International Journal of Osteopathic Medicine最新文献

Background

Graves' Disease (GD) is an autoimmune disorder, with ∼50% of GD patients developing Graves’ Ophthalmopathy (GO). Common presentations include lid retraction, exophthalmos, disfigurement, ocular pain, and pressure. Treatment of GD depends on disease severity, ranging from artificial tears to ocular surgeries. Patients with GO symptoms experience a decreased quality of life (QoL) and could benefit from additional treatment options.

Objective

This case report describes the use of osteopathic manipulative treatment (OMT) as an adjunct to standard care for a patient with symptomatic GO, and measurement of treatment response with a standardized QoL assessment tool.

Clinical features

Clinical evaluation of a patient with GO showed clinical activity score to be 4 with oppressive feeling behind globes, hyperemia, and eyelid edema. Corneal displacement measured by Hertel exophthalmometer indicated increased proptosis. CT scan showed enlarged extraocular muscles bilaterally, with signs of edema in retrobulbar fat. Visual acuity and optic nerves were within normal limits.

Intervention and outcomes

This case report demonstrates the use of OMT in long-term reduction of ocular pain and pressure by relieving orbital myofascial tension along with improving ocular circulation, in a patient with GO. Using the European Group On Graves’ Orbitopathy QoL questionnaire, the patient noted better quality of life (93, 81.3 for pretreatment visual and appearance scores, respectively, and 100, 87.5 for post-treatment visual and appearance scores, respectively) and perceived reduced exophthalmos.

Conclusions

Providing OMT as a cost effective, non-invasive treatment option for GO symptoms could meet a significant need for GO patients and warrants further study.

Background

The ability of patients suffering from knee osteoarthritis to carry on routine daily activities is a significantly valuable target.

Objectives

This study aimed to assess the effect of quadriceps and hamstring taping using kinesio tape on knee pain, function and range of motion (ROM) in patients suffering from knee osteoarthritis.

Methods

Twenty-four patients, ages ranging between 50 and 70 years, diagnosed with chronic knee osteoarthritis were randomly allocated into two equal groups. Group (A) received kinesio tape on quadriceps and hamstring muscles in addition to conventional exercises while, group (B) received solely conventional exercises. Pain, knee flexion ROM and function were assessed using the visual analogue scale (VAS), the universal goniometer and Western Ontario and McMaster Universities Osteoarthritis Scale (WOMAC) respectively. Both groups were assessed before and after four weeks of treatment.

Results

Mixed Design Multivariate Analysis of Variance (MANOVA) revealed non-significant differences between groups in pain, ROM and WOMAC (P > 0.05) post-treatment. Additionally, pairwise tests revealed significant reduction of VAS and WOMAC with significant increase in ROM (P < 0.05) for group (A) post-treatment. While group (B) showed significant reduction of VAS and WOMAC (P < 0.05) with non-significant change in ROM (P = 0.109) post-treatment.

Conclusion

Quadriceps and hamstring taping in addition to conventional exercises has no more effect than conventional exercises alone for decreasing pain and disability and increasing ROM in patients suffering from chronic knee osteoarthritis.

Objective

This study arose from a praxial problem: how best to communicate with patients about the mechanism of cranial osteopathy. The research question was rooted in the phenomenological concept of ‘sense-making’, and was expressed as: ‘What sense do osteopaths and their patients make of the phenomenon of cranial osteopathy?’

Method

Interpretative Phenomenological Analysis (IPA) was used to explore the ‘lived experience’ and embedded sense-making of pairs of osteopaths and patients. Four Fellows of the Sutherland Cranial College of Osteopathy (SCCO) participated, as did one patient of each. The osteopath participants were experienced practitioners, and the patient participants had had positive experiences of cranial osteopathy. The participants were interviewed about their experience of the phenomenon of cranial osteopathy. The semi-structured interviews were audio-recorded, transcribed, and analysed. The analysis was audited alongside the use of a reflexive diary and an account of the theoretical ‘fore-structure’ of the principal investigator, in order to monitor influences on their hermeneutic analysis of the data.

Results

The IPA revealed that both patients and practitioners establish epistemological grounds for their sense-making about their embodied experience of cranial osteopathy (Theme 1: Making sense of sense-making), that they use embodied metaphor and linguistic meta-metaphor to understand their lived experience of cranial osteopathy (Theme 2: Metaphors for mechanisms), and that the mechanism of cranial osteopathy is considered by both patients and practitioners to arise in part from the therapeutic relationship (Theme 3: The meaningful osteopathic relationship).

Conclusions

The main outcome of the study is a hermeneutic model of cranial osteopathy, which posits that the shared, embodied therapeutic relationship facilitates a collaborative rapport which enables the osteopath and the patient to come to an understanding of the source of the patient's malady, and that this understanding is the causal context for the patient's lived experience of better health.

Background

Rotator cuff dysfunction is the main cause of shoulder pain. The shoulder and the diaphragm have an important relationship through the myofascial system and through its innervation.

Objectives

To analyse the effect of diaphragm manual therapy on the symptoms of patients with rotator cuff injury compared to manual treatment on shoulder muscles.

Design

A randomized, controlled, single-blind trial of 45 participants diagnosed with rotator cuff injury.

Method

The sample were divided into 3 groups of treatment.

