The Use of Exercise Prescription in Australian Osteopathy Practice: Secondary Analysis of a Nationally Representative Sample of the Profession.

Introduction: Exercise is beneficial for improving general health, wellbeing, and specific medical conditions. In musculoskeletal conditions such as chronic low back and neck pain, prescribed exercise has been found to be moderately effective in decreasing pain and improving function. Osteopaths are primary contact health professionals who manage predominantly musculoskeletal complaints. This work presents a secondary data analysis of the Australian osteopathy practice-based research network and profiles the characteristics of osteopaths who often use exercise prescription in patient care. Methodology. Secondary analysis of a cross-sectional survey of 992 osteopaths was registered with the Osteopathy Research and Innovation Network, an Australian practice-based research network. Demographics, practice, and treatment characteristics of Australian osteopaths who "often" use exercise prescription in patient care were examined. Results: Seven-hundred and thirty-three Australian osteopaths (74%) indicated that they use exercise prescription "often" in patient care. Australian osteopaths who often use exercise prescription are more likely to be colocated with another osteopath (ORa 1.54) and send referrals to an exercise physiologist (ORa 1.94) and a specialist medical practitioner (ORa 1.72). Those osteopaths who often used exercise prescription were also more likely to discuss physical activity (ORa 5.61) and nutrition (ORa 1.90). Australian osteopaths who use exercise prescription often were more likely to treat patients with sports injuries (ORa 2.43) and use soft tissue techniques (ORa 1.92), trigger point techniques (ORa 2.72), and sports taping (ORa 1.78). Conclusion: Osteopaths who utilise exercise prescription were more likely to discuss physical activity, diet, and nutrition and utilise referral networks with specialist medical practitioners and exercise physiologists. Australian osteopaths who often use exercise prescriptions were also more likely to treat patients with sport injury. The results suggest that most Australian osteopaths use exercise prescription and have referral networks with other health professionals for patient management. Further work is required to explore the type of exercise prescription used and for what conditions.

How do Australian osteopaths manage migraines? Outcomes from a national practice-based research network.

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.

A complementary medicine student-led telehealth clinic: evaluating learning & teaching perceptions.

OBJECTIVES: This study evaluates a multi-centered complementary medicine (CM) student-led telehealth clinic during the COVID-19 pandemic. Likert and qualitative responses explore student and educator learning and teaching perceptions of the implementation of a successful telehealth clinic. RESULTS: 51 students and 17 educators completed the survey. Respondents agreed that support from educators (90%) and orientation (70%) assisted effective performance. Over 90% (93%) of all respondents supported telehealth in student-led clinics, whilst 87% encountered barriers such as technical and infrastructure issues. Respondents agreed that telehealth practice skills improved in case history taking (90%), treatment (90%) and building patient rapport (60%). Respondents (61%) disagreed that physical examination was effectively performed, and 100% of respondents agreed telehealth was a valuable learning experience. This study is the first to explore student and educator perceptions of telehealth in an Australian University multi-centered CM student-led clinic. To be successful in an educational environment, students and educators require digital literacy and adequate telehealth practice infrastructure. Whilst some in-person practice skills are transferable to telehealth, educators need to adapt curriculum to ensure counselling and physical examination skills are specifically taught for virtual consultations. Telehealth in clinical practice requires continued investigation and educational development.

Changes in biochemical markers following a spinal manipulation - a systematic review update.

OBJECTIVE: The aim of this systematic review was to update the current level of evidence for spinal manipulation in influencing various biochemical markers in healthy and/or symptomatic population. METHODS: This is a systematic review update. Various databases were searched (inception till May 2023) and fifteen trials (737 participants) that met the inclusion criteria were included in the review. Two authors independently screened, extracted and assessed the risk of bias in included studies. Outcome measure data were synthesized using standard mean differences and meta-analysis for the primary outcome (biochemical markers). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the quality of the body of evidence for each outcome of interest. RESULTS: There was low-quality evidence that spinal manipulation influenced various biochemical markers (not pooled). There was low-quality evidence of significant difference that spinal manipulation is better (SMD -0.42, 95% CI - 0.74 to -0.1) than control in eliciting changes in cortisol levels immediately after intervention. Low-quality evidence further indicated (not pooled) that spinal manipulation can influence inflammatory markers such as interleukins levels post-intervention. There was also very low-quality evidence that spinal manipulation does not influence substance-P, neurotensin, oxytocin, orexin-A, testosterone and epinephrine/nor-epinephrine. CONCLUSION: Spinal manipulation may influence inflammatory and cortisol post-intervention. However, the wider prediction intervals in most outcome measures point to the need for future research to clarify and establish the clinical relevance of these changes.

