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Osteopathy in Switzerland; Practice and Contribution to Healthcare 2016-2017
Abstract and Figures
This report describes scope of practice for osteopathic care in Switzerland. It is the result of a practice review run with over 500 osteopaths who reported their management for 4 of their patients in 2016 using their patient record.
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... Celle-ci se focalise de plus en plus sur les causes environnementales de la plainte, sur l'interprétation du patient de ses symptômes et du sens qu'il leur donne (21) . La lombalgie représente ainsi un point de départ intéressant pour explorer la complexité de l'examen physique, étant également le motif de consultation le plus courant en ostéopathie (22) . La recherche progresse dans le domaine du raisonnement clinique en ostéopathie (6,9,15,17,(22)(23)(24) , mais elle n'a, pour l'instant, pas de cadre théorique solide par rapport à son examen physique, que ce soit pour la lombalgie ou même plus globalement (3,9,25) . ...
... La lombalgie représente ainsi un point de départ intéressant pour explorer la complexité de l'examen physique, étant également le motif de consultation le plus courant en ostéopathie (22) . La recherche progresse dans le domaine du raisonnement clinique en ostéopathie (6,9,15,17,(22)(23)(24) , mais elle n'a, pour l'instant, pas de cadre théorique solide par rapport à son examen physique, que ce soit pour la lombalgie ou même plus globalement (3,9,25) . Plusieurs études décrivent ce que les ostéopathes font (10,22,26) , mais très peu explorent les raisons sous-jacentes. ...
... La recherche progresse dans le domaine du raisonnement clinique en ostéopathie (6,9,15,17,(22)(23)(24) , mais elle n'a, pour l'instant, pas de cadre théorique solide par rapport à son examen physique, que ce soit pour la lombalgie ou même plus globalement (3,9,25) . Plusieurs études décrivent ce que les ostéopathes font (10,22,26) , mais très peu explorent les raisons sous-jacentes. La taille de l'échantillon a été déterminée par la saturation des données. ...
Contexte : Les modèles existants pour expliquer les étapes de l'examen physique en ostéopathie restent peu déve-loppés et ne permettent pas de comprendre les processus en jeu.
Objectif : En se focalisant sur la lombalgie, cette étude vise à décrire les différentes étapes du raisonnement clinique de l'examen physique ostéopathique et d'identifier les élé-ments qui influencent ce processus.
Méthode : Des entretiens semi-structurés auprès de douze ostéopathes francophones travaillant en Suisse ont été effectués. Les unités de sens pertinentes ont été extraites en effectuant une analyse thématique. Les résultats ont été affinés et validés par les participants à l'aide d'un processus de consensus en deux tours.
Résultats : Cinq étapes clefs ont été identifiées : l'investigation générale, l'exploration de la plainte, l'orientation fonctionnelle, l'identification des paramètres spécifiques et l'évaluation de l'intégration des changements. La routine d'examen physique serait modifiée par les valeurs du patient, l'idée préalable du fonctionnement du patient, ses attitudes et schémas ainsi que ses ressources. Ces résultats ont été validés par les ostéopathes ayant participé au consensus.
Conclusion : L'étude a permis de décrire un processus de raisonnement en cinq étapes pour l'examen physique ostéopathique dans un contexte de lombalgie. Ces résultats pourraient dépasser la lombalgie et indiquer un possible consensus dans le raisonnement de l'examen physique en général. La complexité du processus met en avant l'importance du vécu du patient, en mettant l'accent sur la réévaluation et la ratification post-traitement. L'utilisation de ces résultats pourrait favoriser la communication entre professionnels de la santé.
... They were mostly focused on musculoskeletal and spinal column-related conditions. For 81% of patients in the Swiss Osteosurvey 2018, musculoskeletal pain mainly located in the cervical, lumbar and fascial area played a role in the decision towards OMT [29]. Meta-analyses of a Spanish osteopathic patient profile showed lumbar and cervical diagnoses as well as headaches as the main reasons for a consultation [30]. ...
Background
Osteopathy is a type of complementary medicine based on specific manual techniques. In many countries, including Germany, the profession is not officially regulated, and evidence for the effectiveness of osteopathy is insufficient for most diseases. Nevertheless, many health insurances in Germany offer reimbursement for therapy costs, if osteopathy is recommended by a physician.
