Search

The implementation of information technologies into treatment practice of modern health care significantly increases efficiency of diagnosis and treatment of dorsopathies. The purpose of the study is to develop software module to evaluate post-urological status of patients with spine dorsopathy to optimize diagnostic process and treatment planning. The article describes application of original software module to assess the post-urological status of patients with spine dorsopathy. The proposed software module is designed for objective assessment of post-urological status of patients with spine dorsopathy based on photographic images of examined patient. The most important advantage of software module is built-in forecasting function that is implemented by calculation of severity of pain perceptions and movement disorders using generated regression equations. The possibility to record data obtained during measurements permits to store information in single system. The implementation of software module into clinical practice will contribute to qualitative improvement of diagnostic processes, simplify work of osteopath and reduce the time spent on examination.

Background: Individuals who experience migraines often seek out a variety of treatment options including manual or physical therapy. Evidence suggests that manual therapy, including osteopathy, can play a role in the management of migraines. Whilst there is some literature on the role osteopathy therapy plays in migraine management, none describes the treatment approaches used by practitioners., Objectives: To explore the demographic, practice and clinical management characteristics of Australian osteopaths who report treating migraine 'often' in clinical practice., Methods: Secondary analysis of a cross-sectional survey of 988 osteopaths from the Osteopathy Research and Innovation Network (ORION), an Australian practice-based research network. Regression analysis was used to identify demographic, practice and clinical management characteristics of Australian osteopaths who reported 'often' treating migraine patients., Results: Over 40% of respondents (n = 400) indicated treating patients with migraines 'often'. These osteopaths were less likely to be involved in research and be co-located with a dietician compared to osteopaths who do 'not often' treat migraine. Osteopaths who reported 'often' treating migraine were: five times as likely to treat non-English speaking ethnic groups; 2.5 times as likely to treat chronic pain, temporomandibular joint disorders and hand musculoskeletal complaints; compared to those that do not treat migraines 'often'., Conclusion: Australian osteopaths who treat migraine are five times more likely to treat non-English speaking ethnic groups; twice as likely to treat chronic pain; temporomandibular joint disorders, and hand musculoskeletal complaints. More research is needed to identify the practices and patient outcomes associated with osteopathy care for those experiencing migraines., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.)

Background: This study describes osteopathic practise activity, scope of practice and the osteopathic patient profile in order to understand the role osteopathy plays within the United Kingdom's (UK) health system a decade after our previous survey., Method: We used a retrospective questionnaire survey design to ask about osteopathic practice and audit patient case notes. All UK registered osteopaths were invited to participate in the survey. The survey was conducted using a web-based system. Each participating osteopath was asked about themselves, their practice and asked to randomly select and extract data from up to 8 random new patient health records during 2018. All patient related data were anonymised., Results: The survey response rate was 500 osteopaths (9.4% of the profession) who provided information about 395 patients and 2,215 consultations. Most osteopaths were self-employed (81.1%; 344/424 responses) working alone either exclusively or often (63.9%; 237/371) and were able to offer 48.6% of patients an appointment within 3 days (184/379). Patient ages ranged from 1 month to 96 years (mean 44.7 years, Std Dev. 21.5), of these 58.4% (227/389) were female. Infants <1 years old represented 4.8% (18/379) of patients. The majority of patients presented with musculoskeletal complaints (81.0%; 306/378). Persistent complaints (present for more than 12 weeks before appointment) were the most common (67.9%; 256/377) and 41.7% (156/374) of patients had co-existing medical conditions. The most common treatment approaches used at the first appointment were soft-tissue techniques (73.9%; 292/395), articulatory techniques (69.4%; 274/395) and high velocity low amplitude thrust (34.4%; 136/395). The mean number of treatments per patient was 7 (mode 4)., Conclusion: Osteopaths predominantly provide care of musculoskeletal conditions, typically in private practice. To better understand the role of osteopathy in UK health service delivery, the profession needs to do more research with patients in order to understand their needs and their expected outcomes of care, and for this to inform osteopathic practice and education., Competing Interests: AP (corresponding author) is a Director at the Institute of Osteopathy, the members’ organisation for the UK’s osteopathic profession. We confirm that this does not alter our adherence to all PLOS ONE policies on sharing data and materials, and does not influence our sharing of data and/or materials.

Objective: The use of Patient Reported Outcome Measures (PROMs) to evaluate care is being advocated increasingly in clinical settings. Electronic data capture is both resource and environmentally friendly and convenient. This purpose of this study was to test and implement a nationwide system to collect routine PROM data from osteopathic patients using a web and mobile app., Methods: A prospective study design was used to monitor outcomes of care for patients attending osteopathic clinics. Demographic and service data were collected, the primary outcomes were the Bournemouth Questionnaire and a Global Rating of Change score. Data concerning patients' satisfaction and experience of care were collected also. Data were collected at baseline, one week, and six weeks post-treatment., Results: A total of 1721 patients completed the PROM app questionnaire. The majority (65.8%) of patients who used the PROM app were between 40 and 69 years old with 11% being 70 years and over. At baseline 39.8% of patients reported they'd had their symptoms for 13 weeks or more. Low back pain was the most common symptom (55.8%). Patients reported high scores for both satisfaction and experience of osteopathic care: 88.1% were very satisfied at six weeks post-baseline and 93.5% reported very good experience at six weeks post-baseline. Data from the Global Rating of Change scale indicated that at one week post-baseline 89.1% of patients reported some measure of improvement, and at six weeks this figure rose to 92.8%. The mean sum score for the Bournemouth Questionnaire went from 30.8 at baseline to 13.3 at six weeks post-baseline. This represented a significant and clinically meaningful positive change score of 56.8%., Conclusion: The app was well-completed and the data very encouraging. These data will help to form the basis for standards of care for patients attending osteopathic practices., Competing Interests: Carol Fawkes is employed as Senior Research Officer at the National Council for Osteopathic Research (NCOR) and Dawn Carnes is Director of NCOR. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Context: A common reproach precluding the use of osteopathic manipulative medicine (OMM) in pediatrics is a lack of evidence regarding its safety, feasibility, and effectiveness., Objective: We conducted a systematic, scoping review of pediatric osteopathic medicine to identify gaps in the literature and make recommendations for future research., Data Sources: We searched 10 databases using 6 key words and medical subject heading terms for any primary articles reporting OMM use in children published from database inception until initiation of the study., Study Selection: Articles were selected if they reported primary data on OMM conducted in the United States on patient(s) 0 to 18 years old., Data Extraction: Baseline study characteristics were collected from each article and the Grading of Recommendations, Assessment, Development, and Evaluations system was used to critically appraise each study., Results: Database search yielded 315 unique articles with 30 studies fulfilling inclusion and exclusion criteria. Of these, 13 reported the data required to demonstrate statistically significant results, and no significant adverse events were reported. The majority of studies were graded as providing weak clinical evidence because of significant methodologic flaws and biases., Limitations: The review was limited to US-based studies and reports. Minimal discrepancies between reviewers were resolved via an objective third reviewer., Conclusions: There is little strong, scientific, evidence-based literature demonstrating the therapeutic benefit of OMM for pediatric care. No strong clinical recommendations can be made, but it can be medically tolerated given its low risk profile. High-quality, scientifically rigorous OMM research is required to evaluate safety, feasibility, and efficacy in pediatrics., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2021 by the American Academy of Pediatrics.)

