International Journal of Osteopathic Medicine最新文献

Questions relating to osteopathic identity are likely to be characterised by double facets made up of both traditional and contemporary elements. The analysis conducted aims to be robust by presenting these components as elements able to dialogue. It is through Paul Ricoeur's concept that we propose as an approach: the idem identity concerns the elements that provide a certain temporal stability whilst the ipse identity embodies the variable aspects of the constitutive elements of osteopathy. Osteopathy's identity would thus be modelled by the association of these two regularly interacting influences insofar as they serve both issues: shaping a disciplinary specificity, and the requirements focused on the improvement of patient care.

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.

Background and Objectives

Patient-Reported Outcome Measures (PROMs) are instruments that capture patients' perspectives of their own health status and quality of life. As part of rising advocacy for their use in clinical practice, PROMs are said to hold promise for the management of long-term conditions. This study aimed to describe and explore New Zealand osteopaths’ use of PROMs for patients with chronic low back pain.

Methods

An online survey was adapted to investigate New Zealand osteopaths’ use of PROMs with patients who have chronic LBP. Topics included frequency of use, purposes for use, and determinants to use. Respondents were recruited via anonymous and non-randomised sampling across multiple platforms. Frequencies, means, and standard deviations were calculated for all numerical data. Content analysis was used to analyse textual data on determinants to use.

Results

In total, 79 osteopaths were included in data analysis. These respondents most often used PROMs to monitor patients’ pain intensity (80%) and sometimes also functional disability (27%). Although the respondents had some regard for their capability to use PROMs, they also claimed to be constrained by limited time and social or professional norms. Respondents were more attentive to the consequences of PROMs for patients than for other stakeholders.

Conclusions

Although New Zealand osteopaths may use PROMs to monitor the burden of chronic LBP, they probably do not use PROMs for the multidimensional assessment of pain or psychosocial factors. New Zealand osteopaths may be most receptive to adopting PROMs if they are presented with relevant interventions and evidence of their benefits for patients.

Background: Persistent and intractable hiccups are poorly understood and reduce the quality of life of afflicted patients. Hiccups lasting longer than 48 hours are defined as “persistent,” and those lasting longer than 30 days as “intractable.” Both persistent and intractable hiccups are rare diseases included in the National Organization for Rare Disorders (NORD) registry, with cases of intractable hiccups being extremely rare. There are limited effective treatment options currently available for both persistent and intractable hiccups.

Clinical features: Reported here is the case of a 25-year-old female patient with a 7-year history of intractable hiccups that were successfully treated with osteopathic manipulative treatment (OMT). Her hiccups began in 2015, typically occurring in couplets, with upwards of 50 hiccups per day. In 2016, she was treated by her primary care physician for H. pylori, with no improvement. Referred to a gastroenterologist, she underwent an endoscopy that showed normal findings, and she was subsequently referred to a neurologist. A CT scan of the brain was performed and showed normal findings, prompting the neurologist to suggest muscle relaxants (which were refused at the time) and various breathing and relaxation techniques, including talk therapy. With the continued failure of these treatments, the patient attempted acupuncture without benefit. In early 2022, the patient decided to try the muscle relaxant baclofen and found no benefit after two months of treatment.

Intervention and outcomes: In August 2022, osteopathic manipulative treatment (OMT) was administered over five sessions. After the third session, the patient noticed a complete absence of her typical hiccups but began experiencing frequent “micro” hiccups that produced little-to-no sound. After the fourth treatment and continuing past the fifth treatment, the patient has had a near complete cessation of her hiccups, about 1–2 “micro” hiccups per week. Follow up with the patient on May 1, 2023, confirmed the continued resolution of her intractable hiccups.

Conclusion: In a 25-year-old female patient without prior or concurrent medical conditions, OMT techniques successfully treated intractable hiccups of a 7-year duration. This case supports a potential role for OMT in the care of intractable hiccups.

Background

SARS-CoV-2 is a disease with global impact, and in the United States alone, approximately 20 % of children have had SARS-CoV-2. Long-COVID affects a significant number of children and adults with an incidence reported as high as 57 % for a SARS-CoV-2 sequelae. Currently, a gold standard treatment has not been identified for long-COVID. There have been pathologic mechanisms of action proposed for long-COVID, but this is complicated by the wide variety of symptom manifestations.

Objectives

The goal of this case report is to demonstrate and discuss the application of osteopathic manipulative treatment (OMT) and osteopathic principles and practices (OPP) in a patient with long-COVID headache.

Clinical features

In our case report we describe a child with long-COVID headache of 12-months duration with high somatic dysfunction burden found on cranial osteopathic structural examination.

Intervention and outcomes

OMT was utilized to treat a patient with long-COVID headache and may have resulted in its resolution.

Conclusions

This case suggests that OMT and OPP may play a role in the treatment of patients with long-COVID headache.

Implications for practice

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  Our case report highlights OPP as a potential treatment option that may be complimentary to other treatments for pediatric patients experiencing long-COVID headache.

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  Our case report emphasizes the significance of individualized treatment plans, as osteopaths provide in a tailored fashion to each patient based upon their unique history and physical exam findings.

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  Our case report utilizing OMT promotes a non-pharmacological intervention and fosters opportunities for interprofessional collaboration.

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  Our case report sparks interest in further research and clinical trials to investigate the efficacy of OMT in pediatric long-COVID cases and its potential application in a broader range of post-viral syndromes.

Background

Many parents seek osteopathic care for their infants with colic. Our aim was to test the effectiveness of usual light touch osteopathic treatment on crying time for infants with ‘colic’.

