Effect of Osteopathic Manipulations on Portal Venous Flow

Ultrasonography Clinical Trial

— ECOPORTA  

Official title:

Effect of Osteopathic Manipulations on Portal Venous Flow: Randomized Clinical Trial

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03516344
• Other study ID #: Eco_Porta
• Status: Completed
• Phase: N/A
• Start date: August 1, 2018
• Est. completion date: September 30, 2018

Study information

• Verified date: October 2018
• Source: Universidad Antonio de Nebrija
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Since osteopathy it is considered that the alterations in the mobility of the different structures of the organism could cause a decrease in the blood circulation of the tissue causing a functional disorder and, with time, the appearance of a disease.

In visceral osteopathy, the treatment of liver dysfunctions it is important due to their interrelation with the functioning of the rest of the abdominal and pelvic viscera and, especially, through the hepatic portal system. However, there are few studies showing whether a manual therapeutic intervention can affect the mobility, function or vascularization of a viscera.

Ultrasonography is an appropriate tool for validating some of these intervention procedures given their safety, repeatability, autonomy and the low cost of the procedures and technical equipment which, in a non-invasive manner, will allow the effects of the different therapeutic interventions to be verified.

Hypothesis:

1. Vertebral manipulations and pumping of the liver improve the flow of the portal vein in front of the diaphragmatic breathing and the contraction of the psoas iliac muscle.

2. The accuracy of ultrasound to assess venous flow may be useful as an outcome measure.

Objectives: To describe the immediate changes of different manipulative interventions on portal vein flow in healthy women and to obtain baseline measurements for future research.

Sample description: Pilot randomized controlled clinical trial with a sample of 50 healthy adult women recruited intentionally sampled that will be pseudo-randomly forcing equality of groups: control, chest manipulation, liver manipulation, abdominal breathing and iliac psoas muscle contraction.

The minimum size required has been calculated using the program G*Power 3.1.3 for Windows (University Kiel, Germany, 2008) based on an effect size of 0.5, type I error of 5%,type II error of 10% and an effect size of f=0.45.

Description:

The non-invasive intervention procedure in each of the groups is as follows:

1. Control group (CG): Subjects will remain at rest in supine position for one minute.

2. Thoracic manipulation group (GMT): A semi-direct vertebral manipulation will be performed, type Dog Technique in extension, above level D8.

3. Liver manipulation group (HMG): A supine hepatic pumping technique will be performed, performing simultaneous compression in the right hypochondrium and epigastrium, in the opposite direction, during the inspiratory phase, stopping during the expiratory phase and repeating the maneuver for five respiratory cycles.

4. Abdominal breathing group (GRA): Subjects will be asked to perform five cycles of diaphragmatic breathing in the supine position.

5. Psoas exercise group (GPS): In the supine position with a high density foam cushion under the feet of the subject, it will be asked to make a push in the caudal direction, against the cushion, alternating between both feet with the knees stretched, for one minute.

After informed consent and recording of personal data, participants will be placed in a constant and regulated temperature room where they will be placed in supine position for 5 minutes for cardiocirculatory normalization, at least 2 hours after the last meal. The room where the explorations will be carried out is conditioned to keep the ambient temperature constant.

The study will be carried out with independent recruitment and triple blinding: the patient will not know the intervention group, the sonographer will not know the technique applied to the patients, the researcher responsible for recording the flows and diameters and the temperature will also be masked and the data analyst will be masked during the statistical analysis process.

For statistical analysis, a descriptive analysis using means and standard deviations will be performed, as well as ranges and quartiles for quantitative measurements. Qualitative variables shall be summarised by counts and frequencies. The assumption of normality (Shapiro-Wilks test) and equality of variances (Levene's test) prior to the analysis of variance (ANOVA) will be checked for repeated measurements in which the intra-unit factors (three time measurements) will be the dependent variables (velocity, diameter and temperature) and the inter-subject factor, the study group. If it is not possible to assume the application assumptions, the corresponding non-parametric tests will be chosen. Pair comparisons were made with the Dunn-Bonferroni correction for type I erro and the age and BMI variables were entered into the model as covariates to estimate their possible effect on the dependent variables. The percentages of change from the baseline values in the intra-group comparison and from the control group in the intergroup comparison shall be calculated. The effect size will be estimated with the Hedges g statistic.