Background and Objective: Many children receiving chemotherapy struggle with therapy-induced side effects. To date, there has been no literature investigating the needs, knowledge, or implementation of osteopathic manipulative treatments (OMT) as a supportive care option in pediatric oncology. We hypothesized that pediatric oncology clinicians, caregivers, and patients have (a) limited knowledge of OMT and (b) dissatisfaction with current supportive care options and (c) would be interested in having OMT available during chemotherapy, once educated., Methods: Participants included three cohorts: (1) children aged ≥ 9 years, diagnosed with cancer and actively receiving chemotherapy; (2) their caregivers; and (3) oncology clinicians at Nationwide Children's Hospital. Participants completed 1:1 semi-structured interviews, which were audio-recorded, transcribed, and analyzed for thematic content regarding their perception of supportive care measures and views on OMT. Quantitative data was summarized descriptively., Results: A total of 60 participants completed the interview. Participants demonstrated limited awareness of osteopathic medicine; no participant had more than "some" knowledge of OMT. After education about OMT using a brief video, all clinicians, caregivers, and 95% of patients were receptive to OMT as a supportive care option. Major themes included the following: (a) patients have uncontrolled chemotherapy side effects, (b) improved supportive care options are desired, and (c) osteopathic medicine is a favorable supportive care adjunct., Conclusions: Pediatric oncology clinicians, caregivers, and patients reported a need for better management of chemotherapy-associated side effects and an interest in utilizing OMT. These findings support further investigation into the safety, feasibility, and efficacy of implementing OMT in the pediatric oncology clinical setting.

Objective: Aim of the study is to evaluate disorders related to positional plagiocephaly and introduce a new model of early intervention based on the osteopathic integrated approach., Methods: We review clinical experience of the "Program for Neurodevelopmental Follow-up and Pediatric Osteopathy", a service dedicated to newborns at risk for developmental disorders., Results: We present clinical data of 310 newborns followed during first years of life. Data analysis examines perinatal history, general features and disorders that could be related to plagiocephaly., Conclusions: The experience confirms that plagiocephaly is not only a problem regarding the shape of the head, it involves the functions. In our Service most babies (81%) with positional plagiocephaly showed isolated or associated disorders that had an impact on growth, behavior and development. The early intervention based on the osteopathic integrated approach is addressed not only to the cranial shape but consider the baby as a whole, and the environment where he lives., Competing Interests: Declaration of competing interest The authors have no conflicts of interest relevant to this article to disclose., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

Traumatic psychoemotional experiences often manifest in hypersympathetic states of excitement or in immobilization and withdrawal behaviors. A person with this kind of traumatic background may present with an autonomic response consistently maintained in the defensive state, which over time becomes a stressor. In this article, the authors discuss an osteopathic approach to psychoemotional trauma by means of bifocal integration, with an emphasis on promoting a relaxed body and mind by actively involving the patient in the healing process. They briefly discuss the role of mind-body therapies in treatment, considering the popular polyvagal theory and other neuropsychophysiological frameworks. The authors also focus on clinical practice, introducing the reader to the different elements of the osteopathic treatment, including the acknowledgement and integration of top-down and bottom-up dynamics in diagnosis and therapy.

Objective: The objective of this systematic review was to evaluate the effectiveness of an osteopathic treatment on the autonomic nervous system (ANS). For this purpose, published primary studies were analysed and critically evaluated., Method: To generate this review, 15 electronic databases were systematically searched for studies. Randomized clinical controlled trials (RCT) and clinical controlled trials (CCT) are included in the review and evaluated with appropriate assessment tools (Downs and Black Checklist and the checklist from Kienle and Kiene)., Results: 23 published studies (10 RCT, 1 clinic multi-centre study, 1 CCT, 5 randomized cross-over studies, 5 randomized pilot studies and 1 single case study) are included in this review. The studies were evaluated with the assessment tools according to their quality. 3 studies are graded as high quality, 11 as moderate and 8 as low-quality studies., Conclusion: The included published studies represent a good level of evidence. Due to a small number of subjects and no follow-ups, the methodological quality is rated as moderate. A significant change on the ANS was shown in studies including High-Velocity Low-Amplitude Techniques (HVLAT). No statement could be drawn in studies in which they used cranial osteopathic techniques due to the lack of methodological quality. A significant change on the ANS is shown in the treatment of the suboccipital region. In studies which evaluated the effectiveness of mobilization in the cervical and thoracic region, no statement could be displayed due to a low level of evidence. None of the findings in these studies have given statements if ANS activation takes place in the sympathetic or parasympathetic system.