Osteopathy in rural and remote Australia: analysis of demographic, practice and clinical management characteristics from a nationally representative sample of 992 osteopaths.

INTRODUCTION: There is significant interest in allied health and the role it plays in health care for rural and remote populations. In Australia, osteopaths are allied health professionals who manage predominantly musculoskeletal complaints using manual therapy, exercise and patient education. Workforce distribution is a significant issue for osteopathy in Australia with most practitioners centred in the metropolitan regions of Victoria and New South Wales. There is limited evidence about the role osteopathy plays in the musculoskeletal health of Australian rural and remote populations. This research sought to profile the characteristics of Australian osteopaths who practise in rural and remote settings. METHODS: A secondary analysis of the Osteopathy Research and Innovation Network (ORION) data was undertaken to identify the demographic, practice and clinical management characteristics of Australian osteopaths in rural and remote settings. ORION is a practice-based research network for the Australian osteopathy profession. The ORION questionnaire comprised 27 items regarding osteopaths' characteristics. Inferential statistics were used to identify characteristics that were significantly different between Australian osteopaths practising in rural and remote settings compared to those practising in urban settings. Logistic regression was used to calculate adjusted odds ratios (AOR) relating to characteristics significantly associated with practising in a rural and remote setting. RESULTS: Of 992 osteopaths who responded to the ORION questionnaire, 18.3% (n=172) indicated practising in a rural and remote setting. Australian osteopaths in rural and remote settings were more likely to report receiving referrals from massage therapists (AOR 2.17), send referrals to other osteopaths (AOR 1.64), and often treat patients over the age of 65 years (AOR 2.25) compared to their urban counterparts. Osteopaths in rural and remote setting were less likely to report using private health insurance claim systems (AOR 0.36) and to treat non-English-speaking patients (AOR 0.09). CONCLUSION: This secondary analysis identified several practitioner and practice characteristics that differ between osteopaths practising in rural and remote settings and those practising in urban settings. These findings contribute to the emerging picture of the practice of rural and remote Australian osteopaths. Further research is required to understand the role osteopaths play in rural and remote health care, and how the current data can inform workforce and health policy development.

Osteopathy Referrals to and from General Practitioners: Secondary Analysis of Practitioner Characteristics from an Australian Practice-Based Research Network.

Australian osteopaths engage in multidisciplinary care and referrals with other health professionals, including general practitioners (GPs), for musculoskeletal care. This secondary analysis compared characteristics of Australian osteopaths who refer to, and receive referrals from, GPs with osteopaths who do not refer. The analysis was undertaken to identify pertinent characteristics that could contribute to greater engagement between Australian osteopaths and GPs. Data were from the Australian osteopathy practice-based research network comprising responses from 992 osteopaths (48.1% response rate). Osteopaths completed a practice-based survey exploring their demographic, practice, and clinical management characteristics. Backward logistic regression identified significant characteristics associated with referrals. Osteopaths who reported sending referrals (n = 878, 88.5%) to GPs were more likely than their non-referring colleagues to receive referrals from GPs (aOR = 4.80, 95% CI [2.62-8.82]), send referrals to a podiatrist (aOR = 3.09, 95% CI [1.80-5.28]) and/or treat patients experiencing degenerative spinal complaints (aOR = 1.71, 95% CI [1.01-2.91]). Osteopaths reporting receiving referrals (n = 886, 89.3%) from GPs were more likely than their non-referring colleagues to send referrals to GPs (aOR = 4.62, 95% CI [2.48-8.63]) and use the Medicare EasyClaim system (aOR = 4.66, 95% CI [2.34-9.27]). Most Australian osteopaths who report engaging in referrals with GPs for patient care also refer to other health professionals. Referrals from GPs are likely through the Chronic Disease Management scheme. The clinical conditions resulting in referrals are unknown. Further research could explore the GP-osteopath referral network to strengthen collaborative musculoskeletal care. The outcomes of this study have the potential to inform Australian osteopaths participating in advocacy, public policy and engagement with Australian GPs.

