John C Licciardone

University of North Texas HSC at Fort Worth, Fort Worth, Texas, United States

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Publications (68)122.05 Total impact

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    ABSTRACT: Osteopathic manual treatment (OMT) of somatic dysfunction is a unique approach to medical care that may be studied within a practice-based research network. To measure patient characteristics and osteopathic physician practice patterns within the Consortium for Collaborative Osteopathic Research Development-Practice-Based Research Network (CONCORD-PBRN). Design: Cross-sectional card study. Eleven member clinics within the CONCORD-PBRN coordinated by The Osteopathic Research Center. A total of 668 patients seen between January and March 2013. Main Study Measures: Patient age and sex; primary diagnoses; somatic dysfunction as manifested by tenderness, asymmetry, restricted motion, or tissue texture changes; and use of 14 OMT techniques. Results were stratified by anatomical region and adjusted for clustering within member clinics. Clustering was measured by the intracluster correlation coefficient. Patient ages ranged from 7 days to 87 years (adjusted mean age, 49.2 years; 95% confidence interval [CI], 43.3-55.1 years). There were 450 females (67.4%) and 508 patient visits (76.0%) involved a primary diagnosis of disease of the musculoskeletal system and connective tissue. Structural examination was performed during 657 patient visits (98.4%), and 649 visits (97.2%) involved OMT. Restricted motion and tenderness were the most and least common palpatory findings, respectively. Cranial (1070 [14.5%]), myofascial release (1009 [13.7%]), muscle energy (1001 [13.6%]), and counterstrain (980 [13.3%]) techniques were most commonly used, accounting for more than one-half of the OMT provided. Pediatric patients were more likely than adults to receive OMT within the head (adjusted odds ratio [OR], 9.53; 95% CI, 1.28-71.14). Geriatric patients were more likely than adults to receive a structural examination (adjusted OR, 1.83; 95% CI, 1.09-3.07) and OMT (adjusted OR, 1.62; 1.02-2.59) within the lower extremity. Females were more likely than males to receive a structural examination (adjusted OR, 2.44; 95% CI, 1.44-4.16) and OMT (adjusted OR, 2.11; 95% CI, 1.26-3.52) within the sacrum and OMT within the pelvis (adjusted OR, 1.79; 95% CI, 1.12-2.88). Intracluster correlation coefficients for the 4 most commonly used OMT techniques ranged from 0.34 to 0.72. This study provides proof of concept of the feasibility of studying osteopathic medical practice on a national level by developing and growing the CONCORD-PBRN.
    The Journal of the American Osteopathic Association 05/2014; 114(5):344-54.
  • John C Licciardone, Robert Gatchel, Simon Dagenais
    JAMA Internal Medicine 03/2014; 174(3):478-9. · 13.25 Impact Factor
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    John C. Licciardone, Subhash Aryal
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    ABSTRACT: Clinical response and relapse following a regimen of osteopathic manual treatment (OMT) were assessed in patients with chronic low back pain (LBP) within the OSTEOPATHIC Trial, a randomized, double-blind, sham-controlled study. Initial clinical response and subsequent stability of response, including final response and relapse status at week 12, were determined in 186 patients with high baseline pain severity (≥50 mm on a 100-mm visual analogue scale). Substantial improvement in LBP, defined as 50% or greater pain reduction relative to baseline, was used to assess clinical response at weeks 1, 2, 4, 6, 8, and 12. Sixty-two (65%) patients in the OMT group attained an initial clinical response vs. 41 (45%) patients in the sham OMT group (risk ratio [RR], 1.45; 95% confidence interval [CI], 1.11-1.90). The median time to initial clinical response to OMT in these patients was 4 weeks. Among patients with an initial clinical response prior to week 12, 13 (24%) patients in the OMT group vs. 18 (51%) patients in the sham OMT group relapsed (RR, 0.47; 95% CI, 0.26-0.83). Overall, 49 (52%) patients in the OMT group attained or maintained a clinical response at week 12 vs. 23 (25%) patients in the sham OMT group (RR, 2.04; 95% CI, 1.36-3.05). The large effect size for short-term efficacy of OMT was driven by stable responders who did not relapse.