Background: Scar formation is influenced by mechanical forces and may generate mechanical tension. Scars induce a temperature difference in the body objectified by thermal imaging camera. The osteopath's task is to ensure the tissue good mobility in the body. The aim of this study was to measure the influence of osteopathic treatment on a scar by thermal camera., Method: 12 subjects were analyzed: 4 scars by wounds and 8 by operations. A thermal camera was used to measure the temperature variations of the scars and peri-scar area after cooled stimulation. Measurements were made before and after osteopathic treatment., Results/findings: A significant difference was found between the scar and the peri-scar area before osteopathic treatment (p = 0.044) and no significant difference after osteopathic treatment (p = 0.069). Results showed that osteopathic treatment on a scar induces a more homogeneous local warming temperature., Conclusion: The osteopathic treatment allows different warming between scar and peri-scar area; this suggests a modification of the connective tissue function after osteopathic treatment. Further studies are required to better understand the function of connective tissue and the mechanism of healing., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating syndrome of unknown origin, characterized by profound postexertional malaise and fatigue, unrefreshing sleep, cognitive impairments, immune dysfunction, pain, autonomic dysfunction, and neuroendocrine symptoms. Although ME/CFS is well documented within the medical literature, it remains difficult to diagnosis and manage. Some of the current challenges include an absence of diagnostic markers, differing diagnostic criteria, and an overall lack of awareness within the medical community. As a result, patients are often frustrated by the difficulties in acquiring a diagnosis and from the overall lack of available treatments. In an effort to increase awareness, this review discusses disease pathophysiology, clinical presentation, and treatment options, while also highlighting the benefits of an osteopathic approach.

Recent breakthroughs in the fields of genomics and biology have resulted in a better understanding of diseases and their underlying biology. New targeted and immune-based therapies take advantage of these new discoveries to treat the patient individually. This scientific revolution toward personalized medicine reflects osteopathic medicine's emphasis on patient-centered care and its tenets, which go against the "one-size-fits-all" approach. The authors discuss the importance of applying osteopathic philosophy to the delivery of patient-directed cancer care revolutionized by scientific advances.

Background: Polycystic ovary syndrome (PCOS) is a common hormone disorder that affects the reproductive, metabolic, and psychological health of reproductive-aged females, with a number of long-term health risks, including type 2 diabetes mellitus and cardiovascular sequelae. Sympathetic hyperactivity in affected persons may be involved in the pathogenesis of the disorder., Objective: To determine whether physiologic and osteopathic measures of increased sympathetic tone correlate in a population of women with PCOS., Methods: For this descriptive observational study, women with PCOS between the ages of 20 and 44 years were recruited. Physiologic measures of sympathetic tone (resting heart rate and blood pressure, resting heart rate variability, and postexercise heart rate recovery and blood pressure) were compared with osteopathic measures of sympathetic tone (Chapman points and viscerosomatic reflexes) for the heart, adrenal glands, and ovaries., Results: Twenty-four women participated in the study. Overall, the participants exhibited both physiologic and osteopathic signs of increased sympathetic tone compared with reference values. In some participants, the number of osteopathic findings were greater than the number of physiologic findings of increased sympathetic tone., Conclusions: Women with PCOS exhibit increased sympathetic tone by physiologic and osteopathic measures, indicating the utility of assessing sympathetic hyperactivity in these patients by osteopathic methods. Osteopathic structural examination is a valuable diagnostic tool that may allow detection of sympathetic hyperactivity in women with PCOS even before physiologic symptoms manifest. The osteopathic indicators of increased sympathetic tone may represent potential therapeutic targets to improve health in this population. (ClinicalTrials.gov NCT03383484).

The aim of the current study was to evaluate the literature examining the impact of osteopathic care for spinal complaints. The bibliographic databases Medline (Pubmed), Web of Science, Embase, and PEDro were searched. In addition, a number of grey literature sources were searched. Only randomized controlled trials conducted in high-income Western countries were considered. Two authors independently screened the titles and abstracts. Primary outcomes included 'pain' and 'functional status', while secondary outcomes included 'medication use' and 'health status'. It was examined if differences existed related to the treatment protocol and geography (European vs. US studies). Study quality was assessed using the risk of bias tool of the Cochrane Back Review Group. Nineteen studies were included and qualitatively synthesized. Nine studies were from the US, followed by Germany with seven studies. The majority of studies (n = 13) focused on low back pain. In general, mixed findings related to the impact of osteopathic care on primary and secondary outcomes were observed. For the primary outcomes, a clear distinction between US and European studies was found, in favor of the latter ones. Studies were characterized by substantial methodological differences in sample sizes, number of treatments, control groups, and follow-up. In conclusion, there is some evidence suggesting that osteopathic care may be effective for people suffering from spinal complaints. Further studies with larger study samples and assessment of long-term impact are required to further increase the evidence-based knowledge of the potential of osteopathic care for individuals suffering from spinal complaints., Competing Interests: Patrick van Dun is an osteopath.

Introduction: Persistent pain affects a large percentage of the UK population and its burden has wide ramifications that affect physical, psychological, socioeconomic and occupational status. Pain has a significant impact on people's well-being and quality of life. Some of the most common comorbidities found in this population are depression and anxiety and also maladaptive behaviours such as fear avoidance and catastrophising., Methods and Analysis: This is a protocol for a study assessing the feasibility and acceptability of a novel Acceptance and Commitment Therapy (ACT)-based intervention for people from Southwest Wales who live with persistent pain. A group of 12 participants will be recruited through the Health and Wellbeing Academy (Swansea University). After being referred by an Osteopath, and attending a brief meeting with the researcher, the participants will take part in six sessions over six consecutive weeks. 'A Mindful Act' is an ACT-based group programme aiming to teach people how to develop more acceptance and self-compassion, be more mindful and clarify personal values in order to live a more rich and meaningful life. The main outcomes will include the feasibility of the recruitment process and the measurement tools, the acceptability of the intervention for both the participants and the Osteopaths and the adherence to the programme. In order to measure acceptability of the intervention, qualitative interviews will be conducted to provide an insight into peoples' experiences of taking part. Data will be analysed using Thematic Analysis, with the use of NVIVO 10. In addition, quantitative data will be collected at baseline, on completion of the programme and at 1 month and 3 months follow-up to reveal any differences in psychological flexibility, depression, anxiety, fear avoidance and general health status. The findings will help enhance the intervention by making appropriate modifications to the processes and procedures involved, following the recommendations made by the Medical Research Council framework. A larger scale study is envisaged to follow, in order to investigate the full effectiveness and cost-effectiveness of 'A Mindful Act'., Ethics and Dissemination: This study was approved by the College of Human and Health Sciences Research Ethics Committee at Swansea University in December 2017. The findings will be disseminated through various means including: the first author's PhD thesis, peer-reviewed journals as well as well as national and international conferences and public events., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: This research aimed to explore the perceptions and experiences of cancer patients receiving osteopathic treatment as a complementary therapy when it is used in addition to conventional treatment for cancer pain., Methods: This qualitative study employed semi structured interviews of cancer patients in a palliative care unit in Lyon, France, who received treatment from an osteopath alongside their conventional cancer treatment. We analysed data using grounded theory and qualitative methods., Results: We interviewed 16 patients. The themes identified through the analysis included a low awareness of osteopathy among the population and an accompanying high level of misconceptions. The benefits of osteopathy were described as more than just the manual treatments with participants valuing osteopathy as a holistic, meditative, and non-pharmaceutical approach. Participants also described the osteopathic treatments as assisting with a range of cancer-related health complaints such as pain, fatigue, and sleep problems. Offering osteopathic treatment at an accessible location at low or no cost were identified by participants as enablers to the continued use of osteopathy., Conclusions: The findings of this study provides preliminary data which suggests, when delivered alongside existing medical care, osteopathy may have health benefits for patients with complex conditions such as cancer.