Demographic, practice and clinical management characteristics of osteopaths referring to podiatrists: secondary analysis of a nationally representative sample of Australian osteopaths.

BACKGROUND: Interprofessional care is paramount in contemporary healthcare practice. How different professions interact, and the characteristics of those practitioners who practice in an interprofessional way are rarely described in the literature. The aim of the current work was to identify the demographic, practice and clinical management characteristics of Australian osteopaths who report referring to podiatrists. METHODS: The study was a secondary analysis of data from the Osteopathy Research and Innovation Network (ORION). Inferential statistics were generated to identify statistically significant demographic, practice and clinical management characteristics associated with referrals to podiatrists by Australian osteopaths. RESULTS: Nine-hundred and ninety-two Australian osteopaths responded to the questionnaire. Sending referrals to a podiatrist was reported by 651 participants (65.6%). Female Australian osteopaths were less likely to report referring to podiatrists compared to male osteopaths (OR 0.76, 95%CI 0.59-0.99). Australian osteopaths who reported referring to podiatrists were more likely to report receiving referrals from podiatrists (OR 9.75, 95%CI 6.98-13.61), use orthopaedic testing in patient assessment (OR 7.62, 95%CI 2.82-20.60), and often treat patients with postural disorders (OR 1.71, 95%CI 1.03-2.26), compared to osteopaths who do not refer to podiatrists. CONCLUSION: This study provides initial evidence for the referral relationship between Australian osteopaths and podiatrists. Further work could explore the nature of these referrals, including the complaints resulting in referral and outcomes of care. This information will be useful to those involved in health policy development and the professions advocating for their role in the wider healthcare system.

Utilisation of pain counselling in osteopathic practice: secondary analysis of a nationally representative sample of Australian osteopaths.

OBJECTIVES: Advice, reassurance and education are recommended as first line treatments for musculoskeletal pain conditions such as low back pain. Osteopaths are registered primary contact allied health professionals in the Australian healthcare system who primarily manage acute and chronic musculoskeletal pain conditions. This study aimed to investigate the proportion of Australian osteopaths who do and do not utilise advice, reassurance and education (pain counselling) in their clinical practice, and determine the characteristics associated with the frequency of using pain counselling in clinical practice. METHODS: A secondary analysis of practice characteristics from a nationally representative sample of Australian osteopaths was undertaken. Participants completed a 27-item practice characteristics questionnaire between July-December 2016. Bivariate analyses were used to identify significant variables for inclusion in a backward multiple logistic regression model. Adjusted odds ratios (OR) were calculated for significant variables. RESULTS: Responses were received from 991 Australian osteopaths, representing 49% of the profession. Of these 264 (26.64%) indicated often utilising pain counselling, and 727 (73.36%) reported not often utilising pain counselling. Those who utilised pain counselling were more than twice as likely to report research evidence had a high impact on their clinical practice (OR 2.11), and nearly twice as likely to discuss physical activity with their patients (OR 1.84). CONCLUSIONS: Pain counselling is under-utilised by nearly three quarters of the Australian osteopathic profession as a management strategy. Future studies are required to explore the reasons why most in the profession comprised in this sample are infrequently utilising this guideline recommendation. Given the frequency of chronic musculoskeletal pain conditions presenting to Australian osteopaths, strategies appear to be needed to advance the profession via professional development in accessing and using evidence-based care for pain conditions.

PROMIS Neuropathic and Nociceptive Pain Quality in Musculoskeletal Pain Presentations.

