Review article Osteopathic manipulative treatment: A systematic review and critical appraisal of comparative effectiveness and health economics research Amie Steel a, b, * , Tobias Sundberg a, c , Rebecca Reid b , Lesley Ward a, d , Felicity L. Bishop a, e , Matthew Leach a, f , Holger Cramer a, g , Jon Wardle a , Jon Adams a a Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney,15 Broadway, Ultimo, NSW, 2007, Australia b Endeavour College of Natural Health, Level 2, 269 Wickham St, Fortitude Valley, QLD, 4006, Australia c Research Unit for Studies of Integrative Health Care, Karolinska Institutet (NVS/OMV), Alfred Nobels Alle 23, 14183, Stockholm, Sweden d Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), B4495, Oxford, OX3 7LD, University of Oxford, Oxford, United Kingdom e Centre for Applications of Health Psychology, Faculty of Social Human and Mathematical Sciences, Building 44 Highfield Campus, University of Southampton, Southampton, SO17 1BJ, United Kingdom f School of Nursing & Midwifery, Health Economics & Social Policy Group, University of South Australia, 101 Currie St, Adelaide, Australia g Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45141, Duisburg, Germany article info Article history: Received 22 July 2016 Received in revised form 25 October 2016 Accepted 27 October 2016 Keywords: Osteopathy Osteopathic manipulative treatment Comparative effectiveness research Economic evaluation Pragmatic research abstract In recent years, evidence has emerged regarding the effectiveness of osteopathic manipulative treat- ments (OMT). Despite growing evidence in this field, there is need for appropriate research designs that effectively reflect the person-centred system of care promoted in osteopathy and provide data which can inform policy decisions within the healthcare system. The purpose of this systematic review is to identify, appraise and synthesise the evidence from comparative effectiveness and economic evaluation research involving OMT. A database search was conducted using CINAHL, PubMed, PEDro, AMED, SCOPUS and OSTMED.DR, from their inception to May 2015. Two separate searches were undertaken to identify original research articles encompassing the economic evaluation and comparative effectiveness of OMT. Identified comparative effectives studies were evaluated using the Cochrane risk of bias tool and appraised using the Good Reporting of Comparative Effectiveness (GRACE) principles. Identified eco- nomic studies were assessed with the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines. Sixteen studies reporting the findings of comparative effectiveness (n ¼ 9) and economic evaluation (n ¼ 7) research were included. The comparative effectiveness studies reported outcomes for varied health conditions and the majority (n ¼ 6) demonstrated a high risk of bias. The economic evaluations included a range of analyses and considerable differences in the quality of reporting were evident. Despite some positive findings, published comparative effectiveness and health economic studies in OMT are of insufficient quality and quantity to inform policy and practice. High quality, well-designed, research that aligns with international best practice is greatly needed to build a pragmatic evidence base for OMT. © 2016 Elsevier Ltd. All rights reserved. 1. Introduction Osteopathic healthcare is a holistic person-centred system of care aligned with the philosophy, principles of practice and appli- cation of osteopathic manipulative treatment (OMT) (Osteopathy International Alliance, 2012). While OMT can be prescribed for the management of various health conditions, it is most commonly indicated for the care of painful disorders such as low back pain (Murthy et al., 2015; van Dun et al., 2013), headaches (van Dun et al., 2013; Dalla Libera et al., 2014), and neck pain (Frawley et al., 2015). In addition to OMT, osteopathic practitioners may also prescribe other medical therapies (including pharmaceuticals) depending on the medico-legal and regulatory standards of the country and scope of osteopathic training and practice (Osteopathy * Corresponding author. Endeavour College of Natural Health, Level 2, 269 Wickham St, Fortitude Valley, QLD 4006, Australia. E-mail address: amie.steel@uts.edu.au (A. Steel). Contents lists available at ScienceDirect Musculoskeletal Science and Practice journal homepage: www.journals.elsevier.com/aquaculture-and-fisheries/ http://dx.doi.org/10.1016/j.math.2016.10.067 1356-689X/© 2016 Elsevier Ltd. All rights reserved. Musculoskeletal Science and Practice 27 (2017) 165e175