Objectives: The aim of this study was to describe osteopathic activity and scope of practice to understand the current and future role of osteopathy in the Swiss healthcare system., Design: A questionnaire survey that included a patient record-based retrospective clinical audit., Setting/population: Osteopaths with a national diploma (n=1086) were invited by mail to participate in an online survey. Osteopathic assistants (n=84) were identified through their national association., Questionnaire: The survey was constructed from previous surveys and tested for face validity with experts, osteopaths and patient representatives. The questionnaires were completed online in English, German and French between April and August 2017. Osteopaths anonymously reported information about themselves, their practice, and the treatment and care for four randomly selected patients they managed in 2016., Results: The response rate from the survey was 44.5% (521/1171). Data on osteopathic care were collected for 1144 patients and 3449 consultations. In 2016, osteopaths saw approximately 6.8% of the Swiss population for 1700 000 consultations and an overall estimated cost of 200 million Swiss francs. 76% of patients sought care directly without a referral from another care provider. Few osteopaths (<1%) work in a hospital setting and 46% work in isolation in private practice. Infants (under 2 years old) made up 10% of all patients and 9% of patients were ≥65 years. Patients most commonly sought treatment for musculoskeletal conditions (81%) with the spine being the most frequent location (66%). Treatments also included exercise advice (34.2%) and lifestyle management (35.4%). Fewer than 1 patient out of 10 were referred to another health profession or provider., Conclusions: In Switzerland, osteopathic care represents an important first line management for musculoskeletal conditions that alleviates some of the burden of care in the Swiss primary healthcare system., Competing Interests: Competing interests: The researchers work for the Unit of Research in Mobility at the School of Health Sciences Fribourg which includes the division of osteopathy., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Temporomandibular disorders are a common musculoskeletal condition causing severe pain, physical and psychological disability. The effect and evidence of osteopathic manipulative treatment and osteopathy in the cranial field is scarce and their use are controversial. The purpose of this pilot study was to evaluate the effectiveness of osteopathic manipulative treatment and osteopathy in the cranial field in temporomandibular disorders., Methods: A randomized clinical trial in patients with temporomandibular disorders was performed. Forty female subjects with long-term temporomandibular disorders (>3 months) were included. At enrollment, subjects were randomly assigned into two groups: (1) osteopathic manipulative treatment group (20 female patients) and (2) osteopathy in the cranial field group (20 female patients). Examination was performed at baseline (E0) and at the end of the last treatment (E1), consisting of subjective pain intensity with the Visual Analog Scale, Helkimo Index and SF-36 Health Survey. Subjects had five treatments, once a week. 36 subjects completed the study (33.7 ± 10.3 y)., Results: Patients in both groups showed significant reduction in Visual Analog Scale score (osteopathic manipulative treatment group: p = 0.001; osteopathy in the cranial field group: p< 0.001), Helkimo Index (osteopathic manipulative treatment group: p = 0.02; osteopathy in the cranial field group: p = 0.003) and a significant improvement in the SF-36 Health Survey - subscale "Bodily Pain" (osteopathic manipulative treatment group: p = 0.04; osteopathy in the cranial field group: p = 0.007) after five treatments (E1). All subjects (n = 36) also showed significant improvements in the above named parameters after five treatments (E1): Visual Analog Scale score (p< 0.001), Helkimo Index (p< 0.001), SF-36 Health Survey - subscale "Bodily Pain" (p = 0.001). The differences between the two groups were not statistically significant for any of the three target parameters., Conclusion: Both therapeutic modalities had similar clinical results. The findings of this pilot trial support the use of osteopathic manipulative treatment and osteopathy in the cranial field as an effective treatment modality in patients with temporomandibular disorders. The positive results in both treatment groups should encourage further research on osteopathic manipulative treatment and osteopathy in the cranial field and support the importance of an interdisciplinary collaboration in patients with temporomandibular disorders. Implications for rehabilitation Temporomandibular disorders are the second most prevalent musculoskeletal condition with a negative impact on physical and psychological factors. There are a variety of options to treat temporomandibular disorders. This pilot study demonstrates the reduction of pain, the improvement of temporomandibular joint dysfunction and the positive impact on quality of life after osteopathic manipulative treatment and osteopathy in the cranial field. Our findings support the use of osteopathic manipulative treatment and osteopathy in the cranial field and should encourage further research on osteopathic manipulative treatment and osteopathy in the cranial field in patients with temporomandibular disorders. Rehabilitation experts should consider osteopathic manipulative treatment and osteopathy in the cranial field as a beneficial treatment option for temporomandibular disorders.

