Headache in children: update on complementary treatments.

Complementary and alternative medicine (CAM) is widely used by both physicians and patients with primary headache syndromes. Despite a considerable number of articles addressing CAM in primary headache syndromes, the overall evidence for CAM is still poor. The aim of this review was to give an overview of the current evidence of the main alternative therapies used in the treatment of primary headache syndromes of childhood. MEDLINE and Cochrane Library were systematically searched for articles dealing with complementary and alternative treatment or prophylaxis of headache and migraine published within the past 20 years.

[Osteopathic medicine]. / Osteopathie in der Orthopädie.

Osteopathic medicine is a healing modality applied with the doctor's two hands that is similar to but goes far beyond the Manual medicine/chirotherapy which is well known in Germany. Founded in 1874 by Dr. A.T. Still in Kirksville, Missouri in the USA, osteopathic medicine is in addition to the M.D. degree in allopathic medicine a fully accepted and regulated medical profession ending in the granting of the D.O. (doctor of osteopathic medicine) degree. In 2009 the German Medical Council presented a position paper on osteopathy and osteopathic medicine which has ignited controversial discussions about the possible integration of this modality into the German medical health care system. There is currently an enormous interest in osteopathy and osteopathic medicine in Germany and the demand for this modality is continuously increasing. Although this modality is over 140 years old there are few solid studies that conclusively show its effectiveness.

Conditions and diagnoses for which osteopathic primary care physicians and specialists use osteopathic manipulative treatment.

Data presented in this study were gathered in 1998 through a national mail survey of 3000 randomly selected osteopathic physicians. Of 979 (33.4%) questionnaires returned, 955 (97.5%) were usable for analysis. The use of osteopathic manipulative treatment (OMT) was determined for primary care physicians and specialists. Osteopathic manipulative treatment specialists and family physicians provided OMT significantly more frequently than other primary care physicians and non-primary care specialists. More than 50% of respondents (513) administered OMT on less than 5% of their patients. Nevertheless, it should be noted that physicians from 40 of 46 specialties and subspecialties represented in the survey (678, 71%) identified an average of 3.3 conditions and diagnoses per physician that were managed with OMT. The conditions and diagnoses for which OMT is used have been enumerated and codified. More than 50% of conditions (1135) for which respondents treated patients with OMT related to the musculoskeletal system, but extensive overlap among other body systems and body regions attests to the continued incorporation of OMT into holistic patient care by a broad range of osteopathic physicians.

Clinical decision-making and therapeutic approaches in osteopathy - a qualitative grounded theory study.

There is limited understanding of how osteopaths make decisions in relation to clinical practice. The aim of this research was to construct an explanatory theory of the clinical decision-making and therapeutic approaches of experienced osteopaths in the UK. Twelve UK registered osteopaths participated in this constructivist grounded theory qualitative study. Purposive and theoretical sampling was used to select participants. Data was collected using semi-structured interviews which were audio-recorded and transcribed. As the study approached theoretical sufficiency, participants were observed and video-recorded during a patient appointment, which was followed by a video-prompted interview. Constant comparative analysis was used to analyse and code data. Data analysis resulted in the construction of three qualitatively different therapeutic approaches which characterised participants and their clinical practice, termed; Treater, Communicator and Educator. Participants' therapeutic approach influenced their approach to clinical decision-making, the level of patient involvement, their interaction with patients, and therapeutic goals. Participants' overall conception of practice lay on a continuum ranging from technical rationality to professional artistry, and contributed to their therapeutic approach. A range of factors were identified which influenced participants' conception of practice. The findings indicate that there is variation in osteopaths' therapeutic approaches to practice and clinical decision-making, which are influenced by their overall conception of practice. This study provides the first explanatory theory of the clinical decision-making and therapeutic approaches of osteopaths.

A qualitative grounded theory study of the conceptions of clinical practice in osteopathy - a continuum from technical rationality to professional artistry.

How practitioners conceive clinical practice influences many aspects of their clinical work including how they view knowledge, clinical decision-making, and their actions. Osteopaths have relied upon the philosophical and theoretical foundations upon which the profession was built to guide clinical practice. However, it is currently unknown how osteopaths conceive clinical practice, and how these conceptions develop and influence their clinical work. This paper reports the conceptions of practice of experienced osteopaths in the UK. A constructivist grounded theory approach was taken in this study. The constant comparative method of analysis was used to code and analyse data. Purposive sampling was employed to initially select participants. Subsequent theoretical sampling, informed by data analysis, allowed specific participants to be sampled. Data collection methods involved semi-structured interviews and non-participant observation of practitioners during a patient appointment, which was video-recorded and followed by a video-prompted reflective interview. Participants' conception of practice lay on a continuum, from technical rationality to professional artistry and the development of which was influenced by their educational experience, view of health and disease, epistemology of practice knowledge, theory-practice relationship and their perceived therapeutic role. The findings from this study provide the first theoretical insight of osteopaths' conceptions of clinical practice and the factors which influence such conceptions.