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ObjectiveThis study retrospectively evaluated the effect of OMT on length of stay (LOS) in hospitalized posterolateral postthoracotomy patients.MethodsInpatient medical records of patients who received posterolateral thoracotomies with lung resection between 1998 and 2011 were reviewed for demographic data, LOS, thoracotomy surgery data, consultation data excluding osteopathic manipulative medicine, discharge data, and osteopathic manipulative medicine consultation data.ResultsThirty-eight patients received posterolateral thoracotomies with lung resection; 23 patients received OMT and 15 did not. The mean (standard deviation) LOS was 11.0 (6.8) days (range, 5–29 days) for those who received OMT and 10.4 (5.5) days (range, 3–22 days) for those who did not (P = .90). Five patients developed postoperative ileus, and all had received OMT. Patients receiving 2 surgical procedures had a longer LOS than those receiving 1 surgical procedure (P = .002). Having a decortication performed during the thoracotomy increased LOS by a mean of 6.4 days (P = .005). Patients admitted directly to the intensive care unit were more likely to receive OMT than those who were not (P = .03).ConclusionWhile there was no difference in LOS, severity of illness was different between patients who received OMT and those who did not. Patients who developed postoperative ileus and most of those admitted directly to the intensive care unit received OMT, suggesting that severity of illness was greater for those who received OMT. Future studies should include a higher subject number in order to stratify for illness severity and also assess the effect of OMT on postoperative pain.

Background and Objectives Little is known concerning the preferences for technique selection by osteopaths in the United Kingdom (UK) for the treatment of spinal, pelvic and sacroiliac dysfunction or for the methods of documentation of dysfunction in case records. Part 1 described the perception of usefulness and reported use of physical assessment procedures. This second part surveys the treatment methods reported to be commonly used by UK osteopaths. Methods A web-based questionnaire using a 5-point Likert scale and open-ended responses was developed. Invitations were e-mailed to all registrants of the General Osteopathic Council in the UK with a listed e-mail address. The available response categories (strongly disagree, disagree, etc.) were converted into numerically weighted scales. Responses in the "frequently" and "nearly always" categories were combined for summary reporting purposes. Friedman tests were used to determine if significant differences existed for the reported usage of each item. The effect of gender was analysed using Mann–Whitney tests. The effect of years of practice was examined by categorizing practice experience by decade (0–9, 10–19, 20+) and analysing using Kruskal–Wallis tests. Results 520 Osteopaths (56% male, 44% female) participated in the survey, which was a 19% response rate. Procedures for the treatment of dysfunction of the spine reported to be most commonly used were passive joint articulation (91%) and soft tissue technique (91%), followed by prescription of patient self-stretches (76%) and high velocity low amplitude thrust (HVLA, 74%, p p Conclusion Survey respondent osteopaths in the UK use a large range of manual treatment techniques, with a preference for direct techniques, such as passive joint articulation, soft tissue technique, and HVLA. Females reported more frequent use of a number of procedures, which may represent a reporting bias, but male respondents reported more frequent use of HVLA.

Background Castlio and Ferris-Swift conducted a series of experiments in the 1930s testing the scientific basis for using splenic pump manipulation to stimulate the immune system. Their work is still cited as evidence that the splenic pump technique is beneficial. However, they only reported case summaries of the data, indicating what percent of the cases increased or decreased relative to baseline and, therefore, limiting the certainty of their conclusions. To our knowledge, no one has published research confirming their findings. Objective Our hypothesis is that an updated analysis of the raw data will support the original conclusions that splenic pump manipulation does increase leukocyte counts, lower the erythrocyte counts, not change the leukocyte differentials, and increase the opsonic index. Methods Wilcoxon signed rank tests were used to determine whether there was a significant change in blood cell counts, leukocyte percent differentials, and the opsonic index following splenic pump manipulation. Using Mann–Whitney U -tests, the change from baseline in leukocyte and erythrocyte counts for the first 23 cases managed by an honorary fraternity were compared to the cases managed by Castlio and Ferris-Swift. P values ≤0.05 were considered significant. Results Consistent with Castlio and Ferris-Swift's original conclusions, there was a statistically significant rise in the mean leukocyte counts, a decrease in the mean erythrocyte counts, no change in the leukocyte differentials, and an increase in the opsonic index following splenic pump treatment. However, subgroup analysis shows that most of the mean increase in the leukocyte count came from the first 23 subjects processed by a fraternity. The erythrocyte counts were less affected by this variable while the differential and opsonic index tests were unaffected because Castlio and Ferris-Swift performed these. Discussion Statistical analysis of Castlio and Ferris-Swift's published raw data lends support to their original conclusions. However, subgroup analysis showed a distinct difference, relative to the rise in serum leukocytes, between subjects managed by the fraternity and those managed by the Castlio and Ferris-Swift research team. Conclusion Modern, well-designed studies which incorporate demographic information, blinding methods to limit measurement bias, and a control group are needed to clarify the effect of the splenic pump on blood cell counts and other immune parameters.