Background: In 2010, the World Health Organization published benchmarks for training in osteopathy in which osteopathic visceral techniques are included. The purpose of this study was to identify and critically appraise the scientific literature concerning the reliability of diagnosis and the clinical efficacy of techniques used in visceral osteopathy., Methods: Databases MEDLINE, OSTMED.DR, the Cochrane Library, Osteopathic Research Web, Google Scholar, Journal of American Osteopathic Association (JAOA) website, International Journal of Osteopathic Medicine (IJOM) website, and the catalog of Académie d'ostéopathie de France website were searched through December 2017. Only inter-rater reliability studies including at least two raters or the intra-rater reliability studies including at least two assessments by the same rater were included. For efficacy studies, only randomized-controlled-trials (RCT) or crossover studies on unhealthy subjects (any condition, duration and outcome) were included. Risk of bias was determined using a modified version of the quality appraisal tool for studies of diagnostic reliability (QAREL) in reliability studies. For the efficacy studies, the Cochrane risk of bias tool was used to assess their methodological design. Two authors performed data extraction and analysis., Results: Eight reliability studies and six efficacy studies were included. The analysis of reliability studies shows that the diagnostic techniques used in visceral osteopathy are unreliable. Regarding efficacy studies, the least biased study shows no significant difference for the main outcome. The main risks of bias found in the included studies were due to the absence of blinding of the examiners, an unsuitable statistical method or an absence of primary study outcome., Conclusions: The results of the systematic review lead us to conclude that well-conducted and sound evidence on the reliability and the efficacy of techniques in visceral osteopathy is absent., Trial Registration: The review is registered PROSPERO 12th of December 2016. Registration number is CRD4201605286 .

Background: Diagnostic reasoning refers to the cognitive processes by which clinicians formulate diagnoses. Despite the implications for patient safety and professional identity, research on diagnostic reasoning in osteopathy remains largely theoretical. The aim of this study was to investigate the influence of perceived task difficulty on the diagnostic reasoning of students osteopaths., Methods: Using a single-blinded, cross sectional study design, sixteen final year pre-registration osteopathy students diagnosed two standardized cases under two context conditions (complex versus control). Context difficulty was manipulated via verbal manipulation and case order was randomized and counterbalanced across subjects to ensure that each case was diagnosed evenly under both conditions (i.e. half of the subjects performed either case A or B first). After diagnosis, participants were presented with items (literal, inferred and filler) designed to represent analytical and non-analytical reasoning. Response time and error rate for each item were measured. A repeated measures analysis of variance (concept type x context) was performed to identify differences across conditions and make inferences on diagnostic reasoning., Results: Participants made significantly more errors when judging literal concepts and took significantly less time to recognize filler concepts in the complex context. No significant difference in ability to judge inferred concepts across contexts was found., Conclusions: Although speculative and preliminary, our findings suggest the perception of complexity led to an increased reliance on analytical reasoning at the detriment of non-analytical reasoning. To reduce the associated cognitive load, osteopathic educational institutions could consider developing the intuitive diagnostic capabilities of pre-registration students. Postgraduate mentorship opportunities could be considered to enhance the diagnostic reasoning of professional osteopaths, particularly recent graduates. Further research exploring the influence of expertise is required to enhance the validity of this study.

Objectives: To investigate the experiences of patients seeking osteopathy treatment in New Zealand; and to describe their perceptions of osteopathic treatment., Design: Survey-based research design., Setting: Private osteopathy practices., Main Outcome Measures: Demographic survey and the Patient Perception Measure-Osteopathy (PPM-O)., Results: Twelve osteopaths were recruited as practitioners. Responses from 107 patients were analysed. Approximately 75% of patients reported receiving a 'mostly cranial' treatment approach. The majority of patients (96.2%) indicated that osteopathic treatment helped their condition. The most frequently experienced sensation was 'relaxed'. A positive relationship was observed between the PPM-O and demographic variables., Conclusions: This is the first study to report on New Zealand osteopathy patient's experience of their treatment. The sensations and emotions experienced are largely consistent with previous Australian research. Predominantly positive perceptions of osteopathic treatment were reported. The current study provides some evidence of the construct validity of the PPM-O in a New Zealand patient population., (Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.)

Background: Ectopic pregnancies occur when the implantation of a fertilized ovum occurs outside the endometrial cavity. Such pregnancies occur in approximately 1.5% to 2.0% of all pregnancies and cause 6% of maternal deaths., Objectives: To evaluate osteopathic structural examination (OSE) findings in patients with ectopic pregnancies of uncommon locations and to establish the utility of these findings in the diagnosis of these ectopic pregnancies., Methods: In this prospective case series, a focused OSE was performed on each patient with an ectopic pregnancy at her initial presentation after the patient history but before other diagnostic or laboratory tests were performed and surgical treatment was initiated. Chapman reflex points (CRPs) were evaluated pre- and postoperatively. For comparison, patients who had otherwise normal first pregnancies, underwent elective postpartum bilateral tubal ligation, or had simple ovarian cysts were also included and received OSEs., Results: Seven cases with ectopic pregnancies outside the fallopian tube were included. Two primary ovarian pregnancies and 1 heterotopic pregnancy (uterine and ovarian) had somatic dysfunction at the T10-T11 spinal levels and CRPs posterior for the ovary, 1 primary omental pregnancy with somatic dysfunction at the T9-T12 spinal levels and CRPs anterior and posterior for the ileum and jejunum, and 1 tubal pregnancy with somatic dysfunction at the T10-L1 spinal levels and CRPs anterior and posterior for the fallopian tube. Two cornual ectopic pregnancies were not associated with unique findings. These somatic dysfunctions and CRP findings appear to be distinct from those of comparison cases, including first pregnancies at any trimester, simple ovarian cysts, and elective bilateral tubal ligation., Conclusion: The OSE findings demonstrated in these cases aided in the final diagnosis and thus can potentially prove helpful in cases of ovarian, tubal, and omental pregnancies to provide clues to abnormal ectopic pregnancy locations where diagnostic imaging results are insufficient or equivocal. Osteopathic structural examinations may allow osteopathic physicians to better prepare for treatment approaches, including surgery.

