International Journal of Osteopathic Medicine最新文献

Objective

This paper investigates the perceptions, attitudes and experiences of osteopathy students who had opportunity to engage with differing curriculum interventions focused on patient communication, and compare these with those of industry professionals.

Method

Three different osteopathy student cohorts had opportunity to engage with different communication curriculum interventions. Using focus group discussions, perceptions, attitudes, and experiences about patient centred care were gathered and thematically analysed using a realist lens. Semi-structured interviews were conducted with industry professionals to capture their perceptions, attitudes and experiences about patient centred care and compared to those of the students.

Results

Cohorts with zero or one semester of advanced communication curriculum displayed underdeveloped concepts about the professional skill sets needed of an osteopath, patient-centred care and confidence and readiness for supervised clinical practise. In stark contrast, the one cohort who had opportunity to engage with the full communication curriculum i.e. introductory and advanced displayed views about patient centred care closely aligned with the views of industry professionals, demonstrated advanced ideas about skill sets of an osteopath, and were eager to commence supervised clinical practise.

Conclusion

An explicit and appropriately integrated curriculum appears to expedite student confidence and maturity to align more closely with industry professional views regarding the skill priorities needed of an osteopath.

Background

Game-based simulation education is becoming an integral component in healthcare programs. It is defined as any educational activity implying simulation procedures to recreate clinical scenarios. Previous studies have shown that simulation can improve patient safety by enhancing healthcare providers' competencies. However, few studies have investigated students' perceptions of simulation within osteopathic programs.

Aim

This study aimed to measure and compare Year three osteopathy students’ perceptions of a game-based simulation versus traditional clinical training.

Methods

Year three students at the end of their 12 weeks clinical training were invited to participate in this research project. This included filling out a Likert-based survey and semi-structured interviews. Three clinical training modalities were implemented and evaluated: a demonstration clinic, a video-streamed demonstration clinic, and a game-based simulation, the clinical battle.

Results

Sixty-seven Year three osteopathy students completed the surveys, and eight students were interviewed. The clinical battle was significantly felt as the most engaging, most useful to gain feedback, and least stressful of the three training modalities proposed (p < 0.05). The clinical battle was also perceived as similar to a demonstration clinic in formulating a diagnosis and for reflective practice (p > 0.05). The semi-structured interviews offered deep structured explanatory narratives drawn from thematic analyses. Five themes were identified: engagement, clinical reasoning improvement, stress, ideas for improving clinical training, and reflective practice and self-assessment.

Conclusion

The simulation-based training implemented in this study was positively perceived by students for their clinical education. Future research could focus on the effectiveness of game-based simulation versus traditional training on clinical competencies acquisition.

Background

Musculoskeletal prevention is a key priority in public health and for national health systems due to the increasing number of people living with persistent conditions, including musculoskeletal (MSK) complaints. There is no robust review of the evidence on COP interventions and MSK prevention, such as what the current state of conceptual debate is about a possible role of COP interventions in prevention, where and how this has been studied, and what the evidence for effectiveness is.

Objectives

A scoping review was conducted to chart and appraise the available evidence regarding primary and secondary prevention in MSK care in the chiropractic, osteopathic and physiotherapy (COP) professions.

Methods

The review was prospectively registered (https://osf.io/bqe5x/). Studies were eligible if they were primary quantitative research on COP interventions for primary and secondary prevention, delivered in clinical settings, and to patients of any age who were asymptomatic or had any MSK pain or disability. Screening, data extraction, and risk of bias assessment were conducted in duplicate by independent reviewers. The data was synthesised narratively.

Results

Twenty-one articles were included in the final synthesis: 17 randomized controlled trials, 3 cross sectional studies, and 1 experimental study. Studies were mostly moderate-quality clinical trials (n = 17) on manual therapy (n = 14) for low back pain (n = 10) that measured prevention by assessing healthcare use (n = 14) or symptom recurrence (n = 11). Heterogeneity of methods, low numbers, and mixed quality did not allow for conclusions about the effectiveness of COP interventions in preventing MSK complaints.

Conclusions

The evidence base is heterogeneous and of moderate quality making clinical recommendations challenging, but future research priorities have been identified, including a need for further research into primary, but mostly in secondary and tertiary prevention in COP; future research in COP should be designed in line with best practices and existing guidelines; and a need for the development and validation of reliable tools to stratify risks and management options.

