International Journal of Osteopathic Medicine最新文献

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

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.

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.

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.

Objective

This study investigated the Portuguese Osteopaths attitudes towards a biomechanical or biopsychosocial approach of care in patients with chronic low back pain (cLBP).

Methods

A cross-sectional questionnaire-based survey of Portuguese registered osteopaths was composed using sociodemographic determinants, the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) and Pain Attitudes and Beliefs for Physiotherapists (PABS-PT). The HC-PAIRS assesses the attitudes and beliefs about the functional expectations of patients with cLBP, and the PABS-PT assesses the dominant model of care.

Results

Portuguese registered osteopaths (n = 103) had mean PABS-PT subscale scores of 29.6 ± 7.7 [CI95% 28.12–31.14] (biomechanical) and 22.9 ± 5.3 [CI95% 21.88–23.94] (biopsychosocial). The mean HC-PAIRS total score was 52.4 ± 9.0 [CI95% 50.66–54.16]. There was a strong and positive correlation between the HC-PAIRS and the PABS-PT biomechanical subscale (n (103) = 0.55, p < 0.001, and in PABS-PT a negative correlation between the biomechanical and biopsychosocial subscale scores (n(103) = -0.21, p = 0.028).

Conclusions

Portuguese osteopaths tend to adopt a biomechanical model of care instead of a biopsychosocial model in the management of patients with chronic low back pain. They seem to agree that chronic low back pain was due entirely to tissue damage, indicating strong biomechanical beliefs about the pain that may ultimately influence their clinical decisions.

Background

Metabolic syndrome (MSy) is a risk factor for cardiovascular disease. The decrease in vagal activity has been related to the mechanism of MSy development. Recently, it has been proposed that the WBV exercise, as well as osteopathic manipulative treatment (OMT) stimulate cardiac autonomic modulation.

Aim

The aim of this study is to evaluate the acute effects of whole body-vibration (WBV) exercise and OMT on heart rate variability (HRV) in individuals with MSy.

Methods

Cross-sectional, randomized, cross-over study (one-week wash-out between interventions) and blinding analysis. Individuals with MSy will be randomized into 5 groups: 1) whole body-vibration exercise group (WBVG), 2) osteopathic manipulative treatment group (OMTG), 3) WBVG + OMTG, 4) OMTG + WBVG, 5) control group (CG). OMT will consist of suboccipital decompression technique, myofascial relaxation on cervical and diaphragm muscles. The HRV measurement will be done with the individual at rest, during the 2-min step test (2MST) and during interventions. After the treatment, the measurements will be repeated.

Discussion

The modulation of ANS is important in the management of MSy individuals. The investigation of intervention modalities to improve this modulation is necessary and it is expected that this protocol can promote this modulation and improve the HRV.

Background

Observing how individuals actively adapt to their environment may provide additional insights into traditional clinical tests. Rather than using tests that only identify joint mobility limitations, it seems relevant to use clinical motion tests that assess global biomechanical functions more generally and identify functional behaviours.

Objectives

This study explores whether different functional kinematic behaviour patterns appear when executing a new complex motor task and whether those observations are consistent over multiple executions.

Methods

Marker-based kinematic analyses of the lumbo-pelvic complex were conducted on 29 asymptomatic athletes during two active self-induced motion tests: the one-sided tilt test and a modified version of this test limiting the trunk axial rotation. Marker data served as an input for a full musculoskeletal model to compute the lumbar and lower limb joint angles. Latent class analysis and intraclass correlation coefficients were calculated to identify different classes of functional kinematic behaviour and assess the reliability between measurements.

Results

The methodology allowed us to identify four distinctive classes of possible movement combinations based on these two functional tests: standard movement, low knee and lumbar engagement, high pelvis engagement and high lumbar flexion. All ICCs for the lumbo-pelvic complex degrees of freedom were higher than 0.6, suggesting a moderate to good reliability for the overall test.

Conclusion

It remains unknown whether the observed reproducible patterns emerging from the motion test relate to motivation and prior experiences. Further exploration is required to investigate whether these behaviours can be correlated to empirical clinical observations, past experiences, and future vulnerabilities for musculoskeletal conditions.

Objective

Patient-reported outcome measures (PROMs) provide information on patients’ views of their symptoms, functional status, health related quality of life and are an important part of evidence-informed practice and patient-centred care. The utilisation of and attitudes to PROMs by Australian osteopaths is unknown.

Methods

An online survey was designed to investigate the self-reported utilisation of PROMs by Australian osteopaths, including the frequency of use, the types of PROMs used, the features of PROMs are most useful, the attitudes towards PROMs, and the barriers and enablers for use of PROMs. The survey was a 14-item questionnaire that used a 5-point Likert scale or required free text answers. The effect of gender and years in practice was analysed using Mann-Whitney U tests. Effect sizes were calculated where possible.

Results

166 (male = 69, female = 97) osteopaths participated in the survey. Nearly half (47.6%) reported that pain scales were used ‘frequently’ or ‘always’, but there was less frequent use of PROMs other than pain scales (14.2%), except for third party paying patients (57.4%). Australian osteopaths reported using PROMs most frequently for patients with neck pain (31%) and low back pain (29%). The majority agreed PROMs were important for tracking improvement in patients (61%). The greatest barrier identified by osteopaths was the burden on consultation time.

Conclusion

This study highlighted only the minority of Australian osteopaths use PROMs frequently and consider them important. Professional organisations should consider professional development aimed to upskill and support practitioners in the efficient use of PROMs in practice.

Implications for clinical practice

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  Nearly half (47.6%) of 166 osteopaths reported using pain scales ‘frequently’ or ‘always’, but there was a less frequent use of PROMs other than pain scales (14.2%), except for third party paying patients (57.4%).

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  The majority of osteopaths agreed that PROMs were important for tracking clinical improvement in patients (61%), although only 48% agreed that PROMs were important in osteopathic practice.

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  The greatest barrier identified by osteopaths to using PROMs was the burden on consultation time and most common enabler was the requirement of PROMs by third party payers.

Sarcopenia, the decrease of muscle mass and performance, is a growing health concern in the face of an ageing population. Sarcopenia is an important contributor to falls and fall related injury in older adults, and allied health musculoskeletal clinicians are well placed to play a key role in the prevention, diagnosis, and management of the disease. This masterclass aims to provide clinical confidence for musculoskeletal allied health professionals working with older adults to incorporate management of sarcopenia into their practice. Specifically it will focus on diagnosis of disease, appropriate and safe therapeutic exercise prescription, as well as appropriate referral for these patients. We hope that equipping clinicians with skills and knowledge of sarcopenia directly translates into more effective prevention and management of disease, and improved patient outcomes in older age.