Context: The mission of the American Academy of Osteopathy (AAO) emphasizes "the integration of osteopathic principles, practices and manipulative treatment in patient care." Osteopathic manipulative treatment (OMT) can be used to address serious conditions affecting older persons (≥65 years). However, the percentage of osteopathic physicians who use OMT in older patients, the differences in conditions for which OMT is used, and the OMT techniques used in older patients compared with younger patients are unknown., Objective: To determine the use of OMT by osteopathic physicians in older patients compared with younger patients., Methods: Members of the AAO were invited, via 3 e-mail messages sent over the course of a 4-month period, to participate in an anonymous online survey. The survey asked physicians to report the percentage of patients by age group (<65 years, 65-79 years, and ≥80 years) to whom they provided OMT, the types of musculoskeletal and system-based conditions for which OMT was used, and the specific OMT techniques used., Results: A total of 197 of 629 AAO members (31.3%) responded to the survey. Respondents indicated that OMT was used at approximately the same rate in all patients in the 3 age groups. Osteopathic manipulative treatment was frequently used to manage a variety of musculoskeletal conditions, with the exception of osteoporosis, in all patients in the 3 age groups. The system-based conditions most often managed with OMT were respiratory and neurologic conditions. Various OMT techniques were used to treat patients in the 3 age groups; however, high-velocity, low-amplitude (HVLA) was usually avoided in patients aged 65 years or older., Conclusion: Osteopathic physicians who used OMT in their practice administered OMT for a variety of musculoskeletal and system-based conditions in patients of all ages. Various OMT techniques were used by these physicians for patients of all ages, with the exception of HVLA, which was mainly used in patients younger than 65 years.

In pregnant women, the risk of venous thromboembolism increases 4 to 5 fold over that in nonpregnant women. Deep vein thromboses in the calf occur in approximately 6% of cases, with a 20% incidence of propagation, but new imaging methods suggest a higher rate. Nevertheless, the management of isolated soleal vein thrombosis is currently one of the most debated issues in the field of venous thromboembolism, and a clear set of principles for the management of this unique clinical problem remains undefined. The authors present the case of a 37-year-old woman with a history of recurrent spontaneous abortions and cervical insufficiency who presented with a short cervix and acute right isolated soleal vein thrombosis. Long-term anticoagulantion therapy was recommended. Future studies on the risk of isolated soleal vein thrombosis propagation in the setting of pregnancy are required to identify the most effective treatment options for this clinical problem.

Context: The establishment of a single accreditation system for graduate medical education in the United States suggests a convergence of osteopathic and allopathic medicine., Objective: To compare the characteristics of medical care provided by osteopathic and allopathic physicians., Methods: Five-year data from the National Ambulatory Medical Care Survey were used to study patient visits for primary care, including those for low back pain, neck pain, upper respiratory infection, hypertension, and diabetes mellitus. Patient status, primary reason for the visit, chronicity of the presenting problem, injury status, medication orders, physician referrals, source of payment, and time spent with the physician were used to compare osteopathic and allopathic patient visits., Results: A total of 134,369 patient visits were surveyed, representing a population (SE) of 4.57 billion (220.2 million) patient visits. Osteopathic physicians provided 335.6 (29.9) million patient visits (7.3%), including 217.1 (20.9) million visits for primary care (9.7%). The 5 sentinel symptoms and medical diagnoses accounted for 233.0 (12.4) million primary care visits (10.4%). The mean age of patients seen during primary care visits provided by osteopathic physicians was 46.0 years (95% CI, 44.1-47.9 years) vs 39.9 years (95% CI, 38.8-41.0 years) during visits provided by allopathic physicians (P<.001). Osteopathic patient visits were less likely to involve preventive care (OR, 0.55; 95% CI, 0.44-0.68) and more likely to include care for injuries (OR, 1.60; 95% CI, 1.43-1.78). Osteopathic physicians spent slightly less time with patients during visits (mean, 16.4 minutes; 95% CI, 15.7-17.2 minutes) than allopathic physicians (mean, 18.2 minutes; 95% CI, 17.2-19.3 minutes). The most distinctive aspect of osteopathic medical care involved management of low back pain. Therein, osteopathic physicians were less likely to order medication (OR, 0.33; 95% CI, 0.15-0.75) or to refer patients to another physician (OR, 0.47; 95% CI, 0.23-0.94), despite having more visits paid through Worker's Compensation (OR, 3.63; 95% CI, 1.01-13.07). Osteopathic and allopathic medical care for upper respiratory infection, hypertension, and diabetes mellitus were comparable., Conclusion: Practice patterns of osteopathic physicians generally mirror those of allopathic physicians except that osteopathic physicians deliver more medical care for older patients and at later stages of disease. Osteopathic medicine should be promoted more vigorously among younger and healthier persons. New opportunities may arise for osteopathic physicians to demonstrate a distinctive approach to low back pain as changes emerge in graduate medical education.

Context: Identifying relationships among anatomical structures is key in diagnosing somatic dysfunction. Ultrasonography can be used to visualize anatomical structures, identify sacroiliac landmarks, and validate anatomical findings and measurements in relation to somatic dysfunction. As part of the osteopathic manipulative medicine course at A.T. Still University-Kirksville College of Osteopathic Medicine, first-year students are trained to use ultrasonography to establish relationships among musculoskeletal structures., Objectives: To determine the ability of first-year osteopathic medical students to establish sacral base position (SBP) and sacral sulcus depth (SSD) using ultrasonography and to identify the relationship of SBP and SSD to body mass index (BMI) and sex., Methods: Students used ultrasonography to obtain the distance between the skin and the sacral base (the SBP) and the distance between the skin and the tip of the posterior superior iliac spine bilaterally. Next, students calculated the SSD (the distance between the tip of the posterior superior iliac spine and the SBP). Data were analyzed with respect to side of the body, BMI, sex, and age. The BMI data were subdivided into normal (18-25 mg/kg) and overweight (25-30 mg/kg) groups., Results: Ultrasound images of 211 students were included in the study. The SBP was not significantly different between the left and right sides (36.5 mm vs 36.5 mm; P=.95) but was significantly different between normal and overweight BMI categories (33.0 mm vs 40.0 mm; P<.001) and between men and women (34.1 mm vs 39.0 mm; P<.001). The SSD was not significantly different between left and right sides (18.9 mm vs 19.8 mm; P=.08), normal and overweight BMI categories (18.9 mm vs 19.7 mm, P=.21), or men and women (19.7 mm vs 19.0 mm; P=.24). No significant relationship was identified between age and SBP (P=.46) or SSD (P=.39); however, the age range was narrow (21-33 years)., Conclusion: The study yielded repeatable and reproducible results when establishing SBP and SSD using ultrasonography. The statistically significant relationship between SBP and higher BMI and between SBP and female sex may point to more soft tissue overlaying the sacrum in these groups. Further research is needed on the use of ultrasonography to establish criteria for somatic dysfunction.

