International Journal of Osteopathic Medicine最新文献

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.

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.

Context

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder with a prevalence that is on the rise. Despite a growing body of research, definitive etiology or universally beneficial treatments have not been identified. Patients and providers try therapeutic modalities beyond the conventional interventions, including osteopathic manipulative treatment or OMT. Reports on OMT as therapy for patients with ASD are few. These case reports seek to add to the small body of evidence supporting the use of OMT in patients with ASD.

Objective

To determine whether OMT can be a safe and effective therapeutic intervention for patients with ASD.

Methods

Three students with ASD at a non-public school for youths with ASD and neurodevelopmental disorders received a series of adjunctive OMT sessions and their clinical progress was monitored. These students received a specified series of OMT for at least eight weeks from a pediatrician trained in OMT. Symptoms, including communication, anxiety, classroom behavior, peer interaction and sleep were monitored by the OMT provider, the patient's primary psychiatrist, their parents, and their teachers.

Results

Patients receiving the OMT were observed by parents, teachers, and clinicians to demonstrate improvement in posture, gait, awareness, eye contact, communication, and an overall more relaxed state. All patients tolerated the OMT well with no adverse events reported.

Conclusion

OMT was well-tolerated and improvements were observed in the clinical cases. This series of three cases informs the development of a protocol to demonstrate the potential benefits of OMT for the treatment of ASD.

Implications for practice

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  OMT was well-tolerated in pediatric patients with autism spectrum disorder (ASD).

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  No adverse events/effects were reported in the case series of applying OMT for pediatric patients with ASD.

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  Pediatric patients with ASD who received OMT showed improved mood, concentration, posture, and other benefits as reported by clinicians, teachers, school administrators, and families.

Objective

To analyze the consistency of study designs in osteopathic manipulative treatment (OMT) research, focusing on blinding protocols and the use of sham treatments.

Data source and study selection

PubMed and CINAHL were searched in January 2022. A total of 83 research studies between 2009 and 2021 were selected based on the presence of a double- or single-blind study design and/or sham treatment.

Data extraction and analysis

Data regarding the primary outcome measures, blinding design, measures used to determine success of blinding, osteopathic technique used, and sham technique used for each eligible study were extracted and compared among different study designs.

Results

A total of 5968 subjects participated in the 83 trials. The study population mainly consisted of asymptomatic individuals (25 %) and chronic back pain patients (19 %). Light touch was employed most commonly (49 %) as the sham treatment, followed by unrelated sham (20 %) and incomplete maneuvers (20 %). Most studies blinded the subjects (80 %) or the outcome evaluator/data analyzer (71 %), while only 20 % studies blinded the osteopathic physicians.

Conclusions

Strict double-blinding is achievable for OMT clinical research by blinding the subjects and data collectors/analyzers rather than the osteopaths providing the actual treatment. The use of questionnaires to determine the success of blinding should be considered. Additionally, including OMT-naïve subjects is preferred to enhance blinding success. When designing a sham treatment, careful consideration should be given to blinding the data collector, accounting for the placebo effect, and incorporating an additional no-treatment control group to improve the rigor of the study design.

Implications for practice

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  There is a general paucity of osteopathic manipulative treatment (OMT) clinical trials. The design of OMT clinical studies has room to improve.

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  Double-blind can be achieved by blinding the subjects and evaluators and data collectors/analyzers, which is much more practical than blinding the osteopaths who provide the active treatments.

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  Various methods have been utilized as sham control for OMT, including light touch, unrelated sham, incomplete maneuver, no-treatment control, purposefully incorrect positioning, and combination of several techniques. Among them, light touch is most frequently adopted (49 % of studies).