International Journal of Osteopathic Medicine最新文献

Objective

The aim of this pilot study was to determine which factors (both positive and negative) of a medical students' OMT training influenced their perception of OMT and their intent to use it in the future.

Methods

A computer-based survey was distributed to medical students (years 1–4) at two different campuses of an Osteopathic Medical School based in the United States. Multiple factors affecting students' perception of OMT were assessed, including experiences prior to medical school or during their pre-clinical years, virtual/in-person learning, OMT club, OMT clerkship, and OMT fellowship. Students were also asked about their confidence in using OMT, overall perception of OMT, and future intent to use OMT.

Results

Factors that appeared to positively influence medical students' perception of OMT were in-person hands-on training (76 %), prior medical school experiences (31 %), OMT club activities (19 %), and OMT fellowship (9 %). Those that appeared to negatively influence their perception were virtual learning (47 %) and pre-clinical lecture hours (46 %). Medical students' overall perception of OMT diminished when comparing first-year to third- and fourth-year students. Selecting an osteopathic school for OMT training also had a positive influence on a students' perception of OMT. Students who were satisfied and confident in their training reported a higher likelihood of using OMT in the future.

Conclusions

Students' attitude toward OMT and their reported likelihood of future use of OMT were improved by hands-on/in-person learning, clinical OMT opportunities, and OMT experiences prior to medical school. Greater attention must be focused on these forms of OMT education.

Background

Altered breathing pattern is a consequence of dysfunctional breathing. The respiratory pattern might be impaired in patients with cervical radiculopathy due to the involvement of common nerve roots with the phrenic nerve (C3– C5).

Objective

The aim of this study was to investigate the inter-rater and intra-rater reliability of a technique for evaluating the breathing pattern known as manual assessment of respiratory motion (MARM) in patients with unilateral cervical radiculopathy.

Design

Cross-sectional study.

Setting

Rehabilitation Sciences Research Center

Participants

Twenty-five patients with unilateral cervical radiculopathy aged 30–55 years participated in this study.

Methods

Two experienced physical therapists investigated the respiratory pattern of the patients during normal and deep breathing using MARM, separately. Assessments were repeated again a week apart by each examiner. The inter- and intra-rater reliability of the MARM were calculated.

Results

“Very good” inter-rater and intra-rater reliability were found with the MARM values during both normal and deep breathing patterns. (Inter-rater: ICC range = 0.71 to 0.82; intra-rater: ICC range = 0.72 to 0.80).

Conclusions

MARM is a reliable clinical and research tool for assessing breathing patterns with very good inter- and intra-rater reliability in patients with unilateral cervical radiculopathy.

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).

Objective

The main aim of this study was to test the inter and intra-rater reliability of the Manual Diaphragm Assessment (MED) scale and compared with chest expansion (CE) in healthy participants.

Methods

A reliability study, with a sample of 45 healthy participants, composed of 30 women and 15 men. Participants were evaluated by two raters. The MED assesses seven different points on the diaphragm and rates its degree of restriction on a scale of 1–5. Upper and lower CE were measured in centimeters with a measuring tape, which is a valid and reliable method. The intraclass coefficients (ICC) for inter and intra-rater reliability for CE and MED were calculated for mean measurement consistency using a two-way random effects model.

Results

The intra- and inter-rater reliability of MEDs ranged from low to moderate. The majority of the ICC values in intra-rater reliability were greater than in inter-rater reliability, and the majority of the ICC values in both were higher at the left assessment point. CE inter- and intra-reliability ICC varied from moderate to good. For the upper and lower CE, the inter-rater reliability ICC values were greater than 0.74, and the intra-rater reliability was greater than 0.71.

Conclusion

The manual evaluation diaphragm scale had poor to moderate intra and inter-reliability. The chest expansion's intra and inter-reliability ranged from moderate to good, which was consistent with previous studies. Measuring chest expansion with a tape is a reliable method of evaluating the diaphragm in a clinical setting.

Objective

Neck pain is a highly prevalent condition that leads to considerable pain and disability. There is an economic cost to neck pain at both a personal and broader health system level. Neck pain may be classified as ‘non-specific’ neck pain (NSNP) when there is an absence of identifiable underlying disease or abnormal anatomical structure. Osteopaths play a role in the management of NSNP, but it is unclear how osteopaths specifically manage this condition. This study explores what osteopaths do for patients with NSNP.

Methods

Cross sectional design. Via an online survey.

Results

All participants in this study reported applying soft tissue techniques, using exercise prescription, discussing physical activity levels, physical fitness, stress management, pain education and posture and ergonomics for patients with NSNP. Less than half of the osteopaths in this study reported using PROMs in clinical practice for the management of non-specific neck pain and only a small number completed continuing professional development (CPD) related to the clinical management of NSNP.

Conclusion

This study demonstrates Australian osteopaths use a range of manual therapy techniques and education strategies in clinical practice for the management of NSNP in line with clinical practice guidelines.

Implications for clinical practice

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  All osteopaths in this study reported applying soft tissue techniques, using exercise prescription, discussing physical activity levels, physical fitness, stress management, pain education and posture and ergonomics for patients with NSNP.

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  Less than half of the osteopaths in this study reported using PROMs in clinical practice for the management of non-specific neck pain.

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  Only a small number of Australian osteopaths completed continuing professional development (CPD) related to the clinical management of NSNP.

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.

Running is a widely-adopted exercise modality, with relatively low financial barriers to access, and is associated with a host of health benefits. However, with this high participation rate, comes a high risk of running related injury (RRI)—with rates of up to 85 % being reported. There are many drivers of RRI such as training load, genetic and anthropometric factors, with biomechanical factors being an important consideration also. Traditionally, biomechanical gait analysis was only able to be performed in expensive specialised 3D gait laboratories. However, since the introduction of smart devices and apps, 2D gait analysis is now an accessible tool to any musculoskeletal clinician. Despite the high availability of these technologies in practice, there is currently a lack of resources for proper application and training in clinical gait analysis. Therefore, the aim of this masterclass is to provide an easy to understand, and apply guide to 2D biomechanical running analysis and running retraining in routine clinical practice.

Implications for practice

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  Structured biomechanical analysis and running retraining can be used in the management of some RRIs.

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  Running retraining advice should often be given in conjunction with training load and exercise rehabilitation advice.

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  There is no evidence that prospectively changing an un-injured runner's biomechanics can have an influence on RRI development.

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  More research needs to be performed on the links between running kinematics and RRI.

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.

Objectives

This study aimed to scope the current scientific evidence about the role, use and effects of touch in the form of assessment and manual therapy intervention during osteopathic clinical encounters, in order to provide an up-to-date understanding of the use of hands-on modalities in the field of musculoskeletal (MSK) treatment. The primary research question was “what is the role of touch during osteopathic clinical encounters?”.

Methods

A scoping review was undertaken including all types of research on the topic of touch within the manual therapy world; the neurophysiology of touch; the contextual factors and non-specific effects connected to that. PubMed, Ovid Medline, Ovid Amed, Ovid Emcare and PEDro were searched from 2001 to December 2021. The search was then updated in August 2022.

Results

45 papers were included; much of the available literature revolved around the role of C-Tactile fibres and their interaction within the brain in relation to manual therapy; there is evidence about the non-specific and contextual factors’ influence in this interaction and the communication established between patient and practitioner, as well as treatment outcomes.

Conclusions

Touch can be considered a means through which osteopaths can interact with the patient as a person in a way that goes above and beyond their MSK presentation to enhance better general health and adaptation. However, paucity of data, low quality of evidence and methodological flaws warrant caution in the interpretation of the findings.