A correspondent asked me to look into Airrosti because her employer’s insurance company had started covering it, and she was skeptical. She had tried to look up its effectiveness and safety record on the Internet and hadn’t found much. The information on their website didn’t tell me what I wanted to know, so I did a little digging. Like my correspondent, I am skeptical of their claims.
The name Airrosti stands for Applied Integration for the Rapid Recovery of Soft Tissue Injuries. One writer jokingly renamed it Owwwrosti because his first treatment was so excruciatingly painful. They say, “Wherever you hurt, we can help.” They claim to have special knowledge about the underlying cause of soft tissue injuries and pain problems and how to treat them; they claim they can resolve the problems of most of their patients in only 3 visits. The providers are chiropractors who have been trained by the company in their special methods…whatever they are. Their website is vague about what their modality actually consists of. I was able to piece together some of what they are doing from discussion groups and patient reports. There are plenty of testimonials, and the treatments are described as painful but effective. They offer quality 1-on-1 care for an entire hour, with detailed examination, hands-on soft tissue therapy, foam rolling, instruction in exercise and rehabilitation, and Kinesio Taping. Their main competitors are said to be the Graston technique and Gua Sha technique, and their treatment appears to be centered on myofascial release (MFR). In other words, it’s a mixed bag.
The Airrosti website, prominently featuring several bold claims. Click screenshot to see full size.
Myofascial release is an umbrella term for several overlapping and allegedly advanced techniques and styles of manipulating muscles and fascia (sheets of connective tissue). The other word for all that is “massage.” The major common denominator for the various flavors of MFR is the much ballyhooed notion that fascia has clinically important properties. In fact, there is only a vague scientific rationale and inadequate evidence for any kind of myofascial release.
Wherever you see “myofascial release,” extraordinary claims of efficacy are likely to follow. For instance, the UK Advertising Standards Authority received a complaint in 2011 about claims from a company in the UK similar to Airrosti that offered “integrated myofascial therapy.” Their investigation determined that there was no robust evidence that MFR was an effective treatment for any of the conditions listed, and that the company was in violation of advertising codes. Similarly, the Aetna insurance company does not cover myofascial release and Kinesio Taping because it considers them experimental and investigational.
Airrosti’s methods are reportedly based on the fascial distortion model developed by the late Stephen Typaldos, DO. Apparently he trained a female physical therapist in his methods, then decided not to train any other PTs after she told patients she had developed the methods herself. Later she sold her business concept to entrepreneurs who started training chiropractors. Typaldos described six principal types of fascial distortions, each with its own body language and signature presentation. He tested his model for over 15 years in his own practice; in addition to treating injuries he treated conditions as diverse as Osgood-Schlatter disease, backaches, headaches, sciatica, chronic pain, and kidney stones. The AFDMA (American Fascial Distortion Model Association) was created after his death to continue his work and to educate the medical community. There are also FDM associations in Burkina Faso, Europe and Japan. They recently held a World Congress in San Antonio.
As far as I can determine, Typaldos did not publish any studies. He wrote a book but it is out of print and a used copy sells for $342.84, so needless to say I didn’t read it. On PubMed, a search for “Typaldos” located a single study, not by him but using his model to treat frozen shoulder. A search for “fascial distortion model” brought up only that same article plus one other that was irrelevant, a rabbit study comparing various materials for vaginal sling surgery.
The company’s evidence
So, no evidence in PubMed, but the Airrosti website claims to have evidence. They say:
Airrosti has been proven, through extensive third-party research and analysis, to be the most effective, efficient, and affordable option for resolving musculoskeletal conditions.
And they claim “measurable” prevention of surgeries, hospitalization, MRIs, injections, and pharmaceuticals for back pain and other musculoskeletal conditions.
I wrote the company asking where I could read the details of that third-party research and received this reply:
Thank you for your inquiry and I apologize for the delayed response. I have attached our stats that breakdown our reported outcomes. At Airrosti, our goal is to make an immediate impact on your injury, usually within the first 1-2 treatments and I am confident we can help alleviate any symptoms/pain you may be having. We will detail a personalized treatment plan for you, which will specify the amount of treatments necessary to improve your condition.
