BACKGROUND: Chronic low back pain (CLBP) is a frequent cause of disability and it represents a medical, social and economic burden globally. Therefore, we assessed effectiveness of osteopathic interventions in the management of NS-CLBP for pain and functional status. METHODS: A systematic review and meta-analysis were conducted. Findings were reported following the PRISMA statement. Six databases were searched for RCTs. Studies were independently assessed using a standardized form. Each article was assessed using the Cochrane risk of bias (RoB) tool. Effect size (ES) were calculated at post-treatment and at 12 weeks' follow up. We used GRADE to assess quality of evidence. RESULTS: 10 articles were included. Studies investigated osteopathic manipulative treatment (OMT, n = 6), myofascial release (MFR, n = 2), craniosacral treatment (CST, n = 1) and osteopathic visceral manipulation (OVM, n = 1). None of the study was completely judged at low RoB. Osteopathy revealed to be more effective than control interventions in pain reduction (ES -0.59; 95% CI -0.81 to -0.36; p < 0.00,001) and in improving functional status (ES -0.42; 95% 95% CI -0.68 to -0.15; p = 0.002). Moderate-quality evidence suggested that MFR is more effective than control treatments in pain reduction (ES -0.69; 95% CI -1.05 to -0.33; p = 0.0002), even at follow-up (ES -0.73; 95% CI -1.09 to -0.37; p < 0.0001). Low-quality evidence suggested superiority of OMT in pain reduction (ES -0.57; 95% CI -0.90 to -0.25; p = 0.001) and in changing functional status (ES -0.34; 95% CI -0.65 to -0.03; p = 0.001). Very low-quality evidence suggested that MFR is more effective than control interventions in functional improvements (ES -0.73; 95% CI -1.25 to -0.21; p = 0.006). CONCLUSION: Results strengthen evidence that osteopathy is effective in pain levels and functional status improvements in NS-CLBP patients. MFR reported better level of evidence for pain reduction if compared to other interventions. Further high-quality RCTs, comparing different osteopathic modalities, are recommended to produce better-quality evidence.

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