International Journal of Osteopathic Medicine最新文献

This paper is a critical conflict-based intersectional feminist analysis of professional training that requires students to undress and expose their bodies in order to acquire knowledge. A premise of this essay is that such training is exclusive, harmful and rooted in aesthetic values that tend to percolate osteopathic discourse in multiple ways. The dangerous side of aesthetically guided professional behaviour renders potential harm to people who sit on the margins of what is considered beautiful and normal in the Global North, subsequently contributing to the wider health inequities and social injustice. This paper proposes alternative ways of acquiring knowledge that could support the osteopathic profession and education in becoming more inclusive and socially just, by adopting intersectional feminist framework. At the core of the essay are following questions: Are there ethical costs in prioritising aesthetic and body-based values? In the age of profound socio-political conflicts, what values truly matter in osteopathy? Also, has the time finally come to leave the confines of anatomical aestheticism, and enter the anatomical realm of social justice and transformative action?

Objective

SARS-CoV-2 infection responsible for the COVID-19 pandemic has demonstrated a significant burden on the mental health of health care providers. The purpose of the study is to evaluate the mental health symptoms among osteopathic physicians from a single academic institution during the COVID-19 pandemic.

Methods

This was a cross-sectional, survey-based study conducted during the COVID-19 pandemic from January 2021 to March 2021. The survey was emailed to 4239 alumni physicians from the single medical school in California, USA. Burnout, anxiety, and depression were assessed by the single-item Mini-Z Burnout Assessment, 7-item Generalized Anxiety Disorder Scale, and 2-item Patient Health Questionnaire, respectively.

Results

A total of 104 survey responses were analyzed. Of them, 53 (51.0%) were attending physicians and 51 (49.0%) were residents or fellow physicians. Anxiety, burnout, and depression were reported in 29 (29.9%), 31 (32%), and 11 (11.3%), respectively. Females had increased anxiety (OR 1.66, CI 1.21–2.27; P = 0.002). Resident had higher burnout symptoms (OR 1.28, CI 1.06–1.53; p = 0.009) and depression symptoms (OR 1.15, CI 1.01–1.30; p = 0.032) compared to attending physicians. Physicians who encountered >50 COVID-19 patients had higher depression symptoms (OR 1.17, CI 1.02–1.35; p = 0.027).

Conclusion

Our survey study demonstrated that osteopathic physicians graduated from a single academic institution experienced symptoms of anxiety, burnout, and depression during the COVID-19 pandemic based on the validated questionnaires. A higher prevalence was shown in the lesser experienced group of residents and fellow physicians compared to more experienced attending physicians. In addition, adjustments to the pandemic have caused a financial burden among osteopathic physicians. Future studies are warranted to assess the long-term effects of the pandemic on mental health among osteopathic physicians.

Objective

Osteopathic manipulative treatment (OMT) in surgical patients aims at reducing postoperative pain and enhancing recovery. The effects of OMT have not been extensively studied in cardiac surgery patients, mostly owing to the fact that a limited number of osteopathic physicians are trained in thoracic surgery.

Methods

A systematic review of the literature was performed to identify all currently available data on postoperative OMT in cardiac surgery patients. Case reports and case series were excluded. Risk of bias of the eligible studies was assessed individually using specific protocols. Among the outcomes of interest were postoperative pain, hospital length of stay, changes in respiratory capacity, and changes in cardiac index and mixed oxygen venous saturation (SvO₂) measurements.

Results

We identified four eligible studies which were included in the quantitative analysis of the present review. There were three randomized controlled trials (RCTs) and one non-randomized controlled cohort study which investigated on outcomes of OMT in cardiac surgery patients. The most common cardiac operations performed were coronary artery bypass grafting, valve procedures, combined procedures, and aortic operations. Numerous OMT modalities were used on postoperative patients. The OMT group of patients showed improvement in pain management and respiratory capacity, and shorter hospital length of stay.

Conclusions

Osteopathic treatment might be helpful as an adjunct to current medical therapies in mitigating postoperative pain and improving the overall patient's functional status.