This cross-sectional survey of German general practitioners (GPs) explored beliefs and attitudes towards osteopathic medicine and described their daily interactions with it.
Methods
A random sample of 1000 GPs from all federal states was surveyed by mail using a self-designed questionnaire. We collected data on sociodemographics, personal experiences with osteopathy, and attitudes and expectations towards osteopathy. In particular, participants were asked about indications for osteopathic treatment and their beliefs about its effectiveness for different patient groups and diagnoses. A self-designed score was used to estimate general attitudes towards osteopathy and identify factors correlated with greater openness. Additionally, we performed logistic regression to reveal factors associated with the frequency of recommending osteopathy to patients.
Results
Response rate was 34.4%. 46.5% of participants were women, and the median age was 56.0 years. 91.3% of GPs had referred patients to an osteopath, and 88.0% had recommended osteopathy to their patients. However, 57.5% acknowledged having little or no knowledge about osteopathy. Most frequent reasons for a recommendation were spinal column disorders (46.2%), other complaints of the musculoskeletal system (18.2%) and headaches (9.8%). GPs estimated the highest benefit for chronically ill and middle-aged adults. Female gender (OR 2.09; 95%CI 1.29–3.38) and personal treatment experiences (OR 5.14; 95%CI 2.72–9.72) were independently positively associated with more frequent treatment recommendation.
Conclusion
GPs in Germany have frequent contact with osteopathy, and the vast majority have recommended osteopathic treatment to some extent in their practice, with foci and opinions comparable to other Western countries. The discrepancy between GPs making frequent referrals for osteopathic treatment while self-assessing to have little knowledge about it demonstrates need for intensified research on the collaboration with osteopaths and how to best integrate osteopathic treatments. Our results may help to focus future effectiveness studies on most relevant clinical conditions in general practice.
Background: Osteopathy is a type of complementary medicine based on specific manual techniques. In many countries, including Germany, the profession is not officially regulated, and evidence for the effectiveness of osteopathy is insufficient for most diseases. Nevertheless, many health insurances in Germany offer reimbursement for therapy costs, if osteopathy is recommended by a physician. This cross-sectional survey of German general practitioners (GPs) explored beliefs and attitudes towards osteopathic medicine and described their daily interactions with it.
Methods: A random sample of 1000 GPs from all federal states was surveyed by mail using a self-designed questionnaire. We collected data on sociodemographics, personal experiences with osteopathy, and attitudes and expectations towards osteopathy. In particular, participants were asked about indications for osteopathic treatment and their beliefs about its effectiveness for different patient groups and diagnoses. A self-designed score was used to estimate general attitudes towards osteopathy and identify factors correlated with greater openness. Additionally, we performed logistic regression to reveal factors associated with the frequency of recommending osteopathy to patients.
Results: Response rate was 34.4%. 46.5% of participants were women, and the median age was 56.0 years. 91.3% of GPs had referred patients to an osteopath, and 88.0% had recommended osteopathy to their patients. However, 57.5% acknowledged having little or no knowledge about osteopathy. Most frequent reasons for a recommendation were spinal column disorders (46.2%), other complaints of the musculoskeletal system (18.2%) and headaches (9.8%). GPs estimated the highest benefit for chronically ill and middle-aged adults. Female gender (OR 2.09; 95%CI 1.29-3.38) and personal treatment experiences (OR 5.14; 95%CI 2.72-9.72) were independently positively associated with more frequent treatment recommendation.
Conclusion: GPs in Germany have frequent contact with osteopathy, and the vast majority have recommended osteopathic treatment to some extent in their practice, with foci and opinions comparable to other Western countries. The discrepancy between GPs making frequent referrals for osteopathic treatment while self-assessing to have little knowledge about it demonstrates need for intensified research on the collaboration with osteopaths and how to best integrate osteopathic treatments. Our results may help to focus future effectiveness studies on most relevant clinical conditions in general practice.
Background; Osteopathic medicine frequently focuses on the thoracic spine for various conditions like Somatic Dysfunction by the use of TART. Thoracic HVLA Manipulation can effectively treat such dysfunctions. The characterization of the spinal tissues and joints by their texture is an important clinical identifier of functional abnormalities. Dry Needling to non-myofascial locations has mostly been studied in extremities problems.