Purpose: The objective of this study was to compare the responsiveness (ability to accurately detect change) of 3 self-administered questionnaires to changes produced by carpal tunnel release. Method: The Disabilities of the Arm, Shoulder and Hand (DASH), the Brigham and Women's Carpal Tunnel Questionnaire, and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were completed by 34 subjects before surgery and at 6 and 12 weeks after carpal tunnel release. Results: The instrument most sensitive to clinical change at 12 weeks as judged by effect size and standardized response means was the Carpal Tunnel Questionnaire (effect size/standardized response means, 1.71/1.66) followed by the DASH (1.01/1.13) and the Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain (0.57/0.52) and role physical (0.39/0.39) subscales. There was good correlation between DASH and Carpal Tunnel Questionnaire change scores (Spearman correlation coefficient 0.87). Conclusions: The Carpal Tunnel Questionnaire is the most sensitive to clinical change, but the DASH is sufficiently responsive for use in outcome studies of carpal tunnel syndrome done 12 or more weeks after surgery. (J Hand Surg 2003;28A:250-254. Copyright © 2003 by the American Society for Surgery of the Hand.)

Cutter NC, Scott DD, Johnson JC, Whiteneck G. Gabapentin effect on spasticity in multiple sclerosis: a placebo-controlled, randomized trial. Arch Phys Med Rehabil 2000;81:164-9. Objective: To investigate the effect of gabapentin on subject self-report and physician-administered spasticity scales in individuals with multiple sclerosis. Design: Prospective, double-masked, placebo-controlled, crossover design. Setting: The Multiple Sclerosis Center at the Denver Veterans Affairs Medical Center. Intervention: Subjects were titrated to either 900mg gabapentin orally three times a day or placebo over a 6-day period. Subjects underwent a 14-day washout and then were crossed over. No other changes were made to their medication regimen. Main Outcome Measures: The outcome measures were divided into two categories: subject self-report scales physician-administered scales. Subject self-report scales included the spasm frequency scale, spasm severity scale, interference with function scale, painful spasm scale, and global assessment scale. Physician-administered scales included the Modified Ashworth Scale, clonus scale, deep tendon reflexes, plantar stimulation response, and the Kurtzke Expanded Disability Status (EDSS) Scale. Digit Span and Digit Symbol subtests of the WAIS-R Intelligence Scale were administered to assess for possible impaired concentration. The Fatigue Impact Scale was administered to assess for changes in fatigue. The adjective generation technique was administered to assess for alterations in mood. Results: A statistically significant reduction in the impairment of spasticity was found in the gabapentin-treated subjects compared with placebo as measured by the self-report scales of the spasm severity scale, interference with function scale, painful spasm scale, and global assessment scale and by the physician-administered scales of the Modified Ashworth and plantar stimulation response. No significant difference was noted in the Digit Span, Digit Symbol, adjective generation technique, and EDSS. Conclusion: Gabapentin reduces the impairment of spasticity, compared with placebo, without the side effects of worsening concentration and fatigue. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Creaminess is used by consumers to describe the texture of many food products. The overall objective of this study was to investigate the underlying sensations to the acceptance of textural creaminess. Eight puddings varying in thickness, mouthcoating, rate of melt and smoothness were developed by altering the amount and type of starch, amount of milk-fat and amount of sodium salts. Puddings were evaluated by descriptive analysis for appearance, texture and flavor characteristics. Concurrently, consumers evaluated the puddings for “liking of creamy texture”. Sensory descriptive data were subjected to principal component analysis, resulting in a multidimensional product space that was related to the consumer acceptance data using the AUTOFIT selection strategy. More than 90% of consumer responses were selected and validated by AUTOFIT. A dimension related to thickness seemed important to consumer acceptance of creamy texture. In general, hedonic scores for creamy texture were higher for samples that were smoother and had more dairy flavor, although, hedonic scores for creamy texture varied considerably on dimensions related to dairy flavor and smoothness.