    Manual Therapy. 01/2014;
  • John C. Licciardone, Subhash Aryal
    American journal of obstetrics and gynecology 01/2014; · 3.28 Impact Factor
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    John C. Licciardone, Cathleen M. Kearns, W. Thomas Crow
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    ABSTRACT: The purpose of this study was to measure changes in biomechanical dysfunction following osteopathic manual treatment (OMT) and to assess how such changes predict subsequent low back pain (LBP) outcomes. Secondary analyses were performed with data collected during the OSTEOPATHIC Trial wherein a randomized, double-blind, sham-controlled, 2x2 factorial design was used to study OMT for chronic LBP. At baseline, prevalence rates of non-neutral lumbar dysfunction, pubic shear, innominate shear, restricted sacral nutation, and psoas syndrome were determined in 230 patients who received OMT. Five OMT sessions were provided at weeks 0, 1, 2, 4, and 6, and the prevalence of each biomechanical dysfunction was again measured at week 8 immediately before the final OMT session. Moderate pain improvement (≥30% reduction on a 100-mm visual analogue scale) at week 12 defined a successful LBP response to treatment. Prevalence rates at baseline were: non-neutral lumbar dysfunction, 124 (54%); pubic shear, 191 (83%); innominate shear, 69 (30%); restricted sacral nutation, 87 (38%), and psoas syndrome, 117 (51%). Significant improvements in each biomechanical dysfunction were observed with OMT; however, only psoas syndrome remission occurred more frequently in LBP responders than non-responders (P for interaction=0.002). Remission of psoas syndrome was the only change in biomechanical dysfunction that predicted subsequent LBP response after controlling for the other biomechanical dysfunctions and potential confounders (odds ratio, 5.11; 95% confidence interval, 1.54-16.96). These findings suggest that remission of psoas syndrome may be an important and previously unrecognized mechanism explaining clinical improvement in patients with chronic LBP following OMT.
    Manual therapy 01/2014; · 2.32 Impact Factor
  • John C Licciardone
    The spine journal: official journal of the North American Spine Society 12/2013; · 2.90 Impact Factor
  • John C Licciardone, Subhash Aryal
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    ABSTRACT: Back pain during pregnancy may be associated with deficits in physical functioning and disability. Research indicates that osteopathic manual treatment (OMT) slows the deterioration of back-specific functioning during pregnancy. To measure the treatment effects of OMT in preventing progressive back-specific dysfunction during the third trimester of pregnancy using criteria established by the Cochrane Back Review Group. Design: A randomized sham-controlled trial including 3 parallel treatment arms: usual obstetric care and OMT (UOBC+OMT), usual obstetric care and sham ultrasound therapy (UOBC+SUT), and usual obstetric care (UOBC). The Osteopathic Research Center within the University of North Texas Health Science Center in Fort Worth. Participants: A total of 144 patients were randomly assigned and included in intention-to-treat analyses. Progressive back-specific dysfunction was defined as a 2-point or greater increase in the Roland-Morris Disability Questionnaire (RMDQ) score during the third trimester of pregnancy. Risk ratios (RRs) and 95% confidence intervals (CIs) were used to compare progressive back-specific dysfunction in patients assigned to UOBC+OMT relative to patients assigned to UOBC+SUT or UOBC. Numbers needed to treat (NNTs) and 95% CIs were also used to assess UOBC+OMT vs each comparator. Subgroup analyses were performed using median splits of baseline scores on a numerical rating scale for back pain and the RMDQ. Overall, 68 patients (47%) experienced progressive back-specific dysfunction during the third trimester of pregnancy. Patients who received UOBC+OMT were significantly less likely to experience progressive back-specific dysfunction (RR, 0.6; 95% CI, 0.3-1.0; P=.046 vs UOBC+SUT; and RR, 0.4; 95% CI, 0.2-0.7; P<.0001 vs UOBC). The effect sizes for UOBC+OMT vs UOBC+SUT and for UOBC+OMT vs UOBC were classified as medium and large, respectively. The corresponding NNTs for UOBC+OMT were 5.1 (95% CI, 2.7-282.2) vs UOBC+SUT; and 2.5 (95% CI, 1.8-4.9) vs UOBC. There was no statistically significant interaction between subgroups in response to OMT. Osteopathic manual treatment has medium to large treatment effects in preventing progressive back-specific dysfunction during the third trimester of pregnancy. The findings are potentially important with respect to direct health care expenditures and indirect costs of work disability during pregnancy.
