International Journal of Osteopathic Medicine最新文献

Background

Health care professions face increasing pressure to integrate research evidence into practice to improve patient outcomes. For many professions, the uptake of evidence-based practice (EBP) remains poorly understood, including for osteopaths in Canada. The primary aim of this study was to determine the perceptions, training, self perceived skills, use, barriers, and facilitators of EBP amongst Canadian osteopaths.

Methods

Canadian Osteopaths were invited to participate in an online survey using the Evidence-Based Practice Attitude and Utilisation Survey.

Results

Four hundred and eight osteopaths’ (response rate 13.4%) provided informed consent of which three hundred and forty answered all questions. The majority of respondents had a favorable perception and believed EBP was important (70.8%). Most respondents (>65%) rated their skills in performing EBP at a medium-high level. EBP use was infrequent among respondents. Barriers to the utilisation of EBP were lack of clinical evidence, time, and relevance to osteopathic practice. Facilitators of EBP use included having greater access to research articles and tools, and further information regarding critical analysis of research. Although searching and consulting research information was rarely performed by respondents, they were perceived as the most important aspect of clinical decision making along with clinical practice guidelines, personal and patient preferences.

Conclusion

Canadian osteopathic manual practitioners were largely supportive of EBP but there was limited commitment to its integration within clinical practice. Improving knowledge and skills of EBP, addressing the barriers of EBP uptake, and integrating EBP into educational programs may improve the uptake of EBP within osteopathic practice.

Implications for practice

There is acknowledgement of the importance and benefits of evidence-based practice amongst Canadian osteopaths.

Although Canadian osteopaths recognize the importance of evidence-based practice there is limited commitment to its use within clinical practice.

The major barriers to the use of evidence-based practice are a lack of time and clinically relevant osteopathic literature.

Canadian osteopaths state that patient preference, clinical practice guidelines, published clinical evidence and personal preference where the most important sources of information used for the basis of clinical decision making.

Interventions that aim to improve knowledge and skills, addresses barriers, and fosters alignment between osteopathic models and evidence-based practices may help to improve the uptake among osteopaths in Canada.

Background

Cognitive biases appear to be one of the most common causes of incorrect medical diagnosis. It affects students during their training and could persist after post-graduation. This could deteriorate patient care. Among them, anchoring bias can impair haptic perception and lead to a biased diagnosis.

Objective

Our study assessed the anchoring bias of first-year osteopathic students by determining whether information regarding the PRM rhythm could influence their haptic perception.

Methods

Forty first-year osteopathic students were randomly assigned to three groups. They were given different anchoring values during a PRM rhythm evaluation (3, 10 or 17 movements per minute, mpm). All information were given through video documents. Perceived rhythms were collected before and after anchoring. Wilcoxon and Kruskal-Wallis tests were used to compare intra and intergroup values.

Results

Before receiving the anchor, groups significantly (p = 0.105) perceived the same rhythms (11.8 ± 6.6mpm; 20.9 ± 9.9mpm; 18.2 ± 10.6mpm; respectively) with high variance among students. After receiving the anchor, students perceived significantly different rhythms; 3.5 ± 1.7mpm; 11.4 ± 2.8mpm; 16.8 ± 6.6mpm, respectively (p < 0.0001). Variance decreased significantly.

Conclusion

An anchoring bias might occur among first-year osteopathic students regarding their perception of the PRM rhythm. These results provide insights into the importance of the way of presenting information to students, especially controversial ones. Indeed, the way in which changing the ontological framework can modify the epistemological approach needs to be investigated. This could have implications on a student's clinical diagnosis. Students are encouraged to believe in their haptic ability, but also to use critical thinking.