A test is presented for testing equality of two multivariate populations versus the alternative that the component wise differences between the two populations are ordered. A bootstrap estimate of the variance of the test statistic is proposed and the limiting distribution of the standardized form of the test statistic is shown to be N(0,1). Methods for conducting two-stage tests and an interim analysis are also presented. The joint null limiting distributions for the two-stage test statistics and the interim analysis test statistics are each shown to be bivariate normal.

Objective: To determine national patterns of defining agitation after traumatic brain injury (TBI) by physiatrists with expressed interest in treating TBI survivors. Design: A random sample of 70% of the members of the Brain Injury Special Interest Group (SIG) of the American Academy of Physical Medicine and Rehabilitation (AAPM&R) were surveyed by telephone. Results: The 129 members who responded yielded an 82% response rate. Respondents rated 18 characteristics from established rating scales on a 5-point scale according to each characteristic's relation to its clinical definition of agitation. Physical aggression, explosive anger, increased psychomotor activity, impulsivity, verbal aggression, disorganized thinking, perceptual disturbances, and reduced ability to maintain or appropriately shift attention were rated by at least 50% of the sample as very important or essential to agitation. Delirium, as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), has been proposed as a standard definition of agitation. The degree to which all characteristics from the 3rd revised edition of the DSM (DSM-IIIR), considered together, were perceived to relate to agitation predicted 24% of the degree to which the term "delirium" was perceived to relate to agitation (Canonical correlation r = .48, p = .0002). Physicians' ratings of individual delirium characteristics from the DSM-IIIR were examined to determine if a sufficient number were similarly ranked to fulfill the diagnostic criteria for delirium. A significant number of physicians rated diagnostic criteria for delirium in one direction, yet did not rank the term "delirium" accordingly (McNemar's p = .04). Conclusions: There is considerable variation among physiatrists in their rating of characteristics that define agitation. Many define agitation during the acute recovery phase as posttraumatic amnesia plus an excess of behavior such as aggression, disinhibition, and/or emotional lability. Less support was given to defining agitation by the DSM-IIIR or DSM-IV diagnostic criteria for delirium. Delirium appears related to, but is not sufficient for, a diagnosis of agitation.

Objective: Determine national patterns of measuring and treating agitation after traumatic brain injury (TBI) by physiatrists with expressed interest in treating TBI survivors. Design: A 70% random sample of members of the Brain Injury Special Interest Group of the American Academy of Physical Medicine and Rehabilitation was surveyed by telephone. Main Outcome Measure: The survey instrument was designed to determine the most common pharmacologic interventions for agitation and, where possible, match each drug with the target behavioral and cognitive characteristics for which it is prescribed. Data were also collected on the manner in which participants measured agitation and judged treatment efficacy. Results: One hundred twenty-nine of 157 responded, yielding an 82% response rate. The majority of respondents were not measuring agitation in a standard fashion. The five most frequently prescribed drugs by the expert stratum were carbamazepine, tricyclic antidepressants (TCAs), trazodone, amantadine, and beta-blockers. In comparison, the nonexperts most often reported prescribing carbamazepine, beta-blockers, haloperidol, TCAs, and benzodiazepines. Desyrel ( p = .06) and amantadine ( p = .001) were significantly more likely to be chosen by experts than by nonexperts. Experts chose haloperidol significantly less often than nonexperts ( p = .01). Prescription of sedating drugs such as haloperidol or benzodiazepines was not found to be associated with the acuity of injury of TBI patients in the respondent's practice, practice setting, or years of practice since completing residency. Choice of haloperidol to treat agitation was not significantly associated with the degree to which explosive anger, verbal aggression, or physical aggression were considered important to the respondent's definition of agitation. Conclusions: The majority of physiatrists surveyed did not formally measure agitation. Treatment strategies differ significantly between general physiatrists and those who specialize in the treatment of patients with TBI. The breadth of pharmacologic agents and strategies identified in this survey probably reflects the lack of research specific to the pathophysiology of the disorder of posttraumatic agitation.