Context: Recent evidence suggests that osteopathic manipulative treatment of somatic dysfunction in newborns may decrease complications and hospital length of stay. Such dysfunction may result from external forces related to the birth process, but its incidence is unknown., Objective: To identify the incidence and patterns of somatic dysfunction in healthy newborns at least 6 hours after birth and to correlate those findings with maternal and labor history, gestational age, and findings of the initial newborn assessment performed immediately after birth., Methods: Healthy newborns aged 6 to 72 hours were physically examined and assessed for somatic dysfunction, including asymmetry and motion restriction of the cranial, cervical, lumbar, and sacral regions. The total somatic dysfunction identified was summarized in a somatic dysfunction severity score (SDSS), calculated by assigning 1 point for each identified finding; the SDSS could range from 0 (no somatic dysfunction) to 34 (all somatic dysfunctions assessed present). Findings were correlated with maternal and newborn characteristics and labor history. Descriptive analyses were performed, and findings were compared between the initial newborn assessment and the research examination., Results: One hundred newborns were examined (mean gestational age, 38.5 weeks). In 99 newborns (99%), at least 1 sphenobasilar synchondrosis strain pattern was present, with sidebending rotations being the most common (present in 63 newborns [63%]). Condylar compression was found in 95 newborns (95%), temporal bone restrictions in 85 (85%), motion restriction of at least 1 cervical vertebral segment in 91 (91%) and at least 1 lumbar vertebral segment in 94 (94%), and a posterior sacral base in 80 (80%). The SDSS was not associated with mode of delivery or labor augmentation (P=.49 and P=.54, respectively), but it was positively associated with the duration of labor; each 1-hour increase in labor increased the predicted SDSS by 0.12 points (P=.04)., Conclusion: Somatic dysfunction of the cranial, cervical, lumbar, and sacral regions was common in healthy newborns, and the total somatic dysfunction (SDSS) was related to the length of labor. (ClinicalTrials.gov number NCT01496872).

Background: Research has shown that patients' expectations of health care and health-care practitioners are complex and may have a significant impact on outcomes of care. Little is known about the expectations of osteopathic patients., Objectives: To explore osteopathic patients' expectations of private sector care., Design: Focus groups and individual interviews with purposively selected patients; this was the qualitative phase of a mixed methods study, the final phase being a patient survey., Setting and Participants: A total of 34 adult patients currently attending for treatment at private osteopathic practices across the United Kingdom., Intervention: Focus group discussions and individual interviews around expectations before, during and after osteopathic care., Outcome Measures: Thematic analysis of text data to identify topics raised by patients and to group these into broad themes., Results: Many components of expectation were identified. A preliminary conceptual framework describing the way the therapeutic encounter is approached in osteopathy comprised five themes: individual agency, professional expertise, customer experience, therapeutic process and interpersonal relationship., Discussion and Conclusion: The components of expectation identified in this phase of the study provided potential question topics for the survey questionnaire in the subsequent phase of the investigation. The model developed in this study may add a new perspective to existing evidence on expectations. Further research is recommended to test the findings both within private practice and the National Health Service., (© 2013 John Wiley & Sons Ltd.)

A key osteopathic tenet involves the body's ability to self-heal. Osteopathic manipulative treatment (OMT) has been evolved to improve this healing capacity. The authors' in vitro work has focused on modeling 2 common OMT modalities: myofascial release (MFR) and counterstrain. Their studies have evaluated the effects of these modalities on wound healing, cytokine secretion, and muscle repair. The key components of the host response to mechanical forces are fibroblasts, which are the main fascial cells that respond to different types of strain by secreting anti-inflammatory chemicals and growth factors, thus improving wound healing and muscle repair processes. The purpose of this review is to discuss the cellular and molecular mechanisms by which MFR and other OMT modalities work, in particular, the role of strained fibroblasts in inflammation, wound healing, and muscle repair and regeneration. Changing MFR parameters, such as magnitude, duration, direction, and frequency of strain, might uniquely affect the physiologic response of fibroblasts, muscle contraction, and wound healing. If such results are clinically translatable, the mechanisms underlying the clinical outcomes of OMT modalities will be better understood, and these treatments will be more widely accepted as evidence-based, first-line therapies.

Dissemination is an important part of translational research. When the results of high-quality studies reach a wide audience of peers, they provide an evidence base that can guide practice and improve patient care and safety. From proposal to publication, the authors provide the novice researcher with advice on ethics, tips on selecting a journal, a summary of manuscript requirements, and a brief outline of the submission process and outcomes. By demystifying these processes and outlining some of the basic requirements, the authors hope to encourage novice researchers to engage in quality research and prepare them for disseminating their results.

Objective: To explore the unique ideas, properties, and standards of fracture repositioning with osteopathy in traditional Mongolian medicine in China., Methods: Based on the natural life concept of "integration of universe and man", osteopathy in traditional Mongolian medicine in China uses the modern principles and methods of physiology, psychology, and biomechanics. Against this background, we explored the unique ideas, properties, and stan- dards of fracture repositioning in traditional Mongolian medicine., Results: Fracture treatment with osteopathy in traditional Mongolian medicine in China is based on (a) the ideas of natural, sealed, self and dynamic repositioning of fractures; (b) the properties of structural continuity and functional completeness; (c) the standards of "integration of movement and stillness" and "force to force"., Conclusion: The unique ideas, properties, and standards of fracture repositioning with osteopathy in traditional Mongolian medicine in China have resulted in the widespread use of such techniques and represents the future direction of the development of fracture repositioning.