The significance level will be set to p<0.05 and calculations will be performed with SPSS 19.0

Recruitment information / eligibility

• Status: Completed
• Enrollment: 50
• Est. completion date: September 30, 2018
• Est. primary completion date: September 30, 2018
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: Female
• Age group: 18 Years to 40 Years

Eligibility

Inclusion Criteria:

• Healthy women

• No history of abdominal surgery or liver disease

Exclusion Criteria:

• Fear or apprehension of techniques

Related Conditions & MeSH terms

• Breathing Exercises
• Manipulation, Osteopathic
• Physical Therapy
• Portal Vein
• Respiratory Aspiration
• Ultrasonography

Intervention

Procedure:
• Liver pumping and Spinal manipulation
Interventions are described in group descriptions

Locations

Country	Name	City	State
Spain	José Ríos-Diaz	Madrid

Sponsors (1)

Lead Sponsor	Collaborator
Universidad Antonio de Nebrija

Country where clinical trial is conducted

Spain, 

References & Publications (10)

Allan PL, Ph.D WNM, Pozniak MA, Dubbins PA. Ecografía doppler clínica. Elsevier España; 2008.

Allan PLP, Baxter GM, Weston M. Clinical Ultrasound. 3rd ed. Philadelphia: Churchill Livingstone Elsevier, 2011

Baert AL, Brady LW, Heilmann HP, Molls M, Sartor K. Duplex and color doppler imaging of the venous system. Springer; 2014.

Harris W, Wagnon RJ. The effects of chiropractic adjustments on distal skin temperature. J Manipulative Physiol Ther. 1987 Apr;10(2):57-60. — View Citation

Hebgen E. Osteopatía Visceral. Fundamentos y técnicas. 2ª edición ed. Madrid: McGraw-Hill. Interamericana; 2005

Korr IM. Bases fisiologicas de la osteopatía. 1ª ed.: Mandala; 2004

Martínez-Payá JJ, de-Groot-Ferrando A, Ríos-Díaz J, del-Baño-Aledo ME. Sonoanatomy of the musculoskeletal system. En: Valera F, Minaya F, editores. Advanced Techniques in Musculoskeletal Medicine & Physiotherapy. Edinburgh: Churchill Livingstone; 2016. p.147-70.

Resende C, Lessa A, Goldenberg RCS. Ultrasonic Imaging in Liver Disease: From Bench to Bedside. Rijeka, Croatia: INTECH Open Access Publisher; 2011.p.127-56.

Ricard F. Tratado de osteopatía visceral y medicina interna. Tomo 2: Sistema digestivo. 1ª edición ed. Madrid: Editorial Médica Panamericana; 2008

Welch A, Boone R. Sympathetic and parasympathetic responses to specific diversified adjustments to chiropractic vertebral subluxations of the cervical and thoracic spine. J Chiropr Med. 2008 Sep;7(3):86-93. doi: 10.1016/j.jcm.2008.04.001. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Flow velocity of the portal vein	In cm/s, FV is obtained from ultrasound scans (General Electric LogiqE ultrasound scanner model with the 4C-RS convex probe with a working frequency of 2-5 MHz.).; All image optimization parameters remained constant for all patients and scans. The records will be made by a researcher with 15 years of ultrasound experience.	Pre-intervention, immediately post-intervention and 5-minutes-post-intervention
Primary	Diameter of the portal vein	In mm, DIA is obtained from ultrasound scans (General Electric LogiqE ultrasound scanner model with the 4C-RS convex probe with a working frequency of 2-5 MHz.).; All image optimization parameters remained constant for all patients and scans. The records will be made by a researcher with 15 years of ultrasound experience.	Pre-intervention, immediately post-intervention and 5-minutes-post-intervention
Secondary	Temperature of D7-D8 dermatome	The temperature of the dermatome D7-D8, in relation metameric to the liver, is recorded at the xiphoid process level with an infrared thermometer (ºC)	Pre-intervention, immediately post-intervention and 5-minutes-post-intervention