    The Journal of the American Osteopathic Association 10/2013; 113(10):728-736.
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    John C Licciardone, Cathleen M Kearns, Dennis E Minotti
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    ABSTRACT: PURPOSE: To assess response to osteopathic manual treatment (OMT) according to baseline severity of chronic low back pain (LBP). METHODS: The OSTEOPATHIC Trial used a randomized, double-blind, sham-controlled, 2×2 factorial design to study OMT for chronic LBP. A total of 269 (59%) patients reported low baseline pain severity (LBPS) (<50mm/100mm), whereas 186 (41%) patients reported high baseline pain severity (HBPS) (≥50mm/100mm). Six OMT sessions were provided over eight weeks and outcomes were assessed at week 12. The primary outcome was substantial LBP improvement (≥50% pain reduction). The Roland-Morris Disability Questionnaire (RMDQ) and eight other secondary outcomes were also studied. Response ratios (RRs) and 95% confidence intervals (CIs) were used in conjunction with Cochrane Back Review Group criteria to determine OMT effects. RESULTS: There was a large effect size for OMT in providing substantial LBP improvement in patients with HBPS (RR, 2.04; 95% CI, 1.36-3.05; P<0.001). This was accompanied by clinically important improvement in back-specific functioning on the RMDQ (RR, 1.80; 95% CI, 1.08-3.01; P=0.02). Both RRs were significantly greater than those observed in patients with LBPS. Osteopathic manual treatment was consistently associated with benefits in all other secondary outcomes in patients with HBPS, although the statistical significance and clinical relevance of results varied. CONCLUSIONS: The large effect size for OMT in providing substantial pain reduction in patients with chronic LBP of high severity was associated with clinically important improvement in back-specific functioning. Thus, OMT may be an attractive option in such patients before proceeding to more invasive and costly treatments.
    Manual therapy 06/2013; · 2.32 Impact Factor
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    ABSTRACT: Chronic pain is often present in patients with diabetes mellitus. To assess the effects of osteopathic manual treatment (OMT) in patients with diabetes mellitus and comorbid chronic low back pain (LBP). Design: Randomized, double-blind, sham-controlled, 2×2 factorial trial, including OMT and ultrasound therapy (UST) interventions. University-based study in Dallas-Fort Worth, Texas. A subgroup of 34 patients (7%) with diabetes mellitus within 455 adult patients with nonspecific chronic LBP enrolled in the OSTEOPAThic Health outcomes In Chronic low back pain (OSTEOPATHIC) Trial. Main Study Measures: The Outpatient Osteopathic SOAP Note Form was used to measure somatic dysfunction at baseline. A 100-mm visual analog scale was used to measure LBP severity over 12 weeks from randomization to study exit. Paired serum concentrations of tumor-necrosis factor (TNF)-α obtained at baseline and study exit were available for 6 subgroup patients. Key osteopathic lesions were observed in 27 patients (79%) with diabetes mellitus vs 243 patients (58%) without diabetes mellitus (P=.01). The reduction in LBP severity over 12 weeks was significantly greater in 19 patients with diabetes mellitus who received OMT than in 15 patients with diabetes mellitus who received sham OMT (mean between-group difference in changes in the visual analog scale pain score, -17 mm; 95% confidence interval [CI], -32 mm to -1 mm; P=.04). This difference was clinically relevant (Cohen d=0.7). A corresponding significantly greater reduction in TNF-α serum concentration was noted in patients with diabetes mellitus who received OMT, compared with those who received sham OMT (mean between-group difference, -6.6 pg/mL; 95% CI, -12.4 to -0.8 pg/mL; P=.03). This reduction was also clinically relevant (Cohen d=2.7). No significant changes in LBP severity or TNF-α serum concentration were associated with UST during the 12-week period. Severe somatic dysfunction was present significantly more often in patients with diabetes mellitus than in patients without diabetes mellitus. Patients with diabetes mellitus who received OMT had significant reductions in LBP severity during the 12-week period. Decreased circulating levels of TNF-α may represent a possible mechanism for OMT effects in patients with diabetes mellitus. A larger clinical trial of patients with diabetes mellitus and comorbid chronic LBP is warranted to more definitively assess the efficacy and mechanisms of action of OMT in this population.
