International Journal of Osteopathic Medicine最新文献

Background

Palpation is a fundamental and complex skill for manual practitioners, it is a very difficult task to teach and to learn. Trials suggest that training might increase the reliability of palpation in detection of bony landmarks, nevertheless the poor dependability of the examined tests suggests that teaching methods must be reviewed. Different training methodologies have been implemented to improve learning experience of manual therapists, but none of them were based on students' and teachers’ suggestions.

Objectives

This study aims to find an efficient training, tailored on students' needs, that improve students’ palpatory skills.

Design

Mixed-method study.

Methods

this study was divided in four phases, two quantitative and two qualitative. Pelvis asymmetries were evaluated by 112 students from the Accademia Italiana di Medicina Osteopatica osteopathic Institute using two bony landmarks: the greater trochanter (GT) and the posterior superior iliac spine. The volunteers had a hidden wedge of 2 cm under their heel using a randomization process. Nine students and three teachers were interviewed to explore their lived learning experiences. A tailored training of 1 h was implemented based on their suggestions. Students were then randomly divided into three training groups: tailored training, P.A.L.P.A.T.E. and no training. A second data collection was performed. Students were re-evaluated, asked to make another assessment on another volunteer. Two students and one teacher were then re-interviewed to assess if the tailored training met their expectations. A generalized linear model was used to analyze the data.

Results

76 students completed the trial. Generally, correct detections of higher landmarks increased from the first to the second data collection, except for 5th year students who decreased their performances. Tailored training achieved the best results with a correct detection of the great trochanter by 69% of students and for posterior superior iliac spine by 78% of students. The generalized linear model showed a strong association between correct detection of PSIS and training type (p-value = 0.009) and over time (p-value = 0.01) but no association with year of school (p-value = 0.434). No association between year of study (p-value = 0.228), training types (p-value = 0.267) and correct GT detection over time (p-value = 0.529) was found.

Conclusions

Tailored training was shown to be effective and useful in the improvement of students’ performance, especially for posterior superior iliac spine. Interest levels played an important role in correct detection.

Background

Telehealth is increasingly becoming a significant strategy for the delivery of healthcare in Australia in a wide range of professions. Recent physical distancing requirements were a catalyst for professions such as osteopathy (where the dominant care model is manual therapy) to make significant changes to adapt their approach for telehealth platforms.

Objective

To explore the perceptions of Australian osteopaths’ use of telehealth for patient care, and the associated barriers and enablers of its implementation.

Methods

The Theoretical Domains Framework informed the development of semi-structured interviews which were conducted with osteopaths. Transcriptions were analysed thematically.

Results

Nine osteopaths participated in semi-structured interviews. They described their beliefs about osteopathy and the challenge telehealth has posed to their professional identity as healthcare providers. Osteopaths described uses ranging from simply staying connected with patients, through to innovative ways to assess and teach patients how to self-treat and self-manage their conditions.

Conclusion

Enablers for the use of telehealth by participating osteopaths were face-to-face practice restrictions imposed during the pandemic lockdown and acknowledgement of the potential for telehealth to offer convenient and beneficial care, particularly for patients with limited access. Participating osteopaths who saw their value and self-worth as healthcare providers of manual therapy, and a lack of training in telehealth platforms, were major barriers to its uptake in osteopathic practice.

Objectives

To examine the agreement and interrater reliability of a palpation method for locating the C1 transverse processes (C1TP) and the association between personal characteristics with the observed agreement.

Methods

Single-blinded, inter-rater reliability study. Ninety-nine participants (58 women, age 44 ± 10 years, body mass index 26.1 ± 4.3 kg/m², neck disability index = 8.4 ± 7.3 points) were enrolled in this study. Two raters blinded to each other's assessment performed the palpation for locating the C1TP and marked it with invisible ultra-violet ink. A research assistant measured the distance between the skin marks labeled as C1TP. The association between sex, age, body mass index, neck pain intensity and disability on the interrater agreement was verified using a point-serial correlation coefficient.

Results

Absolute and percent agreement for the right and left body sides were 90/99 (90.9 %, 95%CI 83.4 to 95.8) and 96/99 (97.0 %, 95%CI [91.4 to 99.4]), respectively. Interrater reliability was excellent for both right (Gwet's AC1 0.883, 95%CI [0.881 to 0.885]) and left body sides (Gwet's AC1 0.894, 95%CI [0.894 to 0.896]). After adjustment for multiple comparisons, no statistical evidence of correlation was observed for age, sex, body mass index, and NDI with the agreement for location of C1TP (r = −0.206 or lower, adjusted P-value = 0.328 or higher).

Conclusions

The palpatory method for the location of C1TP has excellent interrater agreement and reliability. Age, sex, body mass index, and disability show weak-to-negligible correlation with the agreement for location of C1TP.

