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In 2022, ACC Commissioned an independent, systematic review of the published clinical research on the effectiveness and safety of osteopathy for the management of musculoskeletal conditions. The review was carried out by the International Centre for Allied Health Evidence (iCAHE) at the University of South Australia, and a project summary was published in July 2023.

This is the most significant independent assessment of the osteopathic evidence base in the New Zealand context to date - and every practitioner should be familiar with its findings.

ACC funds more than 100,000 osteopathy claims each year. This review was commissioned to better understand osteopathy's role in rehabilitation and to inform how ACC invests in the profession on behalf of its clients.

Crucially, this is not a document produced by osteopaths about osteopathy. It is an independent, ACC-funded appraisal using robust systematic review methodology. That independence is precisely what gives it weight - with funders, referrers, and the public alike.

Osteopaths New Zealand nominated sector representatives to the Expert Reference Group that guided the review process. ONZ is committed to ensuring members understand and can engage with its findings.

The review examined 84 studies - including 24 systematic reviews, 38 controlled trials, and 19 observational studies - covering a wide range of musculoskeletal conditions and body sites.

Where the evidence is strongest:

• Non-specific neck pain - strong to moderate evidence that osteopathy may significantly reduce pain and improve function in the short to medium term, and may be superior to other treatment options including physiotherapy and exercise for pain reduction.
  
  
• Cervicogenic headache - strong evidence that osteopathy may significantly reduce headache pain, intensity and frequency in the short to medium term compared to other treatment options.
  
  
• Non-specific low back pain (acute) - very strong evidence that osteopathy performs comparably to other treatment options including physiotherapy, exercise and standard care for improving pain and function.
  
  
• Non-specific low back pain (chronic) - strong evidence that osteopathy may be superior to other treatment options in the short to medium term, though results are more inconsistent over the long term.
  
  
• Shoulder pain and dysfunction - strong to moderate evidence that osteopathy may reduce pain in the short term, and moderate evidence for reducing disability in the medium to long term.

On safety:

Studies consistently reported associations between osteopathic treatment and minor, transient side effects - such as temporary increased soreness or tiredness. Serious adverse events appear to be rare. This is consistent with the profession's established safety record.

Use it in clinical conversations. When patients ask whether osteopathy is evidence-based, you can point to an independent, ACC-commissioned review that supports osteopathic care for the conditions you treat most commonly.

Understand ACC's perspective. ACC is using this evidence base to assess and develop its investment in osteopathy. Being familiar with what the review found - including where evidence is strong and where gaps exist - positions you to engage constructively in any ACC-related conversations.

Know where the gaps are. The review identified a clear need for better quality, more rigorously reported osteopathy research, particularly on longer-term outcomes. This is a call to the profession - not a criticism of current practice - and ONZ is committed to supporting efforts that strengthen the evidence base over time.

For conditions with the strongest evidence base, the review identified the following treatment durations used in research studies:

These figures reflect what was reported in the research literature and are not prescriptive clinical guidelines.

Understanding what "weak evidence" actually means

One of the most important things to understand about this review - and about evidence-based practice more broadly - is what weak evidence actually means.

Weak evidence is not the same as evidence that something does not work.

When the review describes evidence for a condition as weak or very weak, it means that too few studies of sufficient quality exist to draw firm conclusions. It does not mean osteopathic treatment has been shown to be ineffective for that condition. The absence of evidence is not evidence of absence.

This distinction matters - because the conditions where evidence is currently weakest are ones that osteopaths treat every day.

The research gap in practice

Consider some of the conditions where evidence was rated weak or very weak:

• Whiplash - one of the most common ACC-funded presentations, yet the review found very weak evidence on osteopathy's effectiveness for pain, disability or quality of life.
• Sacroiliac joint dysfunction and coccydynia - frequently presenting in clinical practice, with only weak or very weak evidence available, limited to short-term outcomes.
• Plantar fasciitis, Achilles tendinopathy, hip labral tear and meniscal injury - all common musculoskeletal complaints, all with weak or very weak evidence focused on short to medium-term management only.
• Knee osteoarthritis - evidence is generally weak, and results on pain relief specifically are inconsistent.
• Subacromial impingement and carpal tunnel syndrome - weak or very weak evidence focused on short-term management only.
• Temporomandibular joint disorders - weak and conflicting evidence on both short and long-term outcomes.

In each of these cases, the limitation is not clinical. It is a research infrastructure problem. The studies simply have not been done, or have not been done well enough to meet the inclusion criteria for a systematic review of this kind.

ACC funds over 100,000 osteopathy claims annually. As the profession's funder for a significant portion of clinical work in New Zealand, ACC will continue to use the evidence base to inform how it invests in osteopathy. Where evidence is thin, the profession is vulnerable - not because osteopathy does not work, but because it cannot yet prove that it does to the standard that funders and policymakers require.

This is why research participation is not just an academic pursuit. It is a professional responsibility.

Every osteopath can contribute

• Participate in clinical trials when opportunities arise.
• Use standardised outcome measures consistently in practice - this builds the data foundation for future research.
• Support colleagues and students who are undertaking research.
• Engage with iCAHE, university osteopathy programmes, and ONZ on research priorities and opportunities.

The review specifically recommended use of the TIDieR framework to improve how osteopathic interventions are reported in clinical trials — making it easier to replicate studies and build a more robust evidence base over time. ONZ supports this recommendation and encourages members to familiarise themselves with it.

The profession has a window of opportunity

The ACC evidence review has named the gaps clearly. That transparency is valuable - it gives the osteopathic profession in New Zealand a roadmap for where research effort is most needed, and where a relatively small number of well-designed studies could significantly strengthen the evidence base.

ONZ is committed to advocating for research investment in osteopathy and to keeping members informed as the evidence evolves. If you are involved in research, or interested in becoming involved, we want to hear from you.

This webinar helps us to understand what the ACC data tells us and why it matters for our profession. 

The ACC evidence review has named the gaps clearly. That transparency is valuable - it gives the osteopathic profession in New Zealand a roadmap for where research effort is most needed, and where a relatively small number of well-designed studies could significantly strengthen the evidence base.

ONZ is committed to advocating for research investment in osteopathy and to keeping members informed as the evidence evolves. If you are involved in research, or interested in becoming involved, we want to hear from you.

Read the ACC Review of Osteopathy