Physicians primarily use palpation of anatomical landmarks to guide the placement of needles when administering neuraxial anesthetics. For patients with anatomical abnormalities such as scoliosis, it is also important for physicians to understand Fryette mechanics and spinal curvature anatomy, as well as preprocedural radiography and ultrasonography, to ensure accuracy in neuraxial anesthetic procedures. The authors report the case of a patient with severe scoliosis who required neuraxial anesthesia for total hip arthroplasty. Using palpation and imaging, his physicians were able to successfully administer a subarachnoid anesthetic injection on the first attempt. The authors discuss considerations for improving success rates of neuraxial anesthetic administration in these patients., (© 2014 The American Osteopathic Association.)

Objective: To explore the concept of classification and reduction manipulation of fractures in Chinese traditional Mongolian osteopathy., Methods: Based on the linear classification of fractures in Chinese traditional Mongolian osteopathy and the practice of reduction manipulation, a dynamic classification and reduction manipulation concept of fractures was established with the use of modern biomechanical principles and methods., Results: We classified the linear classification and reduction manipulation of fractures in Chinese traditional Mongolian osteopathy based on the achievement of fracture line and used the cause of the formation of the fracture line for our dynamic classification and reduction manipulation of fractures concept., Conclusion: The etiology of the formation of fracture lines can be used to decrease diagnostic error, increase therapeutic effects of manipulation, and further provide a new concept and method for the development of the reduction concept of fractures.

The number of US older adults with dementia is expected to grow over the next several decades. For instance, the number of persons with Alzheimer disease is predicted to increase by 50% by 2030. Physicians commonly come into contact with patients who have dementia and, as such, need to understand its varied presentation. In the current review, the most common types of dementia, including Alzheimer disease, frontotemporal dementia, dementia due to vascular disease, and several others, are described. Characteristics and etiologic findings of cortical and subcortical dementias are differentiated, and cognitive profiles and symptoms of specific types of dementia are reviewed. An osteopathic approach to care, focusing on establishing a relationship with patients and their families, is also discussed.

Context: Palpatory skills are a central part of osteopathic manipulative treatment and palpatory diagnosis. The aim of osteopathic structural examination is to locate somatic dysfunction and cranial strain pattern, which are the hallmarks that form the basis for treatment decisions and strategy. In the osteopathic literature, there is a lack of studies evaluating preterm or term newborns during hospitalization., Objective: To determine the prevalence of somatic dysfunction and cranial strain pattern in a population of preterm and term newborns who were treated in a neonatal intensive care unit (NICU)., Methods: During a period of 6 months--November 2009 through April 2010--the authors performed a retrospective review of data on consecutive preterm and term newborns who were admitted to the NICU of the Spirito Santo Public Hospital. Osteo pathic evaluation was performed once on each newborn, and somatic dysfunction and cranial strain pattern were identified. Descriptive analysis and test of association based on the χ(2) test were performed., Results: One hundred fifty-five preterm and term newborns met the study's eligibility criteria. The highest rate of somatic dysfunction was found in the pelvic area of 63 newborns (40.7%). The sacroiliac joints were compressed unilaterally or bilaterally in 82 newborns (52.9%); the lumbosacral junction was restricted in 61 newborns (39.4%), and intraosseous lesions of the sacral bone were diagnosed in 57 newborns (36.8%). The spine accounted for somatic dysfunction in 38 newborns (24.5%), with the middle thoracic and lower thoracic areas restricted in 29 (18.7%) and 21 (16.8%) newborns, respectively. Sphenobasilar synchondrosis compression and lateral-vertical strain were diagnosed in 57 newborns (36.8%), with the sagittal and the coronal sutures found restricted in 35 (22.6%) and 30 (19.4%) newborns, respectively. The occipital bone presented the highest rate of intraosseous lesions, with the left condyle compressed in 48 newborns (31%), the right condyle in 46 newborns (29.7%), and the squama in 38 newborns (24.5%)., Conclusion: Results showed that osteopathic findings are not secondary to gestational age and weight at birth.

The estimated prevalence of gastritis in the general US population is approximately 50%. Patients with gastrointestinal disease often present to the primary care practitioner with dyspepsia and abdominal pain. Osteopathic palpatory evaluation suggests that there is an association among gastrointestinal disease, the presence of posterior midthoracic pain, and chronic headache. On the basis of findings from a review of the literature, the author assesses the potential etiologic mechanisms of this clinical association. Possible mechanisms include the physiologic function of the vagus nerve, a neural convergence model, and the inherent properties of Helicobacter pylori. To demonstrate the clinical significance of these mechanisms, the author presents the case of a 30-year-old woman with headache, thoracic discomfort, and gastritis associated with H pylori infection. The author suggests that successful treatment of patients with gastrointestinal disease includes osteopathic manipulative treatment, behavioral modification, and pharmacotherapy, even when challenged by antibiotic resistance.

There is growing recognition of the role that osteopathy can play in the treatment of women during pregnancy (King et al 2003; Sandler 1996; Green 2000). It is usual for the osteopathic training colleges to run a pregnancy clinic and give students the opportunity to focus on the particular changes the body will go through from a neuro-musculo-skeletal view point during this unique period of a woman's life. Also, osteopathy can help make a difference in a woman's overall antenatal care by using gentle procedures to help alleviate many common pregnancy related ailments. A recent literature review (Lavelle 2012) found that this included not only relief of pain for a variety of musculoskeletal conditions but also a reduction in the duration of labour and the avoidance of some complications of labour. To date, there has been less of a focus on what osteopathy can provide women postnatally; indeed, within the profession, there has been little research carried out in this area. However, many osteopaths are confident in the results they can achieve working with postnatal mothers, based on a sound working hypothesis of osteopathic principles.

Objective: To explore the concept and norm of fracture healing with osteopathy in traditional Mongolian medicine (TMM)., Methods: Based on the correspondence between man and the universe (including psychosomatic integration) in fracture healing with osteopathy in TMM, we used modern physio-psychological and biomechanical principles and methods to probe the integrated, dynamic and functional characteristics of fracture healing., Results: Based on the integration of limbs and the body, unification of the body and function and harmony of man and nature (including psychosomatic integration), fracture healing with osteopathy in TMM comprises the concept of natural functional healing of fractures, and follows the norm of considering physiological healing and psychological function as well as limb healing and motor function., Conclusion: Fracture healing with osteopathy in TMM is characterized by a lack of trauma without future complications. This therapy makes the concept of fracture healing develop in the direction of humanity, behaviorism and integration.