The osteopathic profession has been challenged over the past decade to provide clinically relevant research. The conduct of evidence-based osteopathic research is imperative not only for scientific, economic, and professional reasons, but also to drive health care policy and clinical practice guidelines. This paper summarizes recent studies in response to the osteopathic research challenge, including clinical trials registered with ClinicalTrials.gov and a systematic review and meta-analysis of osteopathic manipulative treatment (OMT) for low back pain. The concept of the OMT responder is introduced and supported with preliminary data. Within the context of a pain processing model, consideration is given to genomic (e.g., the catechol-O-methyltransferase gene) and psychological (e.g., depression and somatization) factors that are associated with pain sensitivity and pain progression, and to the role that such factors may play in screening for OMT responders. While substantial progress has been made in osteopathic research, much more needs to be done.
Evidence-based medicine (EBM) involves using research data to enhance the diagnosis and treatment of clinical disorders. Somatic dysfunction and osteopathic manipulative treatment (OMT) are two unique aspects of osteopathy that will benefit from a greater emphasis on scientific evidence. Most evidence in osteopathy is based on expert opinions, case reports, case series, and observational studies. Only one systematic review of randomized controlled trials, involving OMT for low back pain, has been published. Although this study demonstrates the efficacy of OMT for low back pain, other clinical trials are needed to expand the evidence base in osteopathy. Undergraduate osteopathy curricula should ensure that students acquire the tools necessary to become knowledgeable consumers of the research and statistics presented in biomedical journals. Such curricula need to be supplemented with graduate training programs and research funding mechanisms to ensure that young osteopathic researchers are able to produce the research needed to practice and advance evidence-based osteopathy in the future.
Pneumonia is a common cause of morbidity and mortality worldwide. While antibiotics are generally effective for the treatment of infection, the emergence of resistant strains of bacteria threatens their success. The osteopathic medical profession has designed a set of manipulative techniques called lymphatic pump techniques (LPT), to enhance the flow of lymph through the lymphatic system. Clinically, LPT is used to treat infection and oedemaand might be an effective adjuvant therapy in patients with pneumonia.The immune system uses the lymphatic and blood systems to survey to rid the body of pathogens; however, only recently have the effects of LPT on the lymphatic and immune systems been investigated. This short review highlightsclinical and basic science research studies that support the use of LPT to enhance the lymphatic and immune systems and treat pneumonia, and discusses the potential mechanisms by which LPT benefits patients with pneumonia.
BackgroundSocietal, clinician and patient expectations of treatment outcomes may differ due to different measures of success. This may have implications for measuring progress, monitoring treatment success and patient satisfaction.ObjectiveTo explore patient communication about pain.MethodA qualitative study using in-depth interviews with people experiencing chronic pain.ResultsThirteen people living with chronic pain were interviewed, five males and eight females. Age range 24–83 years, all had chronic pain in at least one location, 10 had low back pain. We found that the most important outcome markers for patients were functional tasks that affected their every day living. The achievement of these tasks became personal goals. Patients used task achievement to determine treatment success, regardless of whether they had to modify the way they achieved these tasks. Perception of significant pain was characterised by loss of function and inability to self-manage.ConclusionTreatment progress can be more meaningfully monitored by using patient determined goals, rather than clinical outcomes. Patient criteria for success were determined by achieving functional tasks/goals that had previously been difficult. The additional use of aids or encouraging adaptive behaviour should not be under estimated as part of the treatment process. However, realistic goal setting remains an important issue that patients and clinicians can jointly negotiate and address.
The sacroiliac joint (SIJ) is identified as one of many possible sources of non-specific low back pain and may be a target for diagnostic palpation. Putative diagnostic palpation of joint motion, tissue texture changes and pain form a routine aspect of practice in manual healthcare. However, the tactile tradition of diagnostic palpation is beset with anatomical and sensory confounding that may establish an upper ceiling for sensitivity and specificity. For illustrative purposes, this is highlighted by a review of the anatomy of the sacroiliac joint (SIJ). Increasing critical awareness of the inherent limitations in the tactile tradition of diagnostic palpation may lead to the development of a standardised and technologically based approach.
