Table 1 Descriptive characteristics of the included studies

Attali 2013

Irritable Bowel Syndrome

Visceral Osteopathic Manipulation: global visceral technique, the local visceral technique according to highly sensitive zones, and sacral technique.

Placebo (same duration and places treated in the experimental intervention without manipulating visceral tissue)

Cross-over. Only one session.

10 cm Visual Analogue Scales: Constipation, Diarrhea, Abdominal Distension, and Abdominal Pain.

Rectal Sensitivity.

Total and Segmental Colonic Transit Time.

In a global analysis of the cross-over trial, the IG shows significant decreases in self-reported diarrhea, abdominal

distension, and abdominal pain without a change of

VAS constipation. The between-group analysis was not performed.

High

Stepnik 2020

Respiratory function in healthy individuals

3 techniques: Supine thoracic thrust manipulation, Sternal pump, sternal recoil, and Diaphragm stretch in a sitting position

Placebo (soft tissue therapy for the masseter muscle)

Only one session

Spirometry parameters: Forced vital capacity,

forced expiratory volume in 1 s and peak expiratory flow

There were no significant differences between the groups. PEF significantly increased in the IG.

High

Thomaz 2017

Heart failure patients

Osteopathy manual therapy: six selected osteopathy techniques (cranial, myofascial, and visceral

techniques). Each technique was performed for 2 min with a full completed session lasting 15 min.

Subjects in a supine position for 15 min without intervention

Only one session

Doppler: blood pressure, heart rate, and of blood flow in the carotid, brachial and femoral arteries.

There were no statistical differences between groups. No differences were found between pre and post-test in the control or intervention groups

Some concerns

Piche 2014

Irritable Bowel Syndrome associated with Crohn’s disease

Standardized osteopathy (Spinal manipulation and visceral osteopathy).

Each session was performed for 60 min.

Three visits with an osteopath during

which the osteopath offers caring attention and listening without any manipulation.

Three sessions

were performed at 15, 30, and

45 days after the last perfusion of anti-tumor necrosis

factor-α (TNF-α) (infliximab).

Irritable bowel syndrome symptoms (IBS severity scoring system); Fatigue Impact Scale, the Beck Depression Inventory, and the Hospital Anxiety and Depression Scale.

There were no statistical differences between groups. Compared with the baseline, the severity of

IBS-like symptoms were significantly reduced in the IG (At days 30,45 and 60) with a concomitant increase in Qol (At days 30 and 45). Compared with the baseline, the severity of fatigue was significantly reduced in the IG whereas depression and anxiety remained unchanged.

High

Neto 2020

Stroke Survivors

Physical therapy plus visceral manipulation (mobilization of the ascending colon,

descending colon, sigmoid colon, and sphincters)

Physical therapy and sham mobilization were performed

Five intervention sessions were held over two weeks.

A ten-item intestinal symptoms rating scale was used to measure the intensity of intestinal

Symptoms and static balance were evaluated using a force plate.

A statistically significant intra-group difference was found in the IG regarding the intensity of intestinal symptoms, anteroposterior sway, the velocity of anteroposterior sway, and the velocity of mediolateral sway. No statistically significant differences between groups were found regarding any of the

variables related to plantar pressure (static balance).

Low

Panagopoulos 2015

Patients with low back pain

Standard physiotherapy plus

specific visceral

manipulation techniques (5–10 min) - light or deep manual fascial releases and specific organ mobilizations in the thoracic, subdiaphragmatic,

abdominal and pelvic areas as appropriate.

Standard physiotherapy plus placebo visceral

Manipulation (5 min of sham treatment)

All participants were treated one to two times per

week for a minimum of one week and a maximum of

12 treatments over 6 weeks. For both groups, initial treatment sessions lasted for approximately 40 min and follow-up sessions lasted approximately

25–30 min.

The pain was measured with the 0–10 Numerical Pain Rating Scale, disability, with the 0–24 Roland- Morris Disability Scale, and function with the Patient-Specific Functional Scale.

The addition of visceral manipulation did not affect the primary outcome of pain at 6 weeks (− 0.12, 95% CI = − 1.45 to 1.21). There were no significant between-group differences for the secondary outcomes of pain at 2 weeks or disability and function at 2, 6, or 52 weeks. The group receiving the addition of visceral manipulation had less pain than the placebo group at 52 weeks (mean 1.57, 95% CI = 0.32 to 2.82).

low

Yosri 2022

Menstrual

complaints in women with polycystic ovarian

syndrome

Visceral manipulation of the pelvic organs and their related structures over eight sessions, along with

the low-calorie diet.

The Control group followed

a low-calorie diet (standard care)

The interventions lasted for a total of 3 months.

The study’s primary outcome was the severity of menstrual problems evaluated by the Polycystic Ovary Syndrome Health-Related Quality of Life Questionnaire. The secondary outcomes were weight and BMI, measured by a weight–height scale.

There was a statistically

significant reduction in weight, and BMI

for the diet group and the diet + VM group). For the improvement in the

menstrual complaints, a significant increase in the menstruation domain means the score was shown in the diet group and the diet + VM group. On comparing

both groups post-study, there was a statistically significant improvement in the severity of menstruation-related

problems in favor of the diet + VM group.

High

De Marco 2022

Urinary Incontinence

Pelvic Floor Muscle Training and Manual Visceral Therapy - slow and deep mobilizations over the abdominal and pelvic visceral fasciae.

Pelvic Floor Muscle Training and Manual Sham Therapy - gentle techniques were applied to the thoracic spine, scapular waist, and cervical spine.

20 sessions of Pelvic Floor Muscle Training and 5 sessions of Manual Therapy (experimental or sham)

Urinary Incontinence symptoms: ICQ-UI-SF.

Vaginal Resting Pressure and Maximum Voluntary Contraction: Manometry.

There were no significant differences between groups for all outcomes.

High

Lagrange 2019

Incidence of nausea, constipation, and quality of life in women operating for breast cancer and during chemotherapy

Visceral manipulation, consisting of the chest wall and diaphragm muscle relaxation through manual thoracic compression

Superficial/soft tissue manipulation without acting on the deeper chest wall and abdominal structures

3 sessions.

Incidence of nausea and vomiting.

Constipation.

Quality of Life: European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30.

There were no significant differences between groups for all outcomes.

Some concerns

Tamer 2017

Chronic Nonspecific Low Back Pain

Visceral Osteopathic Manipulation.

All techniques implemented in the control group and thorax, lymphatic, and liver pumping techniques, pelvic floor, diaphragm relaxation techniques

Osteopathic Manipulation Technique.

Soft-tissue mobilizations, muscle energy techniques, manipulation, and mobilization for lumbar segment techniques. Exercise approaches were implemented, consisting of spinal stabilization, strengthening, and stretching exercise.

10 sessions for five weeks at two sessions per week.

Pain intensity: Visual Analogue Scale.

Quality of Life: SF-36.

Functionality: Oswestry Function Scale.

There was no significant difference between groups for all outcomes, except for sub-parameters in SF-36.

High

Eguaras 2019

Gastroesophageal Reflux

Visceral Osteopathic Manipulation.

The deep manual technique is applied over the epigastric region.

Sham Technique.

Superficial contact without any pressure over the epigastric region.

2 sessions.

Gastroesophageal reflux symptoms: GerdQ test.

Pressure Pain Threshold (PPT): Algometer.

Cervical Mobility: Goniometry.

There were significant differences between groups in the gastroesophageal reflux symptoms one week after intervention, PPT in C4, and cervical mobility.

Low