Investigating the trustworthiness of randomised controlled trials in osteopathic research: a systematic review with meta-analysis

Abstract

Objective To systematically investigate trustworthiness (methodological rigour, transparency, good governance, research integrity, and absence of misconduct) in randomised controlled trials (RCTs) of osteopathic manual therapy. Methods This prospectively registered review (PROSPERO-ID: CRD42023457697) searched MEDLINE®, EMBASE, CINAHL, AMED, PEDro, ostmed.dr, and Chiroindex for RCTs evaluating osteopathic treatments (January 2021-June 2024). Risk-of-bias was assessed using Cochrane tool 2, while trustworthiness was assessed with the Cochrane Pregnancy and Childbirth Screening Tool and the REAPPRAISED checklist. Journal trustworthiness, misleading representations in abstracts (‘spin’), and results plausibility (via meta-analysis) were also assessed. Findings were synthesised descriptively. Results Sixty-one RCTs were included (median sample size 45, IQR 30-76), largely studying healthy volunteers (29%). Most had high risk-of-bias (74%), and only 7% acknowledged potential conflicts from authors’ professional ties. No journals appeared on cautionary lists, although 23% of articles were published within two months of submission. Only 27% of contactable authors engaged with reviewers. Seven abstracts (12%) were free of spin. Methodological concerns included poor missing data handling (31%), selective analyses (38%), unacknowledged multiple testing (36%), and outcome switching (12%). Meta-analysis found two outliers and five further with very large effects, while 19% provided inadequate data for pooling. Limitations Limitations include incomplete reports and lack of validated trustworthiness assessment tools. Conclusion Adherence to best practices in osteopathic RCTs needs improvement to enhance evidence-based decision making, reduce research waste, and enhance reproducibility. Further research should explore whether these findings apply to other small, under-resourced fields