Objectives

Osteopathic healthcare has been shown to include a broad range of therapeutic interventions, however little is known about the clinical reasoning used by practitioners in their selection of these modalities. The aim of this research is to address this gap in the literature and explore what influences a practitioner's choice of therapeutic approach.

Methods

A sequential mixed methods design was used to explore the question. Quantitative data was obtained by an exploratory national survey and qualitative data was obtained by a practitioner focus group. Survey data was analysed by SPSS while the qualitative data was analysed using a thematic analysis. The results were then synthesised via triangulation.

Results

Findings showed that there are numerous variables involved in clinical reasoning. Quantitative data showed that practitioners look to include patient and practitioner-based factors as well as external influences. Four main themes emerged from the qualitative phase: (1) Patient/person Centred Care, (2) Practitioner Wellbeing, (3) Experiential Learning and (4) Integrating Evidence. Synthesised results revealed the complex nature of CR and how the numerous factors from both sets of data overlap.

Conclusion

This study revealed a diversity of factors influencing clinical reasoning in osteopathic practice in the choice of therapeutic approach.

This narrative review presents key concepts from neurophysiology, phenomenology, psychology, and narrative medicine which underpin a developing enactive-ecological framework for osteopathic practice. This framework aims to provide a coherent theoretical basis for understanding healthcare processes and outcomes, based on the neuroscience principles of active inference and enactivism. It offers insights into factors that influence patients' pain perception and behaviour and foster or inhibit the development of effective therapeutic relationships. Although this approach offers promising opportunities to increase the scope of care by harnessing potential in the unique embodied ecological niches created between patients and osteopaths, it raises challenges to traditional treatment agendas. Healthcare which frames the patient-as-a person, and acknowledges the multidimensional nature of the self, requires practitioners to be collaborative and self-aware, and be able to elicit patients' lived experiences and body stories. Phenomenological and psychological studies into enactivism emphasise the complex, dynamic nature of therapeutic relationships and the need to understand each person's unique lifeworld context. The new framework represents an important step forward, but further research is now needed to explore ways of integrating active and enactive inference into practice, of developing psychological or mindful self- and body-awareness, and narrative communication skills for shared sense-making.

Background

Recurring headache disorders are prevalent conditions that have a substantial impact on both individuals’ daily lives and national health systems. Despite being a treatable condition, they remain underdiagnosed and undertreated. Currently, there is little qualitative research that has explored practitioner experiences of diagnosing and managing these disorders.

Objective

The aim of this study is to provide novel insight into osteopathic practitioners' qualitative experiences of diagnosing and managing primary headache disorders.

Methods

Ten osteopathic clinicians participated in individual semi-structured interviews. These were transcribed and then underwent qualitative thematic analysis.

Results

Thematic analysis of the data found five key themes: History Taking, Osteopathic Assessment, Diagnosis, Management and Interprofessional Care, with further sub-themes emerging.

Discussion

Participants primarily use history taking and osteopathic examination to develop a diagnosis and management plan. However, due to the multifactorial nature of headache disorders, an accurate diagnosis was reported to be difficult to achieve. Additionally, participants outlined numerous treatment interventions and other health professionals they work with to optimise patient outcomes. Lastly, patient compliance and lack of resources were challenges that practitioners commonly described, with more research and resources being specified as ways to overcome these challenges.

Conclusion

Many themes form the basis of the osteopathic diagnosis and management of primary headache disorders. The challenges faced by osteopaths in this clinical area can underpin further research to improve clinician experiences and patient outcomes alike.

Background

Teaching complex physical examination skills in health care is currently challenging. Virtual reality (VR) with haptic feedback may help address the challenge. However, the current usage and/or role of VR with haptic feedback in improving physical examination skills of health care students is unclear.

