International Journal of Osteopathic Medicine最新文献

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.

Background

Although manual therapy is an effective technique for increasing ankle range of motion, the dose-response required is unclear.

Objective

To find out what number of sessions of talus mobilizations will induce a detectable change in weight bearing ankle dorsiflexion range of motion of older adults with limited ankle mobility.

Design

Four-arm randomized clinical trial.

Setting

Community-dwelling.

Methods

62 older adults; aged over 60; with ankle dorsiflexion ROM below 35°. Four groups received from one to four treatment sessions. Each session consisted of 3 mobilizations of 30 s, with of the talus in anteroposterior glide, with a rest of 30 s. Grade IV mobilizations were applied to target the accessory movement of the ankle up to the resistance offered by periarticular tissues. The Lunge test was used to measure weight bearing ankle dorsiflexion.

Results

The four groups increased their ankle mobility after one session, but two sessions were needed to overcome the established 4.7°’ threshold, regardless of group. Only those participants who received four sessions maintained the improvements for 8 weeks.

Conclusions

Two sessions of talus mobilizations are effective in improving weight bearing ankle dorsiflexion ROM. It will be necessary to deliver four sessions of treatment if these improvements are to be maintained for at least 8 weeks.

Clinical trial registration number

NCT04563663.

Background

Low back pain is the main cause of global disability, with 13–30% of patients with low back pain reporting pain in the sacroiliac joint (SIJ). One of the clinical tests available for assessing SIJ mobility is the Downing test. However, information about the reliability and validity of this test is scarce in the scientific literature.

Objectives

To evaluate the construct validity and intra and inter-rater reliability of the Downing test.

Methods

Prospective study, in which the sample consisted of 30 individuals of both sexes. The evaluation team was composed of 5 researchers. The evaluations took place on two different days: (1st day) inter-rater reliability and construct validity; (2nd day) intra-rater reliability. The reference standard used for construct validity was three-dimensional measurements, using the BTS Smart-DX system. Statistical analysis: the percentage (%) agreement and the kappa statistic (k) were used.

Results

Moderate agreement was found for construct validity for the conclusion of the test (% agreement = 54.5%; k = 0.43; p < 0.01) and intra-rater reliability (% agreement = 66.7%; k = 0.43; p < 0.01). However, agreement was poor for inter-rater reliability (% agreement = 16.7%; k = 0.15; p < 0.05).

Conclusions

The construct validity of the Downing test was confirmed, only for the conclusion of the test, and it is reliable when applied by the same rater to healthy people, even if the rater has only 2 years of experience. The test is unreliable when it is performed by different raters. We suggest further studies that investigate the measurement properties of the Downing test, especially in symptomatic patients.

Background

Patellofemoral Pain Syndrome is the most common cause of anterior knee pain, especially in active young people. This study aimed to evaluate the effect of lumbopelvic manipulation on electromyography parameters of gluteus medius and vastus medialis in patients with patellofemoral pain syndrome.

Methods

In this double-blind placebo-controlled randomized clinical trial study, 26 patients with a diagnosis of patellofemoral pain syndrome were randomly divided into two groups. The first group received Lumbopelvic manipulation and the second group was a control group that received placebo manipulation. Electromyography activity of vastus medialis and gluteus medius muscles were evaluated as primary outcomes during the single-leg squat; pain intensity during rest and functional tasks (step up, step down, single leg squat) were assessed by numerical pain rating scale. Functional status was evaluated by step-down test and the score of the Kujala patellofemoral questionnaire, as secondary outcomes. All evaluations were performed before and after the intervention, except pain intensity at rest and the Kujala patellofemoral questionnaire that were assessed before the intervention and one week after.

Result

In both groups, no significant difference was observed before and after the intervention in terms of average amplitude and the onset of gluteus medius and vastus medialis. However, in the lumbopelvic manipulation group, pain intensity during rest and functional tests significantly decreased compared to the control group. Functional status significantly improved in the lumbopelvic manipulation group, with no significant difference between group comparisons.

Conclusion

Lumbopelvic manipulation caused a reduction in pain intensity and improvement of functional status in the rehabilitation of patients with patellofemoral Pain Syndrome. However, it seems that this method could not change the EMG activity of muscles in these patients.

Implications for practice

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  The results of present study can help physiotherapists to understand the possible underlying pathomechanics of patellofemoral pain syndrome and more effective treatment of these group of patients.

Background and objective

Research is a fundamental component of evidence-based practice. This scoping review will explore what peer reviewed empirical studies have been published between January 2010–March 2021 where osteopathic manual therapy (OMT) is used as an intervention. A deeper understanding of what research comprises the osteopathic body of literature may support osteopaths in their clinical decision making process.

Methods

A 5-stage scoping review framework was followed. Finalised search terms were applied to four databases: PubMed, ScienceDirect, EBSCO and BASE. Reference lists of yielded articles were checked until evidence saturation occurred. Extraction fields included author, year of publication, study population and sample size, methodology, intervention, and comparator. Articles were also grouped into 10 broad categories based on the overarching topic of exploration.

Results

A total of 292 studies were included for review, 189 studies were determined as quantitative research with three qualitative and one mixed methods study. The remaining studies comprised 78 case report/case series and 24 systematic reviews. Musculoskeletal, neurological and paediatric categories made up 64% of the total literature.

Conclusion

The osteopathic literature is largely dominated by quantitative research. Yielded studies covered a range of topics. However, the number of isolated research publications gives a fragmented impression of the literature and research gaps suggest inconsistent coverage in some areas. Osteopathic research may benefit from a more considered research agenda where research is methodically generated to fill contextual gaps in the literature.