International Journal of Osteopathic Medicine最新文献

Background

Neural structures of cardiac sympathetic and parasympathetic conduction emerge from the segments of the cervicothoracic spine. The application of high-velocity low-amplitude (HVLA) techniques at this segment can generate responses in heart rate (HR), blood pressure and sympathetic nervous activity of the skin. However, it is not known whether these responses occur in subjects with C7-T1 dysfunction.

Objective

To evaluate the effects of HVLA technique in cervicothoracic junction in HR, blood pressure and skin temperature (ST), in subjects with C7-T1 dysfunction.

Design

This is a randomized crossover trial.

Methods

Twelve male subjects were randomized into two groups: HVLA and Sham. HVLA group received a single manipulation technique for C7-T1 dysfunction, while the sham group received a simulated HVLA. HR, blood pressure and ST were measured pre, immediately after and 10 min after the application of the interventions.

Results

Immediately after the application of the interventions, an increase in HR, systolic blood pressure (SBP) and ST was observed, in addition to a reduction in diastolic blood pressure (DBP). Also, 10 min after, a significant reduction in SBP and DBP was observed in the HVLA group when compared to Sham group.

Conclusion

The application of a single HVLA technique in the cervicothoracic junction produced significative effects on HR, BP and ST in subjects with C7-T1 dysfunction.

Implications for Practice

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  This study showed that a musculoskeletal technique has effect on autonomic nervous system, suggesting that there are still hidden mechanisms behind HVLA techniques.

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  HVLA techniques for cervicothoracic junction can generate changes in cardiovascular variables.

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  HVLA techniques did not cause adverse hypertensive peaks.

Background

Australian osteopaths predominately work in private practice. The vast majority of patients who present to osteopaths fund their own care, with many receiving a rebate through their private health insurance cover. While there is little that describes the relationship between the Australian osteopathy profession and private health insurers, such information could provide an opportunity for insurers to improve coverage of osteopathy through enhanced benefits.

Objectives

To identify the extent of private health insurance cover available for osteopathy and to explore the attitudes of private health insurers towards the Australian osteopathy profession.

Methods

This qualitative study used: 1) content analysis of Australian private health insurers offerings for osteopathy, and 2) the Theoretical Domains Framework (TDF) to inform interviews with representatives from Australian private health insurers. The interviews were transcribed and coded with respect to the TDF.

Results

Of the 35 private health insurers in Australia, 33 offered benefits for osteopathy. Four interviews were conducted with representatives from the 10 largest private health insurers who provide benefits. Osteopathy represents a very small proportion of their services. The inclusion of osteopathic services is market driven. Private health insurance representatives had limited knowledge and understanding of osteopathy, however, they acknowledged the value that some of their members saw in receiving osteopathic care. Osteopathy is bundled with complementary and allied health services by 91.4% of insurers.

Conclusion

Osteopathy is included in the majority of Australian private health insurers’ offerings because the service value-adds to their products. Further research into the efficacy and cost-effectiveness of osteopathy as well as an educational campaign that provides private health insurers with information about the scope of osteopathy are needed to secure its ongoing inclusion in private health insurance in Australia.

Implications for practice

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  Benefits for osteopathic treatment are covered by most private health insurers in Australia.

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  Osteopathy is viewed favourably by these insurers.

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  The findings from this research will inform strategies to secure the ongoing inclusion of benefits for osteopathic treatment by private health insurers in Australia.

Throughout its history, osteopathic medicine has struggled to define its professional identity and distinguish itself from its allopathic counterpart. In this paper, we suggest that osteopathic medicine has an opportunity to define its unique professional identity by embracing the emerging science of evolutionary medicine. We outline the similarities between osteopathic and evolutionary medicine and highlight their shared history. We further emphasize how aspects of evolutionary medicine align with core osteopathic principles and philosophy. We conclude by suggesting ways in which evolutionary medicine concepts can be incorporated into the osteopathic medical curriculum.