    The Journal of the American Osteopathic Association 06/2013; 113(6):468-78.
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    ABSTRACT: PURPOSE We studied the efficacy of osteopathic manual treatment (OMT) and ultrasound therapy (UST) for chronic low back pain. METHODS A randomized, double-blind, sham-controlled, 2 × 2 factorial design was used to study OMT and UST for short-term relief of nonspecific chronic low back pain. The 455 patients were randomized to OMT (n = 230) or sham OMT (n = 225) main effects groups, and to UST (n = 233) or sham UST (n = 222) main effects groups. Six treatment sessions were provided over 8 weeks. Intention-to-treat analysis was performed to measure moderate and substantial improvements in low back pain at week 12 (30% or greater and 50% or greater pain reductions from baseline, respectively). Five secondary outcomes, safety, and treatment adherence were also assessed. RESULTS There was no statistical interaction between OMT and UST. Patients receiving OMT were more likely than patients receiving sham OMT to achieve moderate (response ratio [RR] = 1.38; 95% CI, 1.16-1.64; P <.001) and substantial (RR = 1.41, 95% CI, 1.13-1.76; P = .002) improvements in low back pain at week 12. These improvements met the Cochrane Back Review Group criterion for a medium effect size. Back-specific functioning, general health, work disability specific to low back pain, safety outcomes, and treatment adherence did not differ between patients receiving OMT and sham OMT. Nevertheless, patients in the OMT group were more likely to be very satisfied with their back care throughout the study (P <.001). Patients receiving OMT used prescription drugs for low back pain less frequently during the 12 weeks than did patients in the sham OMT group (use ratio = 0.66, 95% CI, 0.43-1.00; P = .048). Ultrasound therapy was not efficacious. CONCLUSIONS The OMT regimen met or exceeded the Cochrane Back Review Group criterion for a medium effect size in relieving chronic low back pain. It was safe, parsimonious, and well accepted by patients.
    The Annals of Family Medicine 03/2013; 11(2):122-129. · 4.61 Impact Factor
  • John C Licciardone
    Journal of bodywork and movement therapies 01/2013; 17(1):2-4.
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    ABSTRACT: Depression and somatization are often present in patients with chronic low back pain (LBP). To measure the presence of depression and somatization in patients with chronic LBP and to study the associations of depression and somatization with somatic dysfunction, LBP severity, back-specific functioning, and general health. Design: Cross-sectional study using baseline measures collected within a randomized controlled trial. University-based study in Dallas-Fort Worth, Texas. A total of 202 adult research participants with nonspecific chronic LBP. Main Study Measures: Depression was self-reported and also measured with the Modified Zung Depression Index (MZDI). Somatization was measured with the Modified Somatic Perception Questionnaire (MSPQ). The MZDI and MSPQ scores were used to classify patients as "normal," "at risk," or "distressed" using the Distress and Risk Assessment Method. Somatic dysfunction was assessed using the Outpatient Osteopathic SOAP Note Form. A 100-mm visual analog scale (VAS), the Roland-Morris Disability Questionnaire (RMDQ), and the Medical Outcomes Study Short Form-36 Health Survey (SF-36) were used to measure LBP severity, back-specific functioning, and general health, respectively. There were 53 patients (26%) and 44 patients (22%) who were classified as having depression on the basis of self-reports and the MZDI cut point, respectively. A total of 38 patients (19%) were classified as having somatization on the basis of the MSPQ cut point. There were significant correlations among self-reported depression and the MZDI and MSPQ scores (P<.001 for each pairwise correlation). Similarly, the MZDI and MSPQ scores were both correlated with LBP severity and back-specific disability, and they were inversely correlated with general health (P<.001 for each pairwise correlation). Depression and the number of key osteopathic lesions were also each correlated with back-specific disability and inversely correlated with general health (P<.001 for each pairwise correlation). The MZDI (P=.006) and MSPQ (P=.004) scores were also correlated with the number of key osteopathic lesions. The associations among depression, somatization, and LBP in this study are consistent with the findings of previous studies. These associations, coupled with the findings that MZDI and MSPQ scores are correlated with somatic dysfunction, may have important implications for the use of osteopathic manual treatment in patients with chronic LBP.