Methods

A superiority, two arm, single blinded (parent) multi-centre (UK, Australia and Switzerland), randomised controlled trial, included healthy infants between 1 and 69 days of age who excessively cried, fussed, or were distressed and difficult to console. The Test intervention consisted of usual light touch osteopathic treatment, the Control intervention simple light touch to random body locations with no treatment intent. Both groups received best practice advice and guidance. The primary outcome was the daily crying time, reported hourly by parents in a diary, for two-weeks. Secondary outcomes were parenting confidence, global change, satisfaction, and experience of care.

Results

Sixty-six infants were recruited (32 Test: 34 Control group). Mean average daily crying time in the Test group was 124 min (SD = 69, n = 26) and in the Control 115 min (SD = 49, n = 29). After adjustment, infants in the Test group cried 2.2 min more per day than those in the Control group (CI95 % −20 to 25 min, p = 0.849). Parents’ perceptions of global change in symptoms, satisfaction with, and experience of care were high and similar in both groups. There were no serious adverse events related to the treatments or the trial.

Conclusion

Usual light touch osteopathic treatment was not superior to simple light touch without treatment intent. The biomechanical explanatory models and underpinning assumptions about the mechanisms of osteopathic intentional light touch care may require reconsideration.

Trial registration

ACTRN12620000047998 (January 22, 2020).

In September 2023, the first degree program for osteopathy, an Honours Bachelor of Science from Sheridan College in the province of Ontario welcomed its first cohort [1]. This is the first full-time academic degree in Canada that offers a career opportunity in osteopathy directly from high school. The degree will include two new full semester courses that have not been offered in osteopathy in Canada as part of the core curriculum. The courses, Critical Thinking (CT), and The Philosophy and Science of Pain (Pain) are currently in development to start in second year. They constitute an important part of evidence-based education, which is critical to recognition and regulation of the profession.

Implications for practice

There are no direct implications for current practices. The new courses and the change of education type from private business to an academic setting will have significant implications for future practice.

Objective

The current study aimed to investigate the remote effects of upper trapezius (UT) Dry needling (DN) and ischemic pressure (IP) on the pain intensity and threshold of the MTrPs in the extensor carpi radialis longus (ECRL) and the first dorsal interosseous (FDI) muscles.

Methods

Twenty-eight subjects were allocated into two groups in a randomized clinical trial study undergoing DN and IP interventions on the MTrPs of the UT muscle for 3 sessions. Pressure pain intensity was assessed by visual analog scale (VAS) and pressure pain threshold (PPT) before and after interventions. Upper limb functions were evaluated by the disabilities of the arm, shoulder, and hand (DASH) questionnaire.

Results

There were significant interactions between muscle, group, and time for PPT, muscle and group, group and time, and muscle and time for VAS (P < 0.05). In DN group, PPTs and VAS of the ECRL and FDI were changed after treatment in all sessions (P < 0.05). In ECRL and FDI muscles, the DN was more effective than IP (P < 0.05). Comparing the pain intensity and threshold of the ECRL, FDI, and UT muscles it was revealed that the improvement in symptoms of the ECRL muscle was the most in the DN group (P < 0.05). There was a significant interaction between group and time for DASH (P < 0.05). In both groups, the DASH score was reduced (P < 0.001).

Conclusions

UT muscle DN demonstrated significantly better remote effects in alleviating symptoms of the ipsilateral distal muscles than IP. Both interventions were effective in improving the upper limb function in myofascial pain syndrome patients.

Implications for practice

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  This study evaluated the remote effects of most common treatments on myofascial trigger points.

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  Dry needling showed therapeutic effects on pain alleviation in terms of both immediate and short term in the extensor carpi radialis longus muscle.

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  First dorsal interosseous pain threshold and intensity improved following dry needling of the upper trapezius while it is not connected to the upper trapezius muscle myofascially.

Background

Limited evidence exists concerning the long-term follow-up of pain management in individuals with coccydynia.

Objective

This study aimed to examine the effectiveness of combining manipulation and exercise as a treatment approach for patients with coccydynia, while also assessing its long-term outcomes.

Design

Six months follow-up of a randomized controlled trial.

Setting

This study was conducted in a private hospital.

Methods

The control group (n = 23) received exercise alone, while the experimental group (n = 23) received both exercise and manipulation. All participants performed exercises three days a week for four weeks, and the manipulation sessions were conducted once a week for a total of four sessions. Pain levels were assessed using the Visual Analog Scale (VAS), coccydynia symptoms were evaluated using the Paris questionnaire, and pain-related disability was measured with the Oswestry Disability Index (ODI).

Participants

Forty-six participants were enrolled in the study.

Results

No statistically significant differences were observed in the demographic characteristics between the two groups (p > 0.05). However, participants in the manipulation group showed a statistically significant improvement in pain, symptoms, and ODI scores compared to the control group, both immediately after treatment and at the 6-month follow-up (p < 0.05).

Conclusion

This study demonstrates that the combination of exercise and intrarectal manipulation over a four-week period significantly reduced pain, coccydynia-related symptoms, and disability scores in chronic coccydynia patients. However, no therapeutic superiority was observed in the long-term follow-up of six months.

This commentary proposes a framework for considering the philosophical foundations that support osteopathic practice, using the metaphor of ‘tectonic plates’. It is argued that reflective osteopathic practitioners, and the organisations they make up, would benefit from engaging with the differing ontological and epistemological traditions that underpin healthcare theory, evidence and practice. It is proposed that having more insight into the philosophical traditions of reality (ontologies) and forms of knowledge (epistemologies), that underpin medicine and healthcare, will support ethical, reflective practice, informed by the concepts of ontic integrity and epistemic humility. We focus particularly on phenomenological ontology and epistemology, which we propose underpins the relational and embodied concept of osteopathy as hermeneutic, enactive, intersubjective healthcare, locating it within the sphere of phenomenological and enactivist theory and research.