Background Spinal manipulative procedures have been claimed to alter resting electromyographic activity (EMG) of paraspinal muscles, but the evidence is inconsistent. This study examined the effect of two osteopathic techniques, high-velocity low-amplitude (HVLA) thrust and counterstrain (CS), on resting EMG of the deep thoracic paraspinal muscles in regions that appear abnormal to palpation. Methods This randomized controlled crossover study was conducted using 3 treatments, HVLA, CS, and sham laser control, with a 1-week washout between. Dual fine-wire, intramuscular electrodes were inserted into the deep transversospinalis muscles at a thoracic level where the tissues appeared abnormal and tender to palpation (AbP), and at two normal sites superior and inferior to the AbP. Surface electrodes were placed over the erector spinae muscles adjacent to the AbP site. During the following conditions, pre- and post-treatment EMG signals were recorded while subjects were prone: 1. Resting before and after other conditions (baseline); 2. Two 3-s free neck extension tasks (EXT, a sub-maximal functional task); 3. Two 3-s resisted maximal voluntary isometric contractions (MVIC). Two second periods from each condition were processed and the mean amplitude (uV) was normalized to the highest pre-treatment MVIC reading. EMG scores for normal sites were averaged (NTav). Wilcoxon signed ranks tests were used to test whether the normalized baseline scores changed from pre- to post-treatment. Friedman tests were used to determine whether the change in muscle activity from pre- to post-treatment differed between treatments. Results Twenty-two participants were recruited [15 females and 7 males, mean age of 28.1-years (SD = 6.4), mean BMI of 23.8 kg.m −2 (SD = 6.4)]. Mean current pain intensity was 3.2 out of 10 (SD = 1.1). A significant reduction in baseline EMG was found following the CS treatment in the AbP (median decrease 3.3%; p = 0.01, d = 0.33), NTav (median decrease 1.0%; p = 0.05, d = 0.024), and surface (median decrease 2.0%; p = 0.009, d = 0.29) sites. A significant reduction in surface EMG following CS treatment during EXT was also found (median decrease 2.7%; p = 0.003, d = 0.20). EMG activity from other sites and following other treatments was not significantly changed. There was a significant between-group difference in baseline activity for the surface site ( p = 0.02, d = 0.58); the change for the CS treatment (median decrease 2.0%) was larger than the change for the HVLA treatment (median increase 0.6%). There were no other significant differences between the treatments. Conclusions CS appeared to produce small significant reductions in paraspinal muscle activity during resting and free neck extension conditions, whereas the other treatments produced no change. However, given the very small reductions produced, clinical relevance of these changes is unclear.

Introduction: One of the most important notions in osteopathy is that our body structures possess a certain freedom of motion, which is necessary to function properly. We also know that respiration influences the motion of the heart. This study proposes a method to quantify this motion of the heart. Design: Observational study Methods: A Gyroscan T10-NT (magnetic resonance) has been used. In order to obtain a good three-dimensional image, localizer images were made in the three orthogonal planes (axial, sagittal and frontal). After this images were made in the long axis (two-chamber view), short axis and four-chamber view. Images were made in expiration, inspiration and in neutral position using ECG-triggering. The research group for this study consisted of 10 healthy subjects (5 men, 5 woman). A total of 5021 images were made and all results were analysed with the Friedman test, with significant results if p p

Gary Fryer , Michael Bird , Barry Robbins , Jane C. Johnson d a A.T. Still Research Institute, Kirksville, MO, USA; Department of Osteopathic Manipulative Medicine, Kirksville College of Osteopathic Medicine, Kirksville, MO, USA; Centre for Aging, Rehabilitation and Exercise Science, Victoria University, Melbourne, Australia b Truman State University, Kirksville, MO, USA c Kirksville College of Osteopathic Medicine, Kirksville, MO, USA d A.T. Still Research Institute, Kirksville, MO, USA