Pseudoscience has harmful effects on individual patient care, professions and society more broadly. The propagation of pseudoscience and spread of misinformation by a healthcare discipline raises questions as to their legitimacy and ethical standing as a profession. Osteopaths and osteopathic physicians are regulated by law as healthcare professionals in many parts of the world with an expectation that relevant aspects of practice are suitably aligned with the scientific paradigm in the form of a commitment to the values of evidence-based practice. This article discusses the system of pseudoscience and considers its historic, present and potential negative impacts on osteopathy and professional progress. We identify possible incentives for some aspects of osteopathy and osteopaths to engage in pseudoscientific thinking and in doing so we discuss osteopathy's susceptibility to pseudoscience and how practitioners may become more aware of and recognise pseudoscientific information and pseudoexpertise.

Anatomy has been a cornerstone of osteopathic theory, practice and identity since the discipline's emergence in the 1800s and continues to be viewed as core knowledge to the present day. The domain of anatomical knowledge has provided seemingly endless rationales and explanations to justify osteopathic diagnosis, assessment and treatment. Moreover, knowledge of anatomy has been foundational for osteopaths' professional identity and conception of healthcare practice. Anatomical possibilism refers to the imagined, exaggerated, implausible and unproven relationships which are claimed to exist between anatomical structures. In persisting with such an approach to theory, practice and reasoning osteopathy may waste time, energy and intellectual capital and as a result fail to take advantage of opportunities to develop more plausible, ethical and person-focused approaches to patient care.

Background and Objectives

Patient-Reported Outcome Measures (PROMs) are instruments that capture patients' perspectives of their own health status and quality of life. As part of rising advocacy for their use in clinical practice, PROMs are said to hold promise for the management of long-term conditions. This study aimed to describe and explore New Zealand osteopaths’ use of PROMs for patients with chronic low back pain.

Methods

An online survey was adapted to investigate New Zealand osteopaths’ use of PROMs with patients who have chronic LBP. Topics included frequency of use, purposes for use, and determinants to use. Respondents were recruited via anonymous and non-randomised sampling across multiple platforms. Frequencies, means, and standard deviations were calculated for all numerical data. Content analysis was used to analyse textual data on determinants to use.

Results

In total, 79 osteopaths were included in data analysis. These respondents most often used PROMs to monitor patients’ pain intensity (80%) and sometimes also functional disability (27%). Although the respondents had some regard for their capability to use PROMs, they also claimed to be constrained by limited time and social or professional norms. Respondents were more attentive to the consequences of PROMs for patients than for other stakeholders.

Conclusions

Although New Zealand osteopaths may use PROMs to monitor the burden of chronic LBP, they probably do not use PROMs for the multidimensional assessment of pain or psychosocial factors. New Zealand osteopaths may be most receptive to adopting PROMs if they are presented with relevant interventions and evidence of their benefits for patients.

Background: Persistent and intractable hiccups are poorly understood and reduce the quality of life of afflicted patients. Hiccups lasting longer than 48 hours are defined as “persistent,” and those lasting longer than 30 days as “intractable.” Both persistent and intractable hiccups are rare diseases included in the National Organization for Rare Disorders (NORD) registry, with cases of intractable hiccups being extremely rare. There are limited effective treatment options currently available for both persistent and intractable hiccups.

Clinical features: Reported here is the case of a 25-year-old female patient with a 7-year history of intractable hiccups that were successfully treated with osteopathic manipulative treatment (OMT). Her hiccups began in 2015, typically occurring in couplets, with upwards of 50 hiccups per day. In 2016, she was treated by her primary care physician for H. pylori, with no improvement. Referred to a gastroenterologist, she underwent an endoscopy that showed normal findings, and she was subsequently referred to a neurologist. A CT scan of the brain was performed and showed normal findings, prompting the neurologist to suggest muscle relaxants (which were refused at the time) and various breathing and relaxation techniques, including talk therapy. With the continued failure of these treatments, the patient attempted acupuncture without benefit. In early 2022, the patient decided to try the muscle relaxant baclofen and found no benefit after two months of treatment.