Background and ObjectivesLittle is known concerning the preferences for technique selection by osteopaths in the United Kingdom (UK) for the treatment of spinal, pelvic and sacroiliac dysfunction or for the methods of documentation of dysfunction in case records. Part 1 described the perception of usefulness and reported use of physical assessment procedures. This second part surveys the treatment methods reported to be commonly used by UK osteopaths.MethodsA web-based questionnaire using a 5-point Likert scale and open-ended responses was developed. Invitations were e-mailed to all registrants of the General Osteopathic Council in the UK with a listed e-mail address. The available response categories (strongly disagree, disagree, etc.) were converted into numerically weighted scales. Responses in the “frequently” and “nearly always” categories were combined for summary reporting purposes. Friedman tests were used to determine if significant differences existed for the reported usage of each item. The effect of gender was analysed using Mann–Whitney tests. The effect of years of practice was examined by categorizing practice experience by decade (0–9, 10–19, 20+) and analysing using Kruskal–Wallis tests.Results520 Osteopaths (56% male, 44% female) participated in the survey, which was a 19% response rate. Procedures for the treatment of dysfunction of the spine reported to be most commonly used were passive joint articulation (91%) and soft tissue technique (91%), followed by prescription of patient self-stretches (76%) and high velocity low amplitude thrust (HVLA, 74%, p < 0.001). Females reported more frequent use of a number of procedures, but male respondents reported more frequent use of HVLA (p < 0.012). Respondents with 20 or more years experience reported use of a number of techniques less frequently than less experienced respondents. Preferences for the treatment of pelvic and sacroiliac dysfunction mirrored those for the spine. The majority of respondents document the physical findings associated with spinal dysfunction and note the specifics of dysfunction using motion restriction terminology.ConclusionSurvey respondent osteopaths in the UK use a large range of manual treatment techniques, with a preference for direct techniques, such as passive joint articulation, soft tissue technique, and HVLA. Females reported more frequent use of a number of procedures, which may represent a reporting bias, but male respondents reported more frequent use of HVLA.
IntroductionPatients commonly present to osteopaths with a complaint of headache. There is a clear rationale for osteopathic manipulative treatment in management of headaches that involve cervical spine dysfunction such as cervicogenic headache. Recent evidence suggests that deficits in muscle performance of the deep neck flexor muscles may be linked to cervicogenic headache, and that specific exercise prescription may play an important treatment role. Evidence also suggests that combining both manipulative treatment and specific exercise may be an effective treatment approach.MethodsA prospective case study utilising an A–B–C design was used to evaluate the effectiveness of osteopathic treatment and specific exercise of the deep cervical flexor muscles in reducing cervicogenic headache pain and frequency in a 26-year-old female, with a 16-year history of cervicogenic headache. The diagnosis of cervicogenic headache was based upon clinical examination, medical history and fulfilment of cervicogenic headache diagnostic criteria. The study consisted of a three-week baseline data collection phase, a three-week osteopathic manipulative treatment phase and a three-week home based exercise phase. Outcome measures included the quadruple visual analogue scale, a headache diary, and data recorded from a pressure biofeedback device. Osteopathic treatment involved high velocity low amplitude (HVLA) thrust techniques and a low load exercise programme targeting the deep cervical flexor musculature.ResultsVisual analysis of plotted outcome measure data indicated a reduction in both intensity of headache pain and frequency.ConclusionsThe findings of this single case study are limited in their generalisability, but are consistent with the results of other similar studies investigating cervicogenic headache using similar interventions.
This article describes the principles of evidence-based medicine and how these principles may be implemented in osteopathic practice and applied to the use of muscle energy technique. Because the feasibility of strict adherence to ‘evidence-based’ principles is debated, an approach of ‘evidence-informed practice’ is recommended. The principles and diagnostic and treatment practices associated with muscle energy technique are re-examined in light of recent research. Implications for the application of muscle energy are outlined, and recommendations are made regarding clinical practice.
Twenty-first century medical education will be dramatically improved by our rapidly evolving understanding of how to more efficiently, effectively and affordably train future health care providers. The following describes a paradigm that uses Blue Ocean Strategies in training osteopathic physicians and thus, rapidly differentiates osteopathic medical education from contemporary approaches to medical education. By replacing the current medical education system with this model, osteopathic medical education is provided an opportunity to emerge as the standard for training future health care providers.
