Prevalence and profile of Australian osteopaths treating older people

https://doi.org/10.1016/j.ctim.2019.01.013Get rights and content

Highlights

  • Over half of Australian osteopaths treat patients aged 65 years and older.

  • Osteopaths may prescribe exercise, counselling and dietary advice to older patients.

  • Older patients may be referred to an osteopath by their general practitioner.

  • Osteopaths may educate older patients about pain management.

  • Osteopaths who treat older patients refer more frequently for diagnostic imaging.

Abstract

Objectives

To explore the characteristics of the Australian osteopathy workforce who participate in the management of older patients with musculoskeletal complaints.

Design

Secondary analysis of a cross-sectional survey of osteopaths.

Setting

The Osteopathy Research and Innovation Network (ORION), an Australian practice-based research network.

Main outcome measures

The demographic, practice and treatment characteristics of osteopaths who identify as ‘always’or ‘often’ treating patients aged 65 years or over.

Results

Over half (58%) of total participants (n = 992) indicated often treating older people and this was associated with referral patterns with other health professionals and a non-urban practice location. Osteopaths providing care to older people were more likely to discuss diet/nutrition and medications, and provide pain counselling. Osteopaths who treated older adults were more likely to treat shoulder musculoskeletal disorders, degenerative spine disorders, chronic or persistent pain, and tendinopathies.

Conclusions

A substantial proportion of Australian osteopaths treat older adults frequently. The potential value and impact of osteopathy in managing the health needs of an ageing population warrants close examination from both researchers and policy makers.

Introduction

Ageing affects all systems of the body including the musculoskeletal system. Chronic musculoskeletal conditions such as back and neck pain, osteoarthritis and rheumatoid arthritis contribute disproportionally to the burden of disease in Australia.1 Among the elderly, complications associated with these conditions often require protracted management.1 With Australia’s elderly population projected to double by 2057,2 the demand for health services that can manage musculoskeletal conditions will increase substantially. Complicating this scenario is the number of older people who present to public hospitals with non-life threatening musculoskeletal conditions. In 2016-17, there were 1.6 million emergency department presentations among people aged 65 and over, with people aged 85 and over accounting for almost 1 in 4(23%) of those presentations.3 For people 65–74 years old, ‘back and spine pain’ was the fifth most common diagnosis at presentation; for people over the age of 85, the most frequent diagnosis was ‘other symptoms and signs involving the nervous and musculoskeletal systems’.3

Given the prevalence of chronic musculoskeletal conditions among the elderly and the increasing costs associated with hospitalisations for these conditions, there has been a growing interest in non-hospital-based, non-pharmacological management strategies that can deliver improvements in functional independence and quality of life.4 Due to the complex nature of disease in the elderly, managing the health of older people requires a holistic approach that accounts for the individual’s psychological, social, functional and physiological capacities. In Australia, this interest has contributed to a rise in the use of private allied health services such as physiotherapy, chiropractic and osteopathy.5 However, the level of evidence supporting the use of these interventions for managing musculoskeletal conditions in the elderly is limited.6, 7, 8, 9, 10

Osteopaths in Australia are primarily in private practice11 yet are included under the publicly-funded Chronic Disease Management scheme, where general medical practitioners refer people with chronic diseases that require team care to allied health practitioners.12,13 There is an emerging evidence base for the manual therapies used by osteopaths in the adult population, including for spinal manipulative therapy in low back pain, migraine, cervicogenic headache and cervicogenic dizziness, and also for massage in chronic low back and neck pain.14 A number of studies suggest benefit for the management of musculoskeletal complaints that affect the older patient. Findings from a systematic review and meta-analysis support the use of manual therapy in the treatment of the pain, stiffness and dysfunction of osteoarthritis.16 In a randomised trial of 206 individuals comparing usual care to multimodal exercise or manual therapy intervention there was significant improvement in pain and function in both interventions after one year.17 There is also evidence for the use of manual therapy for the older patient in other joint pathologies (e.g. thumb,18,19, foot & ankle20). Manual therapy may also play a role in the management of spinal complaints in the older patient.6,8, 9, 10 For example, short and long-term improvements in back and neck disability following a combination of spinal manipulative therapy and exercise have been demonstrated in the older patient.7 Emerging evidence also exists for the use of manual therapy for gait problems and falls prevention.21,22 Taken together, these studies suggest some benefit for the management of those musculoskeletal complaints that affect the older patient.

From a recent Australian survey utilising a nationally representative sample of 49.1% of registered osteopaths,11 57.7% of participants reported often treating older people (65 years and older). However, little is known about the specific characteristics of osteopaths providing care to older patients and the clinical techniques they employ. In direct response, the aim of this study was to explore the characteristics of the Australian osteopathy workforce who participate in the management of older patients with musculoskeletal complaints.

Section snippets

Study design

This study reports secondary analysis of a cross-sectional survey. The current study was approved by the Human Ethics Committee of the University of Technology Sydney, Australia(approval # 2014000759).

Setting

This study analysed data from the Osteopathy Research and Innovation Network (ORION) Project. Details of this project have been published elsewhere.15 Briefly, the ORION project is the first national practice-based research network (PBRN) focusing on Australian osteopaths.

Participants

The participating sample

Results

Of the 992 registered osteopaths included in this analysis, 572 (58%) had often treated older people while 419 (42%) indicated otherwise. The data from one respondent was missing from this item and as such they were excluded from the analysis. Table 1 provides details of the association between practitioner characteristics and osteopaths treating older adults. With the exception of gender, descriptive statistics indicated statistically significant differences for all practitioner

Discussion

This paper reports findings from a previous study, drawing upon a large national sample of osteopaths to examine the characteristics of the osteopathy workforce who participate in the management of older adults. With Australia’s elderly population projected to double by 2057,2 there is an increasing opportunity for osteopaths to contribute to the wider inter-professional management of musculoskeletal complaints in this population especially given their significant impact on health-related

Conclusion

A substantial proportion of Australian osteopaths appear to frequently treat older adults

and the patient management of this large and fast growing sub-population provides

significant opportunity for the profession. Further empirical work is required to

ascertain health outcomes of osteopathy for treating older patients and to explore

and ultimately improve the role of osteopaths in interprofessional teams providing healthcare for older adults.

Funding

The ORION project is funded by the Osteopathy Australia. The funding source had no influence in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. The research reported in this paper is the sole responsibility of the authors and reflects the independent ideas and scholarship of the authors alone.

Declaration of conflicting interests

The authors have no conflict of interests to declare.

Acknowledgement

There are no acknowledgements to declare.

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