Osteopathic treatment versus physiotherapy for chronic low back pain in rural Cameroon: A pilot exploratory study investigating the "unique practitioner syndrome

Abstract Background Chronic low back pain (CLBP) affects 14–72% of African populations with limited evidence for osteopathic interventions in sub-Saharan Africa. This pilot study explored preliminary effectiveness signals of osteopathic care compared to physiotherapy in rural Cameroon, while investigating healthcare centralization patterns around rare practitioners in resource-limited settings. Methods Pilot exploratory study at Bafoussam Regional Hospital (January 2023-December 2024) designed to generate hypothesis and inform future randomized controlled trials. Patients were allocated by consultation day: osteopathy (Monday/Wednesday, n = 19) versus physiotherapy (Tuesday/Thursday/Friday, n = 28). Primary outcomes included Visual Analog Scale (VAS) and Eifel Disability Index. Secondary outcomes comprised a novel Therapeutic Autonomization Score and culturally-adapted Agricultural Functional Test. The study also examined theoretical constructs including the "unique practitioner syndrome" and associated psychosocial mechanisms. Results Forty-seven patients completed treatment (78.7% women, mean age 44.8 ± 12.3 years), with 95.7% having prior physiotherapy failures. Osteopathic treatment showed greater improvements in pain reduction (-47.3% vs -32.1%, p = 0.008, Cohen's d = 0.85) and functional enhancement (-42.8% vs -31.5%, p = 0.018, Cohen's d = 0.73), with superior therapeutic autonomization scores (16.2 ± 2.3 vs 13.8 ± 3.1, p = 0.005). Treatment required fewer sessions (9.8 ± 0.9 vs 14.1 ± 1.2, p < 0.001) with 24.4% cost reduction. Patient narratives revealed distinct experiential patterns supporting novel theoretical mechanisms including "France-diploma effect" and "therapeutic rarity polarization." Conclusions This pilot investigation generated promising preliminary signals suggesting potential benefits of osteopathic treatment for CLBP in rural Africa among patients with prior treatment failures. However, significant methodological limitations including non-randomized allocation, investigator bias, and highly specific population characteristics substantially limit generalizability and causal interpretation. These exploratory findings require confirmation through properly designed, adequately powered randomized controlled trials with blinded assessment and extended follow-up before evidence-based clinical recommendations can be established. The study provides valuable methodological innovations and theoretical frameworks for future rigorous research in African healthcare contexts.