OSCAR (Osteopathic Single CAse Research): A Single Case Experimental Design study evaluating osteopathic management for non-specific low back pain

Background Non-specific low back pain (NSLBP) is a major global health challenge. While osteopathic treatment shows benefit in managing NSLBP, research comparing traditional approaches with biopsychosocial-informed care is limited. This study aimed to evaluate outcomes from standard osteopathic treatment versus biopsychosocial-informed management and assess the feasibility of conducting Single Case Experimental Design (SCED) research in osteopathic practice. Methods A SCED trial with randomised treatment start times was conducted and reported in accordance with the SCRIBE checklist. Eleven patients with NSLBP were recruited before (between January and February 2022) or after (between June and July 2022) osteopaths completed a Biopsychosocial Pain Management e-learning course. Data was collected during baseline (5–15 days), treatment (4–6 weeks), and follow-up (12 weeks) periods. Primary outcomes were the Numeric Pain Rating Scale (NPRS) and Patient Specific Function Scale (PSFS). Feasibility was assessed through recruitment, retention, and protocol adherence. Results Complete data was obtained from nine osteopath-patient pairs. Linear mixed modelling showed significant daily improvements in pain (NPRS − 0.07/day, p < 0.001) and function (PSFS − 0.12/day, p < 0.001) during treatment, sustained over 12-week follow-up. These changes were clinically meaningful, with treatment-phase reductions exceeding established Minimal Important Change thresholds for both measures. Limited recruitment after the e-learning course prevented comparison of standard versus biopsychosocial-informed treatment approaches. SCED methodology proved feasible, though challenges emerged around recruitment and maintaining randomised treatment delays. Conclusions This first implementation of SCED in osteopathic practice demonstrated significant improvements in pain and function following treatment initiation. While the methodology offers a viable approach for practice-based research, future studies should address identified implementation challenges. The findings advance our understanding of osteopathic care while providing a framework for future research bridging evidence and practice. Trial registration NCT05120921