Implication for practice

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  A palpation method should be accurate and reliable for being introduced in clinical and laboratory settings

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  This is the first study to report interrater reliability results for locating C1 and the reliability is excellent

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  The result of our study increases our confidence in recommending the location of C1 in clinical practices when performing mobility tests for C0–C1–C2, the great nerve occipital palpation, as a start landmark for suboccipital muscle palpation and when applying direct manual procedures to restore mobility in C1–C2 segments as muscle energy technique, high-velocity low amplitude (HVLA) manipulation and mobilization with movement techniques

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  These results benefit the manual therapist's education process as palpatory skills and surface anatomy are core subjects in manual therapy education, including osteopathy, despite the lack of validation of most palpation methods

Thomson and MacMillan's paper What's wrong with osteopathy? has understandably caused some consternation within the profession. In this commentary I want to support the intent of their argument, but also suggest they do not go far enough. Western healthcare is entering a post-professional era which will profoundly affect every profession's identity and social purpose. The effects of late capitalism on the atomisation of the body, the unbundling of goodness and expertise, and the transformative effects of digital technologies are not commonly discussed issues in osteopathy, but they are becoming central concerns for any profession looking to adapt to future healthcare. In this essay, I briefly outline the challenges of post-professionalism and explore some of the reactions we have already seen in other professions like physiotherapy. Four response archetypes are identified: watching and waiting, a modern heritage approach, professional renaissance, and hybrid professionalism that, I argue, lies behind Thomson and MacMillan's proposition. All four of these approaches are shown to have significant limitations, so the paper ends with some suggestions for a direction that might be a better way forward for osteopathy.

In the age of social media, the qualifications and capabilities of osteopathic professionals have been brought into question on a national scale due to the lack of awareness and misconceptions held by many Americans with social platforms. This article investigates the misperceptions behind the recent media coverage of osteopathic physicians. This article highlights the history of osteopathic medicine, as well as the education and training physicians receive. Additionally, this paper offers suggestions on how to combat the stigma in everyday life.

Introduction

The aetiology behind chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) remains unknown, which makes treatment challenging, while the diagnostic uncertainty related to CP/CPPS creates confusion and frustration for both patients and clinicians. As CP/CPSS may be persuaded by nociplastic pain mechanism and is associated with psychosocial and lifestyle factors, interventions should address biopsychosocial factors in combination with the treatment of the biomechanical impairments.

Case description

This is a case study of a 71-year-old man diagnosed with CP/CPPS who was referred to the osteopathic clinic by his urologist. His main complaint was a constant dull aching pain in the urethra and right groin that had started almost 10 years previously. The patient was treated six times over a time period of 5 months using a multimodal osteopathic approach.

Outcomes

The osteopathic intervention significantly decreased the numeric pain rating scale score, improved quality of life and reduced pain and dysfunction as measured with the National Institutes of Health chronic prostatitis symptom index.

Discussion

As CP/CPPS may be a nociplastic pain syndrome, and a multimodal osteopathic approach may therefore be needed that includes treatment of the biomechanical impairments with osteopathic manipulative treatment while also addressing various biopsychosocial factors via education, dietary modifications, advice about physical activity, breathing exercises, sleep and stress management.

Conclusions

Application of the biopsychosocial model in addition to a biomedical osteopathic model seems to be a beneficial intervention strategy to improve quality of life, pain and dysfunction in a patient with CP/CPPS.

Objective

To investigate whether exercise therapy associated with spinal manipulation is more effective than exercise therapy alone in patients with shoulder pain.

Data sources

Studies were identified by searching MEDLINE/PubMed, Embase, CENTRAL, PEDro, and clinical trial registers. Included studies were written in English without date restrictions.

Study selection

We selected controlled trial studies investigating thoracic, cervical, and cervicothoracic spinal manipulations and therapeutic exercises for patients with shoulder pain symptoms and dysfunction outcomes.

Data extraction

The study included six clinical trials with 431 participants. Low and very low-quality evidence suggests that the association of interventions can be effective for pain intensity in the first 2 weeks (mean difference [MD], −0.99; [confidence interval] CI, −1.61–0.38) and from the 4th to the 6th week (MD, −0.61; CI, −1.01 to 0.20), respectively. Furthermore, very low-quality evidence suggests that this association was effective in improving shoulder pain disability for up to 6 weeks (up to 2 weeks, standardized mean differences [SMD], −0.65; CI, −1.25 to −0.06; 4th through the 6th week SMD, −0.48; CI -0.71 to −0.26).

Data synthesis

Comparison of spinal manipulation plus exercises with only exercises for pain intensity and shoulder pain disability showed that: after two and four to six weeks after treatment, there was a significant mean difference between groups for pain intensity pain and disability. At 6 months, there was no difference between the groups neither for pain intensity nor for disability.

Conclusion

The association of spinal manipulation with strengthening and stretching exercises can be more effective than isolated exercises for shoulder pain intensity up to 2 weeks and disability within 6 months.

Implications for practice

Physical therapists may associate spinal manipulation with exercises for shoulder pain, which may improve pain intensity and disability, especially in the initial treatment phase.