1. Manual treatment over the shoulder by ischemic compression of myofascial trigger points (MTP) (Control/Shoulder group -SG-).

2. Diaphragm manual therapy techniques (Diaphragm group -DG-).

3. Active diaphragm mobilization by hypopressive gymnastic exercise (Breathing group -BG-).

Shoulder pain using a numerical rating scale (NRS), shoulder range of motion (ROM), and pressure pain threshold (PPT) were evaluated, and compared between groups.

Results

Both the SG and DG showed a clinically significant improvement, as well as a significant effect size, on the NRS in shoulder flexion and abduction movements. Regarding ROM improvement, only the SG obtained a significant effect size (abduction and external rotation). The PPT at the xiphoid process of the sternum showed a clinically significant improvement in the DG.

Conclusion

Indirect treatment of the shoulder through a protocol of manual therapy techniques on the diaphragm and intervention on MTP of the rotator cuff have been clinically effective in reducing pain on the NRS immediately, in flexion and abduction movements of the shoulder, and more effective compared to the intervention in the breathing group.

Clinical trial registration number

NCT03293329.

Objective

This study aimed to investigate the effects of osteopathic manipulative treatment (OMT) combined with transcranial direct current stimulation (tDCS) in individuals with chronic nonspecific low back pain (CNSLBP).

Methods

This will be a randomized controlled clinical trial of three groups with blinded evaluators and participants. The study will be conducted at the at the Rehabilitation Center of the Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.

Participants

72 participants of both sexes, with CNSLBP.

Intervention

Participants will be randomly allocated into three groups, with 24 participants per group (Group 1: active tDCS + active OMT; Group 2: placebo tDCS + placebo OMT; Group 3: placebo tDCS + active OMT). Assessments will be conducted before and after the intervention protocol and 1 month after the end of the entire process. For tDCS, 10 sessions of 20 minutes over 2 weeks (5 sessions per week). OMT will be performed by an osteopath, with two consultations, one per week, before the first and sixth sessions of tDCS.

Main outcome measures

The primary outcome will be the visual analog pain scale, and the Roland Morris disability and EuroQol-5D quality of life questionnaires will be used as secondary.

Analysis

The statistical analysis will be calculated using linear mixed models and based on intention-to-treat. The level of significance will be set at α = 5%.

Background

The future health and longevity of the osteopathy profession relies heavily on its practitioners and industry stakeholders to support it. Possessing a deeper understanding of practitioner and stakeholder views of the profession may provide crucial insights into the wellbeing of the workforce and their perceived skills and expertise in the wider healthcare landscape.

Objective

To provide a review of current and emerging attitudes, beliefs and behaviours of Australian osteopaths and supportive external stakeholders towards the profession.

Methods

A qualitative approach using grounded theory explored the attitudes, beliefs and behaviours of Australian osteopaths and supportive external stakeholders. Purposive sampling identified 18 practitioners (Victoria 10, Western Australia 5, and New South Wales 3) and 6 external stakeholders. All participated in semi-structured focus groups. A constant comparative method followed data collection whereby repeated ideas formed the extraction of the emerging themes presented.

Results

Central themes for each group included: 1) practitioner wellbeing and 2) osteopathic skills and expertise. Subthemes included: 1) career sustainability and longevity for practitioners, and 2) osteopathy within the broader context of allied healthcare in Australia.

Conclusion

Threats to practitioner wellbeing included lack of early career support, limited career pathways, and uncertainty surrounding the future of the profession. External stakeholders echoed similar concerns regarding the future of the profession, acknowledging whilst osteopathy may play a sustainable role in managing the health and wellbeing of Australians, their skills and expertise are not unique nor exclusive to the profession, are under-evidenced, and undervalued by other healthcare professionals. Fostering a healthy and fulfilled workforce lies in securing a sustainable role for the profession by addressing these limitations.

Objectives

Chronic low back pain (CLBP) is one of the leading causes of disability worldwide and its related healthcare costs are constantly increasing. Imaging studies have limited clinical utility in managing this condition and their overuse can lead to negative effects on patients. Clinicians' and patients' misconceptions seem to be one of the main drivers of such unnecessary use. However, there is a lack of research investigating osteopaths' views on imaging. This study explored Italian osteopaths’ attitudes and beliefs towards imaging and its utilisation in the clinical evaluation and management of CLBP patients.

Methods

A qualitative study, using elements of constructivist grounded theory, was conducted by means of semi-structured interviews. A purposive sampling approach was used to recruit 14 osteopaths practising in Italy with clinical and educational experiences. Data were collected until real saturation, transcribed verbatim and coded by using qualitative thematic analysis identifying categories, concepts and themes.

Results

Two main themes were identified with seven subcategories. The overarching themes were 1) Clinical relevance and utility; 2) Interacting with the patient through a biopsychosocial perspective.

Conclusion

The findings highlight that imaging plays a marginal role in the interviewed osteopaths' clinical practice, except for ruling out red flags or contraindications for treatment. Participants have shown awareness about the potential negative effects of imaging in CLBP patients. They underlined the need to reassure and educate patients to minimise the psycho-behavioural impact of diagnostic investigations on patients’ condition and also to provide a clinical value of their use, especially in relation to the complex and multidimensional nature of CLBP.