Intervention and outcomes: In August 2022, osteopathic manipulative treatment (OMT) was administered over five sessions. After the third session, the patient noticed a complete absence of her typical hiccups but began experiencing frequent “micro” hiccups that produced little-to-no sound. After the fourth treatment and continuing past the fifth treatment, the patient has had a near complete cessation of her hiccups, about 1–2 “micro” hiccups per week. Follow up with the patient on May 1, 2023, confirmed the continued resolution of her intractable hiccups.

Conclusion: In a 25-year-old female patient without prior or concurrent medical conditions, OMT techniques successfully treated intractable hiccups of a 7-year duration. This case supports a potential role for OMT in the care of intractable hiccups.

Questions relating to osteopathic identity are likely to be characterised by double facets made up of both traditional and contemporary elements. The analysis conducted aims to be robust by presenting these components as elements able to dialogue. It is through Paul Ricoeur's concept that we propose as an approach: the idem identity concerns the elements that provide a certain temporal stability whilst the ipse identity embodies the variable aspects of the constitutive elements of osteopathy. Osteopathy's identity would thus be modelled by the association of these two regularly interacting influences insofar as they serve both issues: shaping a disciplinary specificity, and the requirements focused on the improvement of patient care.

Background

Limited evidence exists concerning the long-term follow-up of pain management in individuals with coccydynia.

Objective

This study aimed to examine the effectiveness of combining manipulation and exercise as a treatment approach for patients with coccydynia, while also assessing its long-term outcomes.

Design

Six months follow-up of a randomized controlled trial.

Setting

This study was conducted in a private hospital.

Methods

The control group (n = 23) received exercise alone, while the experimental group (n = 23) received both exercise and manipulation. All participants performed exercises three days a week for four weeks, and the manipulation sessions were conducted once a week for a total of four sessions. Pain levels were assessed using the Visual Analog Scale (VAS), coccydynia symptoms were evaluated using the Paris questionnaire, and pain-related disability was measured with the Oswestry Disability Index (ODI).

Participants

Forty-six participants were enrolled in the study.

Results

No statistically significant differences were observed in the demographic characteristics between the two groups (p > 0.05). However, participants in the manipulation group showed a statistically significant improvement in pain, symptoms, and ODI scores compared to the control group, both immediately after treatment and at the 6-month follow-up (p < 0.05).

Conclusion

This study demonstrates that the combination of exercise and intrarectal manipulation over a four-week period significantly reduced pain, coccydynia-related symptoms, and disability scores in chronic coccydynia patients. However, no therapeutic superiority was observed in the long-term follow-up of six months.

Objective

The aim of this pilot study was to determine which factors (both positive and negative) of a medical students' OMT training influenced their perception of OMT and their intent to use it in the future.

Methods

A computer-based survey was distributed to medical students (years 1–4) at two different campuses of an Osteopathic Medical School based in the United States. Multiple factors affecting students' perception of OMT were assessed, including experiences prior to medical school or during their pre-clinical years, virtual/in-person learning, OMT club, OMT clerkship, and OMT fellowship. Students were also asked about their confidence in using OMT, overall perception of OMT, and future intent to use OMT.

Results

Factors that appeared to positively influence medical students' perception of OMT were in-person hands-on training (76 %), prior medical school experiences (31 %), OMT club activities (19 %), and OMT fellowship (9 %). Those that appeared to negatively influence their perception were virtual learning (47 %) and pre-clinical lecture hours (46 %). Medical students' overall perception of OMT diminished when comparing first-year to third- and fourth-year students. Selecting an osteopathic school for OMT training also had a positive influence on a students' perception of OMT. Students who were satisfied and confident in their training reported a higher likelihood of using OMT in the future.

Conclusions

Students' attitude toward OMT and their reported likelihood of future use of OMT were improved by hands-on/in-person learning, clinical OMT opportunities, and OMT experiences prior to medical school. Greater attention must be focused on these forms of OMT education.