The attachment was a copyrighted PDF that prohibits redistribution or any other use without the expressed written consent of Airrosti. It is an internal company document describing patient-reported outcomes for 62,595 patients, based on questionnaires that patients filled out at their last visit. The data are broken down in several ways. One table shows that 89.6% of patients said Airrosti had resolved their injury/condition, 5,516 individuals said Airrosti had helped prevent a recommended surgery, 93.8% said it had helped them eliminate/reduce medications taken, and 92.3% said it prevented further medical services such as PT and chiropractic visits.
Another table seems to contradict that one. It says that at their last visit, only 60.2% of patients reported their condition “much improved,” and 33.9% “improved.” In another table, 37.4% reported no pain at last visit, 46.2% very little pain, 13.9% moderate pain. The numbers don’t add up, and they don’t tell us how many patients failed to complete the discharge survey or dropped out. They only tell us how patients reported their improvement at the time of the last visit; there was no long-term follow-up. Did the improvement last? Were the patient reports accurate? How much of the perceived improvement was a placebo response? There’s no way to know. The endpoints are all subjective self-reports; there are no measurable objective findings by third parties or even from Airrosti’s own providers, no way to quantify how many surgeries were actually avoided, and no attempt to compare Airrosti outcomes with the outcomes of other treatment methods. There is no attempt at using any kind of controls that might put their numbers into perspective. This information certainly doesn’t qualify as “third-party research” or as proving Airrosti to be the best approach. It is hard to see it as anything more than self-serving internally-generated advertising propaganda.
There are some good signs in the data. The average patient had 3.2 visits to Airrosti. Of patients who chose Airrosti as the first treatment option, 2.4% were referred to specialists. So at least they are recognizing that some patients require more than they can offer, and they are not sucking customers into long treatment plans.
When I complained that they had not forwarded any third-party research, I got an e-mail from “Dr. Jason Garrett,” who is not a medical doctor but a chiropractor and the company’s vice-president of clinical development. He provided a table, with the Airrosti logo, of “cost comparative data provided by Compass Professional Health Services, based on an independent regional analysis of episodic treatment costs according to specific injury/condition diagnosis codes.” It shows average costs for Airrosti cases and for cases without Airrosti, tabulated by knee, back, and other areas of the body. It also shows average post-Airrosti care costs, which are substantial; one can only wonder why care would be needed post-treatment if treatment is as effective as they claim. It shows Airrosti costs as lower across the board. I guess this could be considered “third-party research,” and it is consistent with the quality of other research that has been known to impress some chiropractors. But it doesn’t describe the methods used, the diagnoses, the treatments provided, or the source of the data, and there could be any number of confounders. I don’t think any conclusions can be drawn from such incomplete data, especially when presented second-hand.
The information they sent me doesn’t justify the claims the company makes (that it is proven, through extensivethird-party research and analysis, to be the most effective, efficient, and affordable option for resolving musculoskeletal conditions and that it has measurably prevented surgeries, hospitalization, MRIs, injections, and pharmaceuticals). If Airrosti can really provide less expensive and more effective treatment than other sources of care, I’m all for it; but they haven’t made their case.
There is not enough evidence to determine whether Airrosti is safe or effective, much less whether it’s the best treatment method out there. They appear to have a lot of satisfied customers; but then, so do homeopaths and purveyors of snake oil. I hope they will eventually do some credible research. And if their methods prove to be effective, I hope they will share the details of what they are doing with other practitioners so that patients everywhere can benefit. For the time being, prospective Airrosti customers should understand that the treatment is still in the investigational stage, that they are essentially guinea pigs in an uncontrolled experiment, and that some insurance companies will not pay for it. Airrosti may be the greatest thing since sliced bread, but I will withhold judgment until they can offer some actual evidence from controlled studies.
This article was originally published in the Science-Based Medicine Blog.