Aim of the study; The aim of this study is to evaluate and compare, the effectiveness of 4 treatments (one every week) in patients with thoracic spinal pain between HVLA Manipulation Vs. paraspinal dry needling could paraspinal dry needling (PDN) be possible alternative treatment and effective in the treatment of TART?
Results; PDN and HLVA both work. Depending on how it is measured, sometimes two treatments are needed or one treatment is unnecessary, but the bottom line in each case is that both PDN and HLVA work. This study has shown no significant difference between PDN and HLVA. Sometimes the intermediate results are different (especially with algometer), but the end result is always the same.
Conclusion; 4 treatments show no difference in all measurements between the interventions of HVLA Manipulation & PDN. The main conclusion is that both PDN and HLVA manipulation work to the thoracic facet joints to treat TART. Future studies are highly recommended for the use of PDN in the Osteopathic field and the possible effect on the viscera. This can be a fascinating topic for the Osteopathic community.
Keywords; Paraspinal, Dry Needling, HVLA manipulation, Somatic dysfunction, Thoracic.
Background: As a heterogeneous discipline, osteopathy is currently confronted with fundamental questions of identity, which it has to answer as a discipline in the field of tension between professional challenges and scientific demands. Aims: The aim of this thesis is to identify relevant components of the status quo of osteopathy in Switzerland and to present them using a category system. Methods: Seven guideline-based, problem-oriented interviews with Swiss osteopaths are conducted, transcribed and evaluated on the basis of Philipp Mayring's qualitative content analysis using inductive category formation and the results presented as a category tree. Results: Extensive partial aspects are coded under the three main categories of characteristics, opportunities and challenges. The greatest challenge of osteopathy in Switzerland is the implementation of the new law on health professions, which came into force on 1 Februrary 2020 and has uncertain consequences for osteopaths without a GDK diploma. Conclusions: The extensive number of categories shows that the challenges of osteopathy are multi-faceted. However, for some therapists the above mentioned is of existential importance. Keywords: switzerland, osteopathy, characteristics, opportunities, challenges, COCO, qualitative study
Hintergrund: Als heterogene Disziplin steht die Osteopathie zurzeit vor grundlegenden Identitätsfragen, die sie als Disziplin im Spannungsfeld berufspolitischer Herausforderungen und wissenschaftlicher Ansprüche zu beantworten hat. Ziel dieser Arbeit ist es, relevante Komponenten des Status quo der Osteopathie in der Schweiz zu ermitteln und anhand eines Kategoriensystems darzustellen.
Methodik: Es wurden 7 leitfadengestützte, problemzentrierte Interviews mit Schweizer Osteopathen durchgeführt, transkribiert und anhand der qualitativen Inhaltsanalyse nach Philipp Mayring per induktiver Kategorienbildung ausgewertet und die Ergebnisse als Kategorienbaum dargestellt.
Ergebnisse: Unter den 3 Hauptkategorien der Eigenschaften, Chancen und Herausforderungen werden umfangreiche Teilaspekte kodiert. Größte Herausforderung der Osteopathie in der Schweiz ist die Umsetzung des neuen Gesetzes zu den Gesundheitsberufen, das am 1. Februar 2020 in Kraft getreten ist und für Osteopathen ohne GDK-Diplom Konsequenzen haben dürfte, die noch nicht genau abzusehen sind.
Objective
To conduct a systematic review and meta-analyses to assess the effect of manual therapy interventions for healthy but unsettled, distressed and excessively crying infants and to provide information to help clinicians and parents inform decisions about care.
Methods
We reviewed published peer-reviewed primary research articles in the last 26 years from nine databases (Medline Ovid, Embase, Web of Science, Physiotherapy Evidence Database, Osteopathic Medicine Digital Repository , Cochrane (all databases), Index of Chiropractic Literature, Open Access Theses and Dissertations and Cumulative Index to Nursing and Allied Health Literature). Our inclusion criteria were: manual therapy (by regulated or registered professionals) of unsettled, distressed and excessively crying infants who were otherwise healthy and treated in a primary care setting. Outcomes of interest were: crying, feeding, sleep, parent–child relations, parent experience/satisfaction and parent-reported global change.