    The Journal of the American Osteopathic Association 12/2012; 112(12):783-91.
  • John C Licciardone
    Family medicine 10/2012; 44(9):662-3. · 1.20 Impact Factor
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    ABSTRACT: Little is known about the role that cytokines play in osteopathic manual treatment (OMT) of patients with chronic low back pain (LBP). To measure the baseline concentrations of interleukin (IL)-1β, IL-6, IL-8, IL-10, and tumor necrosis factor (TNF)-α in patients with chronic LBP; the correlations of these cytokine concentrations with clinical measures, including the number of key osteopathic lesions; the changes in cytokine concentrations with OMT; and the association of such changes with clinical outcomes. Design: Substudy nested within a randomized controlled trial of OMT for nonspecific chronic LBP. University-based study in Dallas-Fort Worth, Texas. Seventy adult research patients with nonspecific chronic LBP. A 10-cm visual analog scale, the Roland-Morris Disability Questionnaire, and the Medical Outcomes Study Short Form-36 Health Survey were used to measure LBP severity, back-specific functioning, and general health, respectively. At baseline, IL-1β (ρ=0.33; P=.005) and IL-6 (ρ=0.32; P=.006) were each correlated with the number of key osteopathic lesions; however, only IL-6 was correlated with LBP severity (ρ=0.28; P=.02). There was a significantly greater reduction of TNF-α concentration after 12 weeks in patients who received OMT compared with patients who received sham OMT (Mann-Whitney U=251.5; P=.03). Significant associations were found between OMT and a reduced TNF-α concentration response at week 12 among patients who achieved moderate (response ratio, 2.13; 95% confidence interval [CI], 1.11-4.06; P=.006) and substantial (response ratio, 2.13; 95% CI, 1.07-4.25; P=.01) LBP improvements, and improvement in back-specific functioning (response ratio, 1.68; 95% CI, 1.04-2.71; P=.03). This study found associations between IL-1β and IL-6 concentrations and the number of key osteopathic lesions and between IL-6 and LBP severity at baseline. However, only TNF-α concentration changed significantly after 12 weeks in response to OMT. These discordant findings indicate that additional research is needed to elucidate the underlying mechanisms of action of OMT in patients with nonspecific chronic LBP.
    The Journal of the American Osteopathic Association 09/2012; 112(9):596-605.
  • John C Licciardone
    The Journal of the American Osteopathic Association 09/2012; 112(9):591-5.
  • John C Licciardone, Cathleen M Kearns
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    ABSTRACT: Clinical research is increasingly conducted in real-world settings. Osteopathic practices represent natural laboratories for studying the distinctiveness of osteopathic medicine. The Osteopathic Research Center (ORC) recently developed a triadic paradigm for research consisting of the Consortium for Collaborative Osteopathic Research Development (CONCORD), its affiliated practice-based research network (PBRN), and the patient-centered research (PCR) fellowship program. The CONCORD-PBRN was certified by the Agency for Healthcare Research and Quality in 2011. The inaugural PCR fellowship class completed didactic training that year. Fellows increased their knowledge of research design and biostatistics following participation in the curriculum. In 2012, a card study of osteopathic palpatory findings and manual techniques will be conducted within the CONCORD-PBRN. The ORC plans to use a hub-and-spoke model to grow the CONCORD-PBRN. Further expansion of this triadic paradigm is dependent on funding streams to support the needed research infrastructure.
    The Journal of the American Osteopathic Association 07/2012; 112(7):447-56.