Methods

The following electronic databases will be searched from Jan 2010 to December 2021: PubMed, AMED, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database (PEDro), and SCOPUS. Two independent reviewers will review the articles retrieved from the databases to assess for eligibility. Studies of any design (quantitative, qualitative and mixed methods) that investigated the use of VR with haptic feedback in health care education will be included in the review. Primary outcomes will include any quantifiable measures and/or qualitative themes. The Mixed Methods Appraisal Tool (MMAT) will be used to appraise the quality of included studies. The overall quality of the evidence (high, moderate, low and very low) of quantitative studies and/or qualitative studies will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) and/or GRADE CERQual tools. Discussion: As health care settings (including teaching and clinical practice) are becoming complex, the use of technology such as VR may play a crucial role in facilitating physical examination procedures undertaken by health care professionals. This review will provide a timely overview of the usage of VR with haptic feedback in health care education.

Introduction

As contemporary osteopathy is increasingly mainstreamed into the broader field of American medicine, it is important to understand how osteopathic physicians’ professional identities are shaped, from medical education to practice. This study examines the way in which osteopathic professionals negotiate their identities in relation to the ideas and legacy of osteopathy’s 19 th century founder, Dr. Andrew Taylor Still.

Methods

A thematic analysis of ten years of articles from the Journal of Osteopathic Medicine allowed the researchers to examine themes arising in the dataset, which in turn served as the basis for a thematic distillation of how those themes illuminate negotiations of osteopathic professional identity.

Results

JOM authors evoked Still for several reasons. First, decontextualized “name-checking” served to ground investigations into osteopathic principles and skills in osteopathic history. Second, authors evoke Still’s name and influence on the early profession to negotiate a range of contemporary questions, from identity to health policy. Within this second category, this study finds that American osteopaths engage in a speculative practice about what Still would or would not think about contemporary osteopathic medical education and practice.

Discussion

If osteopathy is concerned with training future generations of practitioners who will continue the traditions that have distinguished osteopathy from mainstream medicine, then understanding its history is an essential step toward professional self-understanding. This study suggests that a close look at how American osteopathic medical professionals relate to Still reveals a great deal, not only about the education and practice of osteopathy, but professional identity formation generally.

Introduction

Gastroesophageal reflux disease (GERD) is a chronic condition resulting from a retrograde flow of part of the gastroduodenal contents into the esophagus. Generally, this reflux is linked to a malfunction of the lower esophageal sphincter. Studies involving manipulative therapies suggested an important role in the coadjuvant treatment for reflux, acting as a form of prevention and treatment.

Objective

to carry out a systematic review of the literature regarding the treatment by means of manual techniques for GERD, aiming to evaluate the methodological quality employed in the studies, summarize the findings, analyze the effectiveness of the intervention and possible recommendation for clinical practice and/or indicate the need for further research.

Methodology

The study is characterized as a systematic review, with research conducted in the English and Portuguese languages, in the databases Bireme, Lilacs, PubMed, PEDro, Scielo, Cochrane and Google Scholar. We exctracted the manual therapy techniques used in the selected studies, and the reporting of the effectiveness of these interventions. The PRISMA reporting guidance was used to structure the review and the PEDro scale was used to evaluate the methodological quality of the included studies.

Results

A total of 6 clinical trials were found and included a total of 218 people analyzed by objective and subjective measures in the pre- and post-intervention phases. Regarding methodological quality, 3 studies had scores higher than 7, i.e. high quality, while one had a score of 4, and 2 had a score of 3, denoting low internal validity. The observed results show positive clinical effects for visceral manual therapy in the gastroesophageal reflux in adults.

Conclusion

The research suggests the presence of favorable results with the use of manual techniques for the treatment of gastroesophageal reflux, seen in studies with high methodological quality, however, due to the small number, and other studies with a low score assigned by the PEDro scale, caution should be adopted and there is the need for further experimental studies.

Randomised placebo-controlled trials (RCT) are implemented to determine whether a particular therapy is superior to placebo and can thus be considered effective. However, adopting the standard RCT design in contexts other than pharmacological trials, such as manual therapy, may result in systematic biases. These biases may occur due to: the impossibility of traditional “double-blinding” in manual therapy trials; insufficient pre-training of operators delivering the treatment and/or sham therapy; biased recruitment of study participants; the problematic use of subjective and/or objective outcomes; and finally, the presence of phenomena mimicking placebo effects. From the perspective of placebo studies, the purpose of this paper is to discuss and make appropriate recommendations to address these five issues in manual therapy research.