International Journal of Osteopathic Medicine最新文献

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.

Background & objective

A 23-year-old female, with ongoing hiccups for five years, known as intractable singultus, was managed with osteopathic manipulative treatment (OMT) to decrease her hiccup bouts and decrease the following associated symptoms: mid-thoracic back pain, nausea, vomiting, reflux, eructation, and abdominal pain. Unlike other documented OMT-managed singultus cases, this patient had no known chronic medical conditions, a limited past medical history, and the longest documented case of singultus to be treated with OMT.

Methods

The patient was evaluated at six visits, four including OMT. Areas of somatic dysfunction were treated with myofascial release, muscle energy technique, counterstrain, and high velocity low amplitude. Objective measures include patient-recorded singultus bouts before and after treatment.

Results

Prior to OMT, the patient averaged approximately 60 hiccups per day with a recorded maximum of 97 hiccups. After the first OMT session, the average number of daily hiccups was reduced nearly 50% (∼30 hiccups per day), and the maximum was reduced by approximately 39% (59 hiccups per day). Additionally, with the exception of mid-thoracic back pain, there was a reduction in associated symptoms of eructation, reflux, abdominal pain, nausea (resolved), and emesis (resolved), which improved the patient's quality of life.

Conclusions

There is little literature surrounding the applications of OMT in the management of chronic and intractable singultus. Thus, this case serves as a foundation for future publications. Based on this case, the authors propose that OMT appears to be a safe, noninvasive management option for patients with singultus, relieve associated symptoms, and potentially decrease singultus-related complications.

Background

Osteopathy has been shown to be effective in the management of chronic low back pain (LBP). Guidelines recommend biopsychosocial care for chronic, complex musculoskeletal conditions, including non-specific LBP.

Objectives

This study has four aims: 1/to assess how patients with LBP improve after osteopathic treatment, both before and after an osteopath has completed a Biopsychosocial Pain Management course; 2/to assess if it is feasible and acceptable for osteopaths to receive weekly SCED data and use it to guide patient management; 3/to assess if it is acceptable for patients to submit daily data and discuss weekly summary with their osteopaths; and 4/to test feasibility for researchers in collecting, managing and storing large quantities of individual patient data.

Methods

A multiple baseline single case experimental design trial with up to 10 UK osteopaths with more than 15 years in practice and 60 patients will assess how change occurs as a result of osteopathic treatment for patients with non-specific LBP of more than 12 weeks’ duration. Statistical analysis will assess the degree and rate of change between baseline, intervention and follow-up periods, and whether differences in effect are observed after the osteopaths have completed the biopsychosocial patient management training course. Primary outcomes will be the Numeric Pain Rating and Patient Specific Function Scales, measured daily at baseline and for 6 weeks during the intervention stage, and weekly or fortnightly during a 12-week follow-up period.

Ethics

This research was approved by the University College of Osteopathy Research Ethics Committee.

Background

The prevalence of natural menopause means that middle aged women seeking osteopathic treatment are likely to have symptoms, but it is unknown how osteopaths explore and give advice about it.

Aim

To explore osteopaths’ experiences of screening for symptoms of menopause and providing advice to climacteric patients.

Methods

Elements of interpretative Grounded Theory, via semi-structured interviews with a purposive sample of six experienced osteopaths and constant comparative analysis to identify themes.

Results

Three themes emerged: Breaking the ice - describing the menopause as a sensitive topic with social, personal, and professional barriers to explore it; Personal - not so personal - revealing the influence of practitioners' personal experiences of the menopause; and Storytelling - illustrating osteopaths’ narratives about patient interactions.

Conclusions

The three themes combined flexibly to form partially overlapping therapeutic approaches, underpinned by participants' personal experience of the menopause and conception of osteopathy. Sharing Stories, where personal disclosure is leveraged to enhance the rapport, with links to the Communicator therapeutic approach; Telling Stories, where the absence of personal experience led to a de-personalised narrative and elements of the Treater approach; and Changing the Story, where personal experience plays no role and the focus is on patients’ empowerment (Educator approach). Further research is needed to explore findings on osteopaths without personal experience of menopause and to evaluate osteopaths’ training to address sensitive topics.

This commentary critically examines the foundational assumptions, practices and claimed distinctiveness upon which osteopathy was built and continues to be structured. Five areas which are considered to be highly problematic for osteopathy, namely its weak theoretical basis, inherent biomedicalism, monointerventionism, default practitioner-centredness and predilection for implausible mechanisms. It is argued that these areas require considerable reflection and action as if not remedied, they constitute a major threat to the development, unity and legitimacy of the osteopathic profession. Ongoing reconceptualisation of underpinning theories, assumptions and associated skills informed by current evidence and knowledge from disciplines outside of the osteopathic domain is necessary for professional maturation.

Implications for practice

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  Osteopathy's weak theoretical basis, biomedicalism, monointerventionism, practitioner-centredness and implausible mechanisms are problematic.

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  These constitute a major threat to the development, unity and legitimacy of osteopathy.

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  Ongoing critical reflection, practice reconceptualisation and research are needed for professional maturation.

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  Osteopaths should draw on theory and evidence from outside the osteopathic domain.