Chronic pain is common and has a substantial impact on individuals’ lives and the society in which they live. However, current strategies for managing chronic pain have low to moderate efficacy. We present a complexity informed model of managing chronic pain.

The authors propose that the biological, psychological and social factors influencing the experience of chronic pain can be framed as elements of a complex system (when ‘system’ is understood as a mental model of a set of relationships in the world) and discuss the advantages of this approach.

The ‘Learning Cycles’ framework of Human Learning Systems is suggested as an appropriate approach to managing chronic pain. There are five elements of the Learning Cycle; ‘understanding the system’, ‘co-design’, ‘experimentation exploration’, ‘embedding and influencing’ and ‘system stewardship’. The authors describe how this could be implemented in osteopathic practice.

The implications of a complexity approach with respect to evidence-informed as opposed to evidence-based practice is briefly discussed. Further, the opportunity for osteopathy to be at the vanguard of broader movement for change in public service and healthcare is highlighted.

Applying Learning Cycles to the context of managing chronic pain requires further research to explore its utility. Learning Cycles provide an action-research model that would supply the rich data by which to understand the efficacy of chronic pain management.

Implications for practice

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  Using a complexity informed approach (Human Learning Systems' Learning Cycles) in the management of chronic pain.

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  Structured and efficient way of providing a co-produced, person specific approach to practice.

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  Practical way of incorporating biological, psychological and social factors influencing the person's experience of chronic pain into management, without assuming causal weighting.

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  Epistemological implications for research and the current understanding of hierarchy of evidence.

Background

The Osteopaths' Therapeutic Approaches Questionnaire (Osteo-TAQ) is a novel 36-item instrument developed from qualitative grounded theory research with osteopaths in the United Kingdom. The Osteo-TAQ has the potential to measure multiple domains of osteopaths' practice including their therapeutic approach, clinical decision-making and therapeutic relationship with patients. It is unknown how well the items in the Osteo-TAQ relate to the practice of Australian osteopaths.

Objectives

To assess and improve the quality of the Osteo-TAQ survey items prior to utilising the Osteo-TAQ amongst the Australian osteopathic profession.

Methods

Cognitive interviews with six Australian registered osteopaths (n = 6) were used to generate data on how participants interpreted and understood the Osteo-TAQ items. Interviews were transcribed verbatim and content analysis was used to identify issues of comprehension and problem areas relating to the Osteo-TAQ.

Results

Three areas for improvement were identified in relation to the core aspects of clinical practice (the patient, examination, treatment and management), use of possessive pronouns and Likert scale frequency response options.

Conclusion

These problems may reflect the similarities in osteopathic practice in the UK and Australia, but also indicate subtle differences in the terminology utilised by osteopaths to describe and communicate areas of their clinical practice.

Objective

To determine whether manual therapy based on joint mobilization techniques applied to recover a limited range of motion (ROM) in older adults could have a beneficial effect on balance.

Methods

Systematic review from MEDLINE, Embase, Cochrane Library, PEDro, WOS, Scopus, and Scielo, including studies with participants over 60, an experimental intervention based on ankle joint mobilization techniques, oriented to restore ankle ROM and assessing the effects on balance and ROM. A descriptive synthesis and a meta-analysis were conducted to estimate the effect of the interventions on balance and ROM, based on mean differences, with CI set at 95 %. Quality was assessed with PEDro scale and risk of bias with the Cochrane tool.

Results

A total of 8 studies were included in the qualitative and 5 in the quantitative synthesis. Manual therapy was shown to be effective, by overall increasing the ankle ROM by 11.3° (95 % CI 6.4 to 15.6). The monopodal stability was improved in 5.8 s (95 % CI 0.1 to 11.4) and the margins of stability in 4.4 cm (95 % CI 0.6 to 8.6). The static balance improved in terms of the center of pressure swayed area with a decrease of 78.4 mm² (95 % CI 46.1 to 110.6), but not of velocity (95 % CI 24.7 to −36.7). The Timed up and go time decreased by 0.86 s (95 % CI 0.38 to −2.08).

Conclusions

Manual therapy based on joint mobilization techniques is an effective approach to increase ankle ROM, with benefits on the stability of older adults.

