08/04/2026
Honest uncertainty is uncomfortable. In clinical practice, and apparently in research too ➡️
A 2025 systematic review examined 61 randomised controlled trials of osteopathic treatment published between 2021 and 2024. Most had significant limitations in study design, and very few authors acknowledged potential conflicts of interest from their professional roles.
This isn’t unique to osteopathy. Across manual therapy research more broadly the picture looks similar. A review of physiotherapy systematic reviews found that 95% were rated critically low quality, and 87.5% of the journals publishing that research don’t even require prospective registration, one of the most basic safeguards against selective reporting.
What I find worth sitting with is, poor quality evidence is not the same as evidence that something doesn’t work. It means we don’t yet have the research rigour to say with confidence HOW or WHY it works. And that is a different, more interesting problem.
The field needs better research. And it needs practitioners who read critically, engage honestly with uncertainty, and resist the pull of overconfident claims.
🔗 Sénéquier et al. (2025). Investigating the trustworthiness of randomised controlled trials in osteopathic research: a systematic review with meta-analysis. Journal of Clinical Epidemiology. doi:10.1016/j.jclinepi.2025.111788
🔗Riley et al. (2023). Trustworthiness, confidence in estimated effects, and the living systematic review project. Archives of Physiotherapy. doi:10.1186/s40945-023-00162-3