Results
Nineteen studies were selected for full review: seven randomised controlled trials, seven case series, three cohort studies, one service evaluation study and one qualitative study. We found moderate strength evidence for the effectiveness of manual therapy on: reduction in crying time (favourable: −1.27 hours per day (95% CI −2.19 to –0.36)), sleep (inconclusive), parent–child relations (inconclusive) and global improvement (no effect). The risk of reported adverse events was low: seven non-serious events per 1000 infants exposed to manual therapy (n=1308) and 110 per 1000 in those not exposed.
Conclusions
Some small benefits were found, but whether these are meaningful to parents remains unclear as does the mechanisms of action. Manual therapy appears relatively safe.
PROSPERO registration number
CRD42016037353.
Background:
Chronic musculoskeletal pain is the leading cause of disability worldwide. The effectiveness of pharmacological treatments for chronic pain is often limited, and there is growing concern about the adverse effects of these treatments, including opioid dependence. Nonpharmacological approaches to chronic pain may be an attractive alternative or adjunctive treatment. We describe the effectiveness of a novel, theoretically based group pain management support intervention for chronic musculoskeletal pain.
Methods and findings:
We conducted a multi-centre, pragmatic, randomised, controlled effectiveness and cost-effectiveness (cost-utility) trial across 27 general practices and community musculoskeletal services in the UK. We recruited 703 adults with musculoskeletal pain of at least 3 mo duration between August 1, 2011, and July 31, 2012, and randomised participants 1.33:1 to intervention (403) or control (300). Intervention participants were offered a participative group intervention (COPERS) delivered over three alternate days with a follow-up session at 2 wk. The intervention introduced cognitive behavioural approaches and was designed to promote self-efficacy to manage chronic pain. Controls received usual care and a relaxation CD. The primary outcome was pain-related disability at 12 mo (Chronic Pain Grade [CPG] disability subscale); secondary outcomes included the CPG disability subscale at 6 mo and the following measured at 6 and 12 mo: anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), pain acceptance (Chronic Pain Acceptance Questionnaire), social integration (Health Education Impact Questionnaire social integration and support subscale), pain-related self-efficacy (Pain Self-Efficacy Questionnaire), pain intensity (CPG pain intensity subscale), the census global health question (2011 census for England and Wales), health utility (EQ-5D-3L), and health care resource use. Analyses followed the intention-to-treat principle, accounted for clustering by course in the intervention arm, and used multiple imputation for missing or incomplete primary outcome data. The mean age of participants was 59.9 y, with 81% white, 67% female, 23% employed, 85% with pain for at least 3 y, and 23% on strong opioids. Symptoms of depression and anxiety were common (baseline mean HADS scores 7.4 [standard deviation 4.1] and 9.2 [4.6], respectively). Overall, 282 (70%) intervention participants met the predefined intervention adherence criterion. Primary outcome data were obtained from 88% of participants. There was no significant difference between groups in pain-related disability at 6 or 12 mo (12 mo: difference -1.0, intervention versus control, 95% CI -4.9 to 3.0), pain intensity, or the census global health question. Anxiety, depression, pain-related self-efficacy, pain acceptance, and social integration were better in the intervention group at 6 mo; at 12 mo, these differences remained statistically significant only for depression (-0.7, 95% CI -1.2 to -0.2) and social integration (0.8, 95% CI 0.4 to 1.2). Intervention participants received more analgesics than the controls across the 12 mo. The total cost of the course per person was £145 (US277], 95% CI -£125 [-US738]), resulting in an incremental cost-effectiveness ratio of £5,786 (US$8,521) per QALY. Limitations include the fact that the intervention was relatively brief and did not include any physical activity components.
Conclusions:
While the COPERS intervention was brief, safe, and inexpensive, with a low attrition rate, it was not effective for reducing pain-related disability over 12 mo (primary outcome). For secondary outcomes, we found sustained benefits on depression and social integration at 6 and 12 mo, but there was no effect on anxiety, pain-related self-efficacy, pain acceptance, pain intensity, or the census global health question at 12 mo. There was some evidence that the intervention may be cost-effective based on a modest difference in QALYs between groups.
Trial registration:
ISRCTN Registry 24426731.
Background:
Complementary medicine (CM) is popular in Switzerland. Several CM methods (traditional Chinese medicine/acupuncture, homeopathy, anthroposophic medicine, neural therapy, and herbal medicine) are currently covered by the mandatory basic health insurance when performed by a certified physician. Treatments by non-medical therapists are partially covered by a supplemental and optional health insurance. In this study, we investigated the frequency of CM use including the evolvement over time, the most popular methods, and the user profile.