Background

Health care professions face increasing pressure to integrate research evidence into practice to improve patient outcomes. For many professions, the uptake of evidence-based practice (EBP) remains poorly understood, including for osteopaths in Canada. The primary aim of this study was to determine the perceptions, training, self perceived skills, use, barriers, and facilitators of EBP amongst Canadian osteopaths.

Methods

Canadian Osteopaths were invited to participate in an online survey using the Evidence-Based Practice Attitude and Utilisation Survey.

Results

Four hundred and eight osteopaths’ (response rate 13.4%) provided informed consent of which three hundred and forty answered all questions. The majority of respondents had a favorable perception and believed EBP was important (70.8%). Most respondents (>65%) rated their skills in performing EBP at a medium-high level. EBP use was infrequent among respondents. Barriers to the utilisation of EBP were lack of clinical evidence, time, and relevance to osteopathic practice. Facilitators of EBP use included having greater access to research articles and tools, and further information regarding critical analysis of research. Although searching and consulting research information was rarely performed by respondents, they were perceived as the most important aspect of clinical decision making along with clinical practice guidelines, personal and patient preferences.

Conclusion

Canadian osteopathic manual practitioners were largely supportive of EBP but there was limited commitment to its integration within clinical practice. Improving knowledge and skills of EBP, addressing the barriers of EBP uptake, and integrating EBP into educational programs may improve the uptake of EBP within osteopathic practice.

Implications for practice

There is acknowledgement of the importance and benefits of evidence-based practice amongst Canadian osteopaths.

Although Canadian osteopaths recognize the importance of evidence-based practice there is limited commitment to its use within clinical practice.

The major barriers to the use of evidence-based practice are a lack of time and clinically relevant osteopathic literature.

Canadian osteopaths state that patient preference, clinical practice guidelines, published clinical evidence and personal preference where the most important sources of information used for the basis of clinical decision making.

Interventions that aim to improve knowledge and skills, addresses barriers, and fosters alignment between osteopathic models and evidence-based practices may help to improve the uptake among osteopaths in Canada.

Background

Cognitive biases appear to be one of the most common causes of incorrect medical diagnosis. It affects students during their training and could persist after post-graduation. This could deteriorate patient care. Among them, anchoring bias can impair haptic perception and lead to a biased diagnosis.

Objective

Our study assessed the anchoring bias of first-year osteopathic students by determining whether information regarding the PRM rhythm could influence their haptic perception.

Methods

Forty first-year osteopathic students were randomly assigned to three groups. They were given different anchoring values during a PRM rhythm evaluation (3, 10 or 17 movements per minute, mpm). All information were given through video documents. Perceived rhythms were collected before and after anchoring. Wilcoxon and Kruskal-Wallis tests were used to compare intra and intergroup values.

Results

Before receiving the anchor, groups significantly (p = 0.105) perceived the same rhythms (11.8 ± 6.6mpm; 20.9 ± 9.9mpm; 18.2 ± 10.6mpm; respectively) with high variance among students. After receiving the anchor, students perceived significantly different rhythms; 3.5 ± 1.7mpm; 11.4 ± 2.8mpm; 16.8 ± 6.6mpm, respectively (p < 0.0001). Variance decreased significantly.

Conclusion

An anchoring bias might occur among first-year osteopathic students regarding their perception of the PRM rhythm. These results provide insights into the importance of the way of presenting information to students, especially controversial ones. Indeed, the way in which changing the ontological framework can modify the epistemological approach needs to be investigated. This could have implications on a student's clinical diagnosis. Students are encouraged to believe in their haptic ability, but also to use critical thinking.

Pseudoscience has harmful effects on individual patient care, professions and society more broadly. The propagation of pseudoscience and spread of misinformation by a healthcare discipline raises questions as to their legitimacy and ethical standing as a profession. Osteopaths and osteopathic physicians are regulated by law as healthcare professionals in many parts of the world with an expectation that relevant aspects of practice are suitably aligned with the scientific paradigm in the form of a commitment to the values of evidence-based practice. This article discusses the system of pseudoscience and considers its historic, present and potential negative impacts on osteopathy and professional progress. We identify possible incentives for some aspects of osteopathy and osteopaths to engage in pseudoscientific thinking and in doing so we discuss osteopathy's susceptibility to pseudoscience and how practitioners may become more aware of and recognise pseudoscientific information and pseudoexpertise.