Background

Femoroacetabular impingement (FAI) syndrome treatment is initially conservative, but the number of studies is limited.

Objectives

To examine the results of an osteopathic treatment approach in a patient with FAI.

Clinical features

The evaluation and osteopathic treatment of an 18-year-old male athlete diagnosis of left hip cam-type FAI are presented.

Intervention and outcomes

Exercises and protective measures were applied together with osteopathic techniques. Treatments were applied for 6 weeks, two days a week for a total of 12 sessions. The Numerical Evaluation Scale was used for pain evaluation. Functional scores were obtained by the Harris Hip Score, and deep squat test. Muscle strength was measured using the Handheld Dynamometer. Short Form-36 was used for the assessment of the quality of life. The final evaluations showed improvement in pain, function, muscle strength, and symptom-specific test results. Three weeks after the treatment, the patient made a complete return to sports, and there was no recurrence in the first year after treatment.

Conclusion

Osteopathic therapy may be effective in the conservative treatment of FAI. Well-designed clinical trials are needed to further evaluate this conclusion.

Sophisticated high-stakes licensure and specialty certification maintenance examinations are educational requirements in osteopathic medicine. Passing the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) USA Level 1 is one of the crucial milestones that osteopathic medical students (DO students) must achieve while starting clinical rotations and before applying to residency programs. While standardized examinations are often used for gatekeeping purposes, the broader goal of COMLEX USA Level 1 is to assess competent osteopathic physicians. This manuscript aims to assist DO students as well as osteopathic medical educators, learning specialists, medical advisors, and administrators in preparing a successful plan for the COMLEX USA Level 1. The tips within this manuscript align with the information taught in osteopathic medical school curricula, including osteopathic principles and practice (OPP), osteopathic manipulative treatment (OMT) and the content outline found within the National Board of Osteopathic Medical Examiners (NBOME) blueprint. The planning tip system is (1) Doctor of Osteopathic Medicine (DO) curriculum focus; (2) OPP/OMT content study; (3) Practice using clinical scenarios; (4) Review the NBOME blueprint; (5) Effective practice using question banks; and (6) Practice using full-length exams. Issues related to allocating DO students' time in preparation for the exam while providing useful resources to learn planning strategies and practice with board-style questions are discussed. Using the DO PREP tip system in this manuscript, DO students can develop more effective board preparation strategies to improve their success on COMLEX USA Level 1. This opinion-based article describes some but not all tips for osteopathic medical students to plan their COMLEX USA Level 1 board preparation.

Adductor Magnus, the largest single contributor to the adductor group of the medial thigh, is a broad functioning muscle with significant contribution to not only adduction, but extension and rotation at the hip. The aim of this review is to investigate the terminology, anatomical and functional characteristics of AM, particularly its role as an extensor and stabiliser at the hip. AM is anatomically divided into four portions: AM1 through AM4; and functionally divided into two portions: anterior and posterior. Functionally, through a range of activities AM has significant contribution to extension and rotation, and in some scenarios may generate greater hip extension torque than the hamstring group. Rehabilitation exercises should consider compound exercises including hip hinge, squatting and lunge variations to highly activate AM. This review suggests that AM, due to its unique anatomical and functional capabilities should be viewed as a primary extensor amongst a range of tasks and as such, injury identification and rehabilitation should include extension-based testing and resistance exercises to ensure optimal outcomes.

Background

There is limited evidence about spinal proprioception deficiency due to different injuries.

Objective

To compare spinal proprioception in patients with Lumbal Spinal Stenosis (LSS) and healthy controls. Secondary objective is to investigate the effect of pain intensity and Thoracolumbar fascia (TLF) flexibility on spinal proprioception deficiency.

Design

Cross-sectional and healthy controlled study.

Setting

This study was conducted in a state hospital.

