quality evidence.
				Osteopathic manipulative treatment (OMT) showed a low-quality effect in pain reduction.
				Craniosacral therapy (CST) and osteopathic visceral manipulation (OVM) showed limited evidence for efficacy.
				Limitations:
				None of the studies were judged at low risk of bias (RoB).
				Low to very-low-quality evidence for some treatments, particularly for OMT and CST.
				Limited diversity in osteopathic treatment types, which hinders generalization of findings.
				Further high-quality trials are needed to better compare different osteopathic techniques.
Nguyen et al. (2021) [61]	Randomized clinical trial	Osteopathic manipulative treatment (OMT)	Adults with nonspecific subacute or chronic low back pain (LBP)	Outcomes:
				The standard OMT group showed a mean reduction in LBP-specific activity limitations of −4.7 points (Quebec Back Pain Disability Index) at 3 months, significantly better than sham OMT group (−1.3 points).
				No significant difference in pain reduction at 3 and 12 months.
				Serious adverse events reported in both groups but not related to OMT.
				Limitations:
				The effect of OMT on LBP-specific activity limitations is small and its clinical relevance is questionable.
				No significant differences found for secondary outcomes such as pain and quality of life.
				The study lacks long-term efficacy data, and the sham OMT may not fully replicate standard OMT in terms of patient expectations.
Farra et al. (2022) [50]	Systematic review and meta-analysis	Osteopathic manipulative treatment (OMT)	Adults with non-specific neck pain	Outcomes:
				Osteopathic interventions showed statistically significant improvements in pain levels and functional status compared to no intervention or sham treatments.
				Limitations:
				Small sample sizes.
				Difficulty standardizing techniques.
				Evidence quality was rated as “very low.”
Lotfi et al. (2023) [51]	Literature review	Osteopathic manipulative teatment (OMT)	Patients with irritable bowel syndrome (IBS)	Outcomes:
				The review suggested that OMT may reduce IBS symptoms such as abdominal pain, bloating, and irregular bowel movements. Improvements were attributed to potential modulation of visceral function and nervous system responses.
				Limitations:
				Evidence relied on a small number of studies with varying methodologies and quality.
				Lack of high-quality RCTs and limited generalizability.
				The findings were based on limited and mixed evidence.
Ceballos-Laita et al. (2023) [58]	Systematic review and meta-analysis	Visceral osteopathy	Adults with low back pain	Outcomes:
				Visceral osteopathy did not show significant improvements in pain intensity, disability or physical function.
				High heterogeneity found in the pain intensity outcome.
				Limitations:
				High risk of bias in the included studies.
				Lack of high-quality studies evaluating the effectiveness of visceral osteopathy for LBP.
				The small number of studies included (5 studies, 268 patients) and heterogeneity in outcomes limit the reliability of conclusions.
Buffone et al. (2023) [55]	Systematic review and meta-analysis	Osteopathic manipulative treatment (OMT)	Irritable bowel syndrome (IBS)	Outcomes:
				OMT showed statistically significant improvement in abdominal pain and constipation, with effect sizes.
				OMT was not superior to control for other IBS symptoms such as severity of IBS, Likert scale ratings, and diarrhea.
				The quality of evidence was deemed “low” for abdominal pain and constipation, and “very low” for diarrhea.
				The evidence did not support the superiority of OMT for all IBS symptoms,
				OMT was found to be safe with no major adverse effects.
				Limitations:
				The methodological quality of the included studies was generally low.
				High risk of bias.
				Low quality of the studies.
				The heterogeneity in study designs and methodologies may limit the generalizability of the findings.
Silva et al. (2023) [54]	Systematic review	Visceral fascial therapy	Patients with visceral dysfunctions	Outcomes:
				Visceral Fascial Therapy showed effectiveness in reducing pain in patients with low back pain when combined with standard physical therapy, and in reducing gastroesophageal reflux symptoms in the short term.
				Limitations:
				High risk of bias.
				Low quality of the studies.
				The heterogeneity in study designs and methodologies may limit the generalizability of the findings.
				The evidence for the effectiveness of Fascial Therapy targeting visceral dysfunctions remains insufficient to support widespread clinical use.
Ceballos-Laita et al. (2024) [56]	Systematic review and meta-analysis	Craniosacral therapy	Various disorders	Outcomes:
				CST produced no statistically significant or clinically relevant changes in pain or disability for musculoskeletal disorders like headache, neck pain, low back pain, pelvic girdle pain, and fibromyalgia.
				CST was also ineffective for non-musculoskeletal disorders like infant colic, cerebral palsy, and visual function deficits.
				Limitations:
				While the literature searches were thorough, it is impossible to ensure no relevant studies were missed.
				The inclusion of a wide range of diverse conditions complicates the interpretation of the results and weakens the strength of the conclusions.
				There was considerable heterogeneity across the included RCTs in terms of treatment duration and outcome variables, which may limit the validity of the quantitative syntheses.
Bonanno et al. (2024) [28]	Scoping review	Osteopathic manipulative treatment (OMT)	Healthy individuals and patients with chronic musculoskeletal pain	Outcomes:
				OMT appears to influence brain activity in healthy individuals and more significantly in patients with chronic musculoskeletal pain. The review includes studies involving fMRI, EEG, and brain connectivity analysis.
				Limitations:
				Limited number of included studies with mixed designs (RCTs, pilot studies, and crossover studies).
				Studies had variable methodologies and sample sizes.
				More high-quality RCTs are needed to confirm the findings on brain activity and neurophysiological effects of OMT.
Carrasco-Uribarren et al. (2024) [149]	Systematic review and meta-analysis	Craniosacral therapy	Patients with headache disorders	Outcomes:
				Craniosacral therapy resulted in a statistically significant but clinically unimportant change in pain intensity.
				No significant change in disability or headache effect.
				Very low certainty of evidence.
				Limitations:
				The evidence quality was downgraded to very low.
				Small number of studies (4 studies) with a limited sample size.
				Pain reduction was statistically significant but clinically irrelevant.
				No significant effects on disability or headache effect.
Farra et al. (2024) [76]	A comprehensive mapping review	Osteopathic manipulative treatment (OMT)	General population with various conditions	Outcomes:
				The review found biological effects induced by OMT, particularly neurophysiological and musculoskeletal changes.
				Limitations:
				Significant variability in study designs, participant conditions, OMT protocols, and documented biological effects.
				The diverse nature of the studies complicates the ability to draw definitive conclusions.
				The review suggests the need for further research to clarify whether these changes are specifically due to OMT and to corroborate their clinical implication.
Ceballos-Laita et al. (2024) [57]	Systematic review and meta-analysis	Visceral osteopathy	Patients with various musculoskeletal and non-musculoskeletal conditions	Outcomes:
				Visceral osteopathy showed no significant improvement in musculoskeletal conditions such as low back pain, neck pain, or urinary incontinence.
				No effect was found for non-musculoskeletal conditions like irritable bowel syndrome, breast cancer, or preterm infants.
				Studies had high risk of bias and low-to-very low certainty of evidence.
				Limitations:
				Most studies were at high risk of bias.
				Certainty of evidence was downgraded to low or very low.
				No statistically significant changes in outcomes.
				Positive results in non-musculoskeletal conditions were based on flawed studies.
				Many studies did not report adverse events.