Methods:
Data of the Swiss Health Surveys 2007 and 2012 were used. In 2007 and 2012, a population of 14,432 and 18,357, respectively, aged 15 years or older answered the written questionnaire. A set of questions queried about the frequency of use of various CM methods within the last 12 months before the survey. Proportions of usage and 95% confidence intervals were calculated for these methods and CM in general. Users and non-users of CM were compared using logistic regression models.
Results:
The most popular methods in 2012 were homeopathy, naturopathy, osteopathy, herbal medicine, and acupuncture. The average number of treatments within the 12 months preceding the survey ranged from 3 for homeopathy to 6 for acupuncture. 25.0% of the population at the age of 15 and older had used at least one CM method in the previous 12 months. People with a chronic illness or a poor self-perceived health status were more likely to use CM. Similar to other countries, women, people of middle age, and those with higher education were more likely to use CM. 59.9% of the adult population had a supplemental health insurance that partly covered CM treatments.
Conclusions:
Usage of CM in Switzerland remained unchanged between 2007 and 2012. The user profile in Switzerland was similar to other countries, such as Germany, United Kingdom, United States or Australia.
@PRISMS_project
NB.: THIS IS A VERY LARGE DOCUMENT. THE BEST WAY TO ACCESS IT IS FROM THE NIHR WEBSITE : http://www.journalslibrary.nihr.ac.uk/hsdr/volume-2/issue-53#hometab0
Abstract
Background
Despite robust evidence concerning self-management for some long-term conditions (LTCs), others lack research explicitly on self-management and, consequently, some patient groups may be overlooked.
Aim
To undertake a rapid, systematic overview of the evidence on self-management support for LTCs to inform health-care commissioners and providers about what works, for whom, and in what contexts.
Methods
Self-management is ‘the tasks . . . individuals must undertake to live with one or more chronic conditions . . . [including] . . . having the confidence to deal with medical management, role management and emotional management of their conditions’. We convened an expert workshop and identified characteristics of LTCs potentially of relevance to self-management and 14 diverse exemplar LTCs (stroke, asthma, type 2 diabetes mellitus, depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and type 1 diabetes mellitus). For each LTC we conducted systematic overviews of systematic reviews of randomised controlled trials (RCTs) of self-management support interventions (‘quantitative meta-reviews’); and systematic overviews of systematic reviews of qualitative studies of patients’ experiences relating to self-management (‘qualitative meta-reviews’). We also conducted an original systematic review of implementation studies of self-management support in the LTCs. We synthesised all our data considering the different characteristics of LTCs. In parallel, we developed a taxonomy of the potential components of self-management support.
Results
We included 30 qualitative systematic reviews (including 515 unique studies), 102 quantitative systematic reviews (including 969 RCTs), and 61 studies in the implementation systematic review. Effective self-management support interventions are multifaceted, should be tailored to the individual, their culture and beliefs, a specific LTC and position on the disease trajectory, and underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Self-management support is a complex intervention and although many components were described and trialled in the studies no single component stood out as more important than any other. Core components include (1) provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their LTC; (2) psychological strategies to support adjustment to life with a LTC; (3) strategies specifically to support adherence to treatments; (4) practical support tailored to the specific LTC, including support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks; and (5) social support as appropriate. Implementation requires a whole-systems approach which intervenes at the level of the patient, the HCP and the organisation. The health-care organisation is responsible for providing the means (both training and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes. More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need.
Conclusions
Supporting self-management is inseparable from the high-quality care for LTCs. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care. Further research is needed to understand how health service managers and staff can achieve this culture change in their health-care organisations.
Study registration
This study is registered as PROSPERO CRD42012002898.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
Knowing the difference between health service evaluation, audit and research can be tricky especially for the novice researcher. Put simply, nursing research involves finding the answers to questions about “what nurses should do to help patients,” audit examines “whether nurses are doing this , and if not, why not,”1 and service evaluation asks about “the effect of nursing care on patient experiences and outcomes .” In this paper, we aim to provide some tips to help guide you through the decision-making process as you begin to plan your evaluation, audit or research project. As a starting point box 1 provides key definitions for each type of project.
### Box 1 Definitions of service evaluation, audit and research
▸ What is service evaluation?