Objective
This commentary promotes the role of accreditation in meeting a school's mission.
Background
Understanding the parallels between the growth of osteopathic educational institutions and the increase in educational standards over time places a historical perspective on this subject.
Data
The concept of minimum competence, exceeding minimum competence, and their link to the assurance of quality in osteopathic medical education is explored. Knowing that a school's mission speaks to excellence and quality, and that the accreditation process is a way to ensure quality, mission and accreditation are therefore linked.
Conclusion
Through the accreditation process, we ensure that our schools' missions are met, and we assure our students and the public that we deliver an osteopathic medical education of the highest quality.
This review provides an overview of evidence-based clinical practice guidelines for acute non-specific low back pain, first introduced in 1994. Since then 11 countries world-wide have produced similar guidelines, which are broadly consistent in their findings. The most recent guidelines were produced in Australia, as part of a wider evidence-based review of acute musculoskeletal pain. Evidence-based clinical practice guidelines are a synthesis of the evidence available at the time of publication, and are employed as a method of aligning different treatment provider groups, including osteopaths, whilst encouraging the adoption of evidence-based 'best clinical practice'. This review provides an overview of evidence-based intervention in acute, non-specific low back pain from the Australian and European guidelines. The review also provides the reader with an insight into how the evidence was categorised in both jurisdictions, and highlights any discrepancies.
Background
The UK General Osteopathic Council (GOsC) has statutory duties of 'promoting high standards of education and training in osteopathy and keeping the provision of that training under review.' Students graduating from osteopathic educational institutions (OEIs) must meet the GOsC Osteopathic Practice Standards. 1
Objectives
One domain within the Osteopathic Practice Standards is 'professionalism'. Supporting guidance requires explicit teaching and learning opportunities about 'professionalism' in osteopathy. Our objectives are to establish the feasibility of adapting e-learning resources used widely in medical education to meet these requirements.
Methods
A consensus group of two senior faculty representatives nominated by their Deans or Principals from each of the 11 UK OEIs and senior officers from the GOsC, with expertise in standards, reviewed and adapted the items of the two Dundee Polyprofessionalism resources used to explore professionalism in medical education. Four additional items were added. The agreed inventory was tested on two groups of 4 and 12 osteopathy students.
Results
The adaptation and feasibility of 34 items for Professionalism in Osteopathy 1 (Academic) and the 45 items for Professionalism in Osteopathy 2 (Clinical) were agreed to explore professionalism in osteopathy.
Conclusions
The Professionalism in Osteopathy e-learning resources will be field tested to explore their potential to guide learning and to track and help to benchmark the learning curve in pre-registration osteopathic professionalism.
Objective
To evaluate “The Niel-Asher Technique (NAT)” for adhesive capsulitis
Method
Prospective observational multi-center study
Subjects
154 patients (113 from Israel, 25 from the UK and 16 from the US) with pain, stiffness and globally restricted gleno-humeral mobility shoulder for more than three months.
Outcome measures
Change in active range of motion (AROM) Flexion and Abduction of the gleno-humeral joint measured by a goniometer; changes in pain as evaluated by the patients on a linear Visual Analogue Scale (VAS). Analysis was based on the intention-to-treat principle.
Results
Multivariate repeated measures analysis of covariance indicated that there was a significant improvement in AROM abduction and flexion across time, with no interaction between time and phase of illness (acute / stiff / resolving). The improvement in range of motion was significantly more pronounced in patients from Israel compared to the UK and US. Similarly, among patients from Israel, large and statistically significant reduction in the VAS pain score between baseline and post-treatment assessments was observed.
Conclusions
All patients demonstrated a significant improvement in AROM for both flexion and abduction. The data supports the notion that NAT is autonomously reproducible. NAT demonstrated significant improvement in AROM for both flexion and abduction with a consistent average of twelve degrees improvement per treatment session. The mean number of treatments was 7. NAT expedites both pain reduction and increased mobility for adhesive capsulitis over and above the natural history.