  • John C Licciardone, Cathleen M Kearns
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    ABSTRACT: Somatic dysfunction is diagnosed by the presence of any of 4 TART criteria: tissue texture abnormality, asymmetry, restriction of motion, or tenderness. To measure the prevalence of somatic dysfunction in patients with chronic low back pain (LBP) and to study the associations of somatic dysfunction with LBP severity, back-specific functioning, and general health. Cross-sectional study nested within a randomized controlled trial. University-based study in Dallas-Fort Worth, Texas. A total of 455 adult research patients with non-specific chronic LBP. MAIN STUDY MEASURES: Somatic dysfunction in the lumbar, sacrum/pelvis, and pelvis/innominate regions, including key lesions representing severe somatic dysfunction. A 10-cm visual analog scale (VAS), the Roland-Morris Disability Questionnaire (RMDQ), and the Medical Outcomes Study Short Form-36 Health Survey (SF-36) were used to measure LBP severity, back-specific functioning, and general health, respectively. Severe somatic dysfunction was most prevalent in the lumbar (225 [49%]), sacrum/pelvis (129 [28%]), and pelvis/innominate (48 [11%]) regions. Only 30 patients (7%) had no somatic dysfunction in the lumbar, sacrum/pelvis, or pelvis/innominate regions. There were 4 statistically significant pairwise correlations for severe somatic dysfunction: thoracic (T) 10-12 with ribs; T10-12 with lumbar; lumbar with sacrum/pelvis; and sacrum/pelvis with pelvis/innominate. Having a key lesion in the lumbar region (ρ=0.80) or sacrum/pelvis region (ρ=0.71) was strongly correlated with the overall number of key lesions. There were no consistent demographic or clinical predictors of somatic dysfunction. The presence (vs absence) of severe somatic dysfunction in the lumbar region was associated with greater LBP severity (median VAS score, 4.7 vs 3.8, respectively; P=.003) and greater back-specific disability (median RMDQ score, 6 vs 4, respectively; P=.01). The presence (vs absence) of severe somatic dysfunction in the sacrum/pelvis region was associated with greater back-specific disability (median RMDQ score, 6 vs 5, respectively; P=.02) and poorer general health (median SF-36 score, 62 vs 72, respectively; P=.002). An increasing number of key lesions was associated with back-specific disability (P=.009) and poorer general health (P=.02). The present study demonstrates that somatic dysfunction, particularly in the lumbar and sacrum/pelvis regions, is common in patients with chronic LBP. Forthcoming extensions of the OSTEOPATHIC Trial will assess the efficacy of OMT according to baseline levels of somatic dysfunction.
    The Journal of the American Osteopathic Association 07/2012; 112(7):420-8.
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    John C Licciardone, Cathleen M Kearns, Paul Ruggiere
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    ABSTRACT: The Osteopathic Survey of Health Care in America (OSTEOSURV) is a decennial national telephone survey. Its goals are to monitor longitudinal trends in awareness, beliefs, utilization, and patient satisfaction relating to osteopathic physicians and to assess beliefs and attitudes regarding contemporary health care issues in the United States. The questionnaire was validated during the administrations of OSTEOSURV-I and OSTEOSURV-II in 1998 and 2000, respectively. In OSTEOSURV 2010, the contemporary health care issues of interest are patient-centered care and the Patient Protection and Affordable Care Act of 2010. The target population was household residents of the United States aged 18 years or older. A total of 10,308 random landline telephone numbers were dialed using a computer-assisted telephone interviewing system to acquire 1000 completed interviews between July 23, 2010, and October 1, 2010. The response, cooperation, and contact rates as defined by the American Association for Public Opinion Research were comparable to those of other national telephone surveys. The survey provides an estimated margin of error no greater than 3% to 4% for both general items and for those relating to the subset of respondents claiming to be aware of osteopathic physicians. Because respondents were older and more likely to be female than referents in the general population, the observed responses will be weighted by age and sex to reflect the US Census estimates for persons aged 18 years or older in 2010. OSTEOSURV 2010 was successfully fielded as the latest national telephone survey relevant to osteopathic medicine and contemporary US health care issues. Data analysis should yield important new findings relating to osteopathic physicians, patient-centered care, and the Patient Protection and Affordable Care Act that may not be readily observed through other national health care data sets. While underrepresented in this survey, which excluded cell phone-only participants, young adult respondents were reflective of their national age referents with regard to health insurance coverage and general health status. Thus, it appears likely that statistical weighting by age and sex of the OSTEOSURV 2010 data will minimize potential bias in estimates of health-related items. Rapidly evolving technology and sociocultural transitions will necessitate changes in the design of OSTEOSURV 2020.