Methods

Ninety participants (mean age: 46.98 ± 12.94 years) were grouped as: Healthy control (n = 30) (Group I), chronic low back pain due to LSS (n = 30) (Group II) and undergoing surgery due to LSS (n = 30) (Group III). Lumbar repositioning error (RE) was defined as reproducing a target position (neutral lumbo-pelvic posture) after tasks. Tasks were: 30° forward bending and 15° backward bending in sitting and standing.

Primary outcome measures

RE, pain intensity and TLF flexibility were assesed with iphone tilt-meter app, VAS and goniometric platform, respectively.

Participants

Sixty patients with LSS and 30 healthy controls.

Results

RE scores of Group II and Group III were significantly higher than Group I (p < 0.001). Group III had lower VAS scores (p < 0.001) than Group II, except during standing with backward bending task. TLF flexibility was not differed between Group II and Group III (p˃0.05). There was no significant association between VAS and RE scores in Group II and Group III (p˃0.05).

Conclussion

Individuals with LSS and healthy controls have different lumbar proprioception sense. TLF flexibility did not differ, due to different injury, in patients with LSS compared to healthy controls.

Objectives

Standards of osteopathic training and regulation differ by geographical location, and little is known regarding the evidence base for education within osteopathy. This review is the first to chart and appraise the osteopathic pedagogical literature and presents recommendations for further research and practice.

Methods

A scoping review was conducted using the Arksey and O'Malley framework. A search was conducted of EBSCO, OVID (Embase, Medline), CINAHL, Psycinfo, Open Grey, ProQuest and ERIC databases, to identify research related to osteopathic education. Review, selection, data extraction, characterization and Risk of Bias was performed by two independent reviewers and results were summarised using Critical Interpretive Synthesis.

Results

The search identified 66 research papers published from 2002 to 2022. The included papers varied in terms of purpose, methodology, and detail of reporting. The returns were grouped into five categories Teaching, Assessment, Clinical education and preparedness for practice, Curriculum and Miscellaneous. The evidence is generally of robust methodological quality, with bias rated as 29 Low, 26 Moderate, and 11 High. However, most of the methodological designs would traditionally be considered low on the hierarchy of evidence, with 19 commentary articles and the only Randomised Controlled Trial being rated High risk of bias.

Conclusions

The evidence regarding what is taught is underdeveloped and enhancing consensus regarding benchmarking of osteopathic education and minimum competencies is needed. Active learning was an area highlighted as preferred by learners as was self-directed study. This may also integrate more practical learning aids and electronic or online learning.

Background

Osteopathy is not a health profession in France but it was regulated in 2007. However, the profession is very popular, and the number of osteopaths is the largest in Europe. Since there is limited published data on the profile and characteristics of osteopaths practising in France, this study aimed to survey the current situation of osteopathic practitioners in France.

Methods

A voluntary online-based survey was distributed to French osteopaths between March and July 2022. This survey consisted of 52 questions adapted from the original French version of the validated Benelux Osteosurvey.

Results

A total of 1461 osteopaths responded to the study, of which 785 (53.73%) were female. The majority of respondents were aged between 30 and 39 years (50.65%), had full-time training (89.73%), during 5 years (67.15%), were self-employed (99.59%), advertised themselves exclusively as osteopaths (90.35%) and showed a solid professional identity. The median number of consultations per week was 21–25, and nearly one-third of respondents (31.42%) reported having other professional activities outside their clinical practice as an osteopath. Osteopaths in France manage acute and chronic complaints in all body areas but mainly in the spine.

Conclusions

This study provides a first overview of the current profile of osteopathic practitioners in France since 2012. At present, it constitutes a new informative report of their characteristics and provides several perspectives on the profession's development in terms of status and training.

Implications for practice

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  The majority of respondents were aged between 30 and 39 years, had undergone a full-time five-year training, advertised themselves exclusively as osteopaths and manifested a strong osteopathic identity.

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  Most reported being self-employed, and managing acute and chronic complaints located in all body areas, but mainly the spine.

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  Respondents expressed a strong desire for a greater integration of osteopathy into the French health system, especially through better collaboration with other healthcare professionals.