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To the Editor: This letter is in response to the original contribution by John Licciardone, DO, MBA; Russell Gamber, DO; and Kathryn Cardarelli, MPH, “Patient satisfaction and clinical outcomes associated with osteopathic manipulative treatment” (JAOA 2002;102:1320). This study wonderfully points out a correlation of patient satisfaction and osteopathic manipulative treatment, but it failed to prove any true clinical outcome. The subjective outcome measures for pain relief and mobility used in this study are possibly just different measures of patient satisfaction. Without objective measures, such as joint range of motion or a change in two points on a visual analog pain scale, the researcher cannot know whether the improved mobility or decreased pain is secondary to the actual therapy or whether it is placebo effect. One can argue that at least one third of the patients who subjectively reported less pain or increased mobility were false positives.1, 2 We would hope this study could be repeated using numerical identifiers to correlate pretreatment and posttreatment objective measures. Such a study would provide for actual clinical results and not inference.

Need for objective measures to prove clinical outcome