Service evaluation seeks to assess how well a service is achieving its intended aims. It is undertaken to benefit the people using a particular healthcare service and is designed and conducted with the sole purpose of defining or judging the current service.2
The results of service evaluations are mostly used to generate information that can be used to inform local decision-making.
▸ What is (clinical) audit?
The English Department of Health3 states …
Background:
Patients' expectations of osteopathic care have been little researched. The aim of this study was to quantify the most important expectations of patients in private UK osteopathic practices, and the extent to which those expectations were met or unmet.
Methods:
The study involved development and application of a questionnaire about patients' expectations of osteopathic care. The questionnaire drew on an extensive review of the literature and the findings of a prior qualitative study involving focus groups exploring the expectations of osteopathic patients. A questionnaire survey of osteopathic patients in the UK was then conducted. Patients were recruited from a random sample of 800 registered osteopaths in private practice across the UK. Patients were asked to complete the questionnaire which asked about 51 aspects of expectation, and post it to the researchers for analysis.The main outcome measures were the patients-perceived level of expectation as assessed by the percentage of positive responses for each aspect of expectation, and unmet expectation as computed from the proportion responding that their expectation "did not happen".
Results:
1649 sets of patient data were included in the analysis. Thirty five (69%) of the 51 aspects of expectation were prevalent, with listening, respect and information-giving ranking highest. Only 11 expectations were unmet, the most often unmet were to be made aware that there was a complaints procedure, to find it difficult to pay for osteopathic treatment, and perceiving a lack of communication between the osteopath and their GP.
Conclusions:
The findings reflected the complexity of providing osteopathic care and meeting patients' expectations. The results provided a generally positive message about private osteopathic practice. The study identified certain gaps between expectations and delivery of care, which can be used to improve the quality of care. The questionnaire is a resource for future research.
Background:
Osteopathy in Australia is a primary care limited scope practice. Practitioner surveys suggest that patients present with chronic pain and receive manual therapies, exercise and lifestyle advice. Further research is required to deepen the understanding of this intervention from the perspective of patients.
Objective:
To explore the experience of patients receiving osteopathic healthcare.
Design:
Mixed methodology.
Method:
A quantitative survey of a convenience sample of patients was followed by qualitative semi-structured interviews in a purposive sample of respondents with chronic non-specific low back pain. The transcripts were analysed using a phenomenological approach.
Results:
The survey results suggested directions of enquiry for the interviews. Eleven subjects were interviewed and reported commonalities in their clinical histories with multisystem co-morbidities. Four themes became apparent: patient decision-making, patient shared experiences of the osteopathic healthcare consultation, tailored patient-centred care, and therapeutic relationship in healthcare.
Conclusion:
This data suggests that patients experience osteopathic healthcare after trying other disciplines; that there are shared aspects of the consultations, with a thorough assessment, education about their condition, multiple manual therapies and lifestyle advice; that the experience is patient-centred and tailored to their context; and that the therapeutic relationship is a key aspect of the experience. These results reflect a number of aspects of osteopathic healthcare from workplace surveys.
There is an increasing emphasis to take an evidence-based approach to healthcare. To obtain evidence relevant to the osteopathic profession a clear research direction is required based on the views of stakeholders in the osteopathic profession. A modified Delphi consensus approach was conducted to explore the views of osteopaths and patients regarding research priorities for osteopathy. Osteopaths and patients were invited to complete an online questionnaire survey (n = 145). Round 1 requested up to 10 research priority areas and the rationale for their selection. All of the themes from Round 1 were fed back verbatim, and in Round 2 participants were asked to rank the importance of the research priorities on a 5-point Likert scale. Finally, in Round 3 participants were asked to rank the importance of a refined list of research topics which had reached consensus. Descriptive analysis and use of Kendall's coefficient of concordance enabled interpretation of consensus. The response rate for Round 1 was 87.9% and identified 610 research priority areas. Round 2 identified 69 research themes as important, and Round 3 identified 20 research priority topic areas covering four themes: effectiveness of osteopathic treatment (7 areas prioritised), role of osteopathy: the management of four conditions were prioritised, risks with osteopathic treatment (two areas prioritised) and outcomes of osteopathic treatment (two areas prioritised). The findings will be taken forward to develop the research strategy for osteopathy.
