CommentaryResponding to the challenge of clinically relevant osteopathic research: Efficacy and beyond
Section snippets
The osteopathic research challenge
In a recent editorial in this journal, Lucas and Moran raised critical questions regarding the relevancy of contemporary osteopathy research in the evolving healthcare environment.1 Their ultimate challenge to the osteopathic profession was to provide the “numbers” supporting the clinical effectiveness of osteopathy, or osteopathic manipulative treatment (OMT) as it is better known in the United States. They aptly identified important consumers of the numbers, including researchers,
The osteopathic manipulative treatment responder
The variability among similar patients in response to a given pain treatment has perplexed health care providers and payers alike for many years.7 At present there is no consensus on what constitutes a favorable response to a given treatment for low back pain. However, Assendelft and colleagues, in conjunction with the Cochrane Collaboration's Back Editorial Board, recommended that a mean pain reduction of 10 mm on a 100-mm visual analogue scale (VAS) be considered clinically relevant when
Genomic considerations in osteopathic manipulative treatment response
With the advent of genomic medicine and greater recognition of host–environment interactions in the etiology of and response to disease,11 another challenge for osteopathic research will be to use emerging technologies to help identify OMT responders. This osteopathic research challenge is currently foreshadowed by analogous developments in pharmacogenomics.12 Responses to drug therapy are quite variable, ranging from complete disease remission to fatal adverse events. Such pharmacologic
Psychological considerations in osteopathic manipulative treatment response
With regard to pain treatment, third-party payers often require pretreatment psychological screenings to help identify patients at risk for poor outcomes.7 Thus, another challenge for osteopathic research is to develop a psychological profile of OMT responders, particularly with regard to chronic pain disorders. The stages of pain processing model developed by Wade and colleagues,16, 17 as schematically represented in Fig. 3, may be used to glean some insight into the multiple factors
Conclusion
A pain processing model such as that presented above provides a useful framework for considering the multifactorial etiology and progression of chronic pain disorders, such as those often treated with OMT. Consequently, in studying the response to OMT, this framework enables integration of both emerging scientific disciplines such as genomics and more traditional disciplines such as psychology. For example, the COMT haplotypes described above serve as key regulators of pain perception,
Acknowledgment
This work was supported in part by a grant (no. K24AT002422) from the National Institutes of Health.
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Cited by (10)
Biological effects of direct and indirect manipulation of the fascial system. Narrative review
2017, Journal of Bodywork and Movement TherapiesCitation Excerpt :Osteopathy has been challenged over the past decade to provide clinically relevant research relative to mechanisms and efficacy. The conduct of evidence-based osteopathic research is imperative not only for scientific, economic, and professional reasons, but also to drive health care policy and clinical practice guidelines (Licciardone, 2007). Lucas & Moran (2006), raised critical questions regarding the relevancy of contemporary osteopathy research in the evolving healthcare environment.
Communicating risk and shared decision-making in osteopathic practice: A pilot study using focus groups to test a patient information leaflet
2014, European Journal of Integrative MedicineCitation Excerpt :The benefits of osteopathy are well established for low back pain [9,43] but absolute benefit is difficult to quantify from the trials data. The proportion of responders to treatment was based on data from a recent patient survey [31] together with a subsidiary analysis of a trial in the USA [44]. For neck pain the evidence of benefit remains weak [45] but there is some evidence of response in around 50% patients [46].
The effects of experience on the inter-reliability of osteopaths to detect changes in posterior superior iliac spine levels using a hidden heel wedge
2013, Journal of Bodywork and Movement TherapiesCitation Excerpt :Inter-examiner reliability refers to the agreement between two or more examiners assessing the same entity, while intra-examiner reliability refers to the agreement of an examiner repeatedly assessing the same benchmark (Lucas and Bogduk, 2011). In the last twenty years there has been a drive for clinical practice to be increasingly informed by research evidence rather than opinion and experience alone (Sackett, 2000) and the osteopathic profession has not escaped the debate (Licciardone, 2007; Fryer, 2008). With an ongoing movement towards evidence-based practice (EBP), osteopaths are required to take a more reflective stance towards their practice and integrate research evidence into their clinical reasoning processes (Thomson et al., 2011).
The immediate effects of sigmoid colon manipulation on pressure pain thresholds in the lumbar spine
2012, Journal of Bodywork and Movement TherapiesCitation Excerpt :Another study that included VMT (Tarsuslu et al., 2009) also focused strongly on clinical observations with little reference to potential physiological mechanisms. VMT like other manual therapy (MT) approaches demands a body of research evidence to help practitioners take an evidence-informed approach to their practice (Licciardone, 2007; Fryer, 2008) and clinical reasoning (Thomson et al., 2011), so that treatments can be applied safely and most effectively. There is, however, a growing body of research which may be drawn upon to help understand the mechanisms by which VMT exerts their effects, which could help inform their application in clinical practice.
Diagnostic reliability in osteopathic medicine
2011, International Journal of Osteopathic MedicineCitation Excerpt :In order to answer the question, “does osteopathy work?”, the randomised controlled trial has been used and recommended.1–3 As a profession, we entertained the idea that if we were to compare ‘osteopathic treatment’ with ‘no osteopathic treatment’, then the positive results would demonstrate the value of our profession and the work we do with patients on a daily basis.
The biopsychosocial model of pain and contemporary osteopathic practice
2010, International Journal of Osteopathic MedicineCitation Excerpt :Cognitive modification by way of simple reassurance at the time of consultation together with (evidence-based) written information39 can also be considered as an essential part of ‘rational treatment’. The need for osteopaths to better understand the psychological components of pain40 and their potential influence on osteopathic treatment41 have been previously highlighted in previous editions of this journal, and also represent another avenue of what can be considered in terms ‘rational treatment’. Rational treatment therefore must incorporate the (evidence-based) holistic view of the patient, their condition, and most importantly the individual context of the individual seeking care.