    The Journal of the American Osteopathic Association 12/2011; 111(12):670-84.
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    John C Licciardone, Karan P Singh
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    ABSTRACT: Health care reform promises to dramatically increase the number of Americans covered by health insurance. Osteopathic physicians (DOs) are recognized for primary care, including a "hands-on" style with an emphasis on patient-centered care. Thus, DOs may be well positioned to deliver primary care in this emerging health care environment. We used data from the National Ambulatory Medical Care Survey (2002-2006) to study sociodemographic and geographic characteristics associated with patient visits to DOs for primary care. Descriptive analyses were initially performed to derive national population estimates (NPEs) for overall patient visits, primary care patient visits, and patient visits according to specialty status. Osteopathic and allopathic physician (MD) patient visits were compared using cross-tabulations and multiple logistic regression to compute odds ratios (ORs) and 95% confidence intervals (CIs) for DO patient visits. The latter analyses were also conducted separately for each geographic characteristic to assess the potential for effect modification based on these factors. Overall, 134,369 ambulatory medical care visits were surveyed, representing 4.6 billion (NPE) ± 220 million (SE) patient visits when patient visit weights were applied. Osteopathic physicians provided 336 million ± 30 million (7%) of these patient visits. Osteopathic physicians provided 217 million ± 21 million (10%) patient visits for primary care services; including 180 million ± 17 million (12%) primary care visits for adults (21 years of age or older) and 37 million ± 5 million (5%) primary care visits for minors. Osteopathic physicians were more likely than MDs to provide primary care visits in family and general medicine (OR, 6.03; 95% CI, 4.67-7.78), but were less likely to provide visits in internal medicine (OR, 0.37; 95% CI, 0.24-0.58) or pediatrics (OR, 0.21; 95% CI, 0.11-0.40). Overall, patients in the pediatric and geriatric ages, Blacks, Hispanics, and persons in the South and West were less likely to utilize DOs, although there was some evidence of effect modification according to United States Census region. Health care reform provides unprecedented opportunities for DOs to reach historically underserved populations and to overcome the "pediatric primary-care paradox."
    BMC Health Services Research 11/2011; 11:303. · 1.77 Impact Factor
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    ABSTRACT: Background Healthy people initiatives have called for more preventive services and health promotion. The purpose of the study was to assess self-reported levels of engagement in general health education (HEd) services among the medical (MD) and osteopathic (DO) primary care providers. Methods Multiple logistic regression was applied to the 2005-2007 National Ambulatory Medical Care Survey (NAMCS) data to assess the provision of HEd counseling by MDs and DOs with patient, visit, and practice characteristics. The complete multistage probability design structure was applied to generate national population estimates of patient visit encounters where HEd services were provided Results About 286 million patient visits were made to both provider groups during 2005-2007 with 7.5% to DOs and 92.5% to MDs. HEd was provided on 103.8 million (37.1%) visits. Fewer services were rendered as patient s aged but did not differ by gender. More HEd was offered to blacks than whites [OR 1.4, 95%CI(1.02, 1.27)] as were other races [OR=1.36, 95%CI(1.12,1.64)]. Providers were more likely to advise patients they diagnosed with hypertension, diabetes, or obesity but not based on computed blood pressure levels or body mass index. Self-paying patients were more likely to receive advice but general advice levels did not differ by provider group. Level of HEd increased with the involvement of nurses in patient care. Conclusion No significant difference in HEd engagement could be identified between MDs and Dos. Despite health care initiatives for primary prevention opportunities are still being missed by primary care physicians.
    139st APHA Annual Meeting and Exposition 2011; 10/2011