OBJECTIVE: Musculoskeletal pain is a significant contributor to the global disease burden. Management of musculoskeletal pain where a neuropathic component is present can be challenging. This study evaluated the internal structure of the Patient-Reported Outcome Measures Information System (PROMIS) pain quality scales, explored the prevalence of neuropathic and nociceptive pain, and identified health demographics and behaviors related to musculoskeletal pain presentations. METHODS: Patients presenting to the Victoria University Osteopathy Clinic (Melbourne, Vic., Australia) were invited to complete a health demographics and behaviors questionnaire, and the PROMIS Neuropathic (NeuroPQ) and Nociceptive (NociPQ) pain quality scales, before their initial consultation. Descriptive, inferential, and correlation statistics were used to evaluate the PROMIS scales, health demographics, and behaviors. Mokken scale analysis was used to evaluate the internal structure and dimensionality of the NeuroPQ and NociPQ scales. RESULTS: Three hundred eighty-three (N=383) patients completed the measures. Mokken scaling suggested the PROMIS scales demonstrated acceptable internal structure and were unidimensional. Over 22% of patients demonstrated cutoff scores above 50, suggesting a substantive neuropathic pain component to their musculoskeletal presentation. Patients who reported cigarette smoking, not being born in Australia or not speaking English at home, demonstrated higher NeuroPQ scores. Females demonstrated significantly higher NociPQ scores than males. Pain intensity demonstrated small to medium correlations with NeuroPQ and NociPQ scores. DISCUSSION: This study provides support for the use of the NeuroPQ and NociPQ scales in musculoskeletal pain patients. Associations with health demographics and behaviors were identified, and patients typically experienced a combination of neuropathic and nociceptive pain.

The clinical management of neck pain of novice and experienced Australian osteopaths: A secondary analysis of a nationally representative sample.

INTRODUCTION: Neck pain is one of the most common musculoskeletal disorders worldwide. Osteopaths are primary contact health professionals who predominantly manage musculoskeletal complaints. How Australian osteopaths manage neck pain is beginning to emerge in the literature and there may be differences based on clinical experience. This work presents a secondary data analysis of the Australian osteopathy practice-based research network and aims to examine the clinical management characteristics of experienced and novice osteopaths who often treat neck pain. METHODOLOGY: Secondary analysis of a cross-sectional survey of osteopaths registered with the Osteopathy Research and Innovation Network (ORION), an Australian practice-based research network. Demographic, practice and treatment characteristics of osteopaths who 'often' treat neck pain. Data was split into two groups: novice practitioners (up to nine years in clinical practice), and experienced practitioners (10 years or more in clinical practice), and clinical management was compared. RESULTS: Most (98%) of the 971 osteopaths reported that they treat neck pain often. Of those that treat neck pain often, 58% reported being male. The mean number of patient care hours per week was 28.1 ± 12.1 and the mean number of patient visits per week was 36.7 ± 18.7. There was a statistically significant difference between novice and experienced groups for discussing occupation (p < 0.01; d = 0.26) and stress (p = 0.045; d = 0.13) during their consultations, with a low to medium and low effect size, respectively. CONCLUSION: This work demonstrates differences in the management strategies of experienced and novice Australian osteopaths that includes utilisation of a multidisciplinary approach to patient management. The results support the conclusion that there are differences in the clinical management strategies employed by experienced versus novice Australian osteopaths.

"If you don't use or understand visceral osteopathy you're not a real osteopath": Professional identity in Australian osteopathy through the lens of a single traditional technique.

BACKGROUND/CONTEXT: Manual therapists utilise a range of techniques in the clinical practice to manage predominantly musculoskeletal complaints. There are, however, a number of practitioners who utilise techniques that are directed towards the bodies' visceral structures. Osteopaths are one such professional group that utilise these techniques in their practice. Like many health professions, the identity of the osteopathy profession is evolving, and the techniques osteopaths use form part of this identity. OBJECTIVE: Explore free text responses to a questionnaire about the use of techniques directed towards the viscera. METHODS/DESIGN: Australian osteopaths who were part of a practice-based research network, were invited to complete a survey about their use of techniques applied to the viscera. Participants were also invited to provide free-text responses to a number of items related to the use of these techniques. Free-text responses were thematically analysed. PARTICIPANTS: 137 participants completed the survey. RESULTS: Three themes were identified: being an osteopath; applying visceral techniques in practice - evidence conflicts with practice; and, inadequate education in visceral techniques. CONCLUSIONS: Participant responses resonated with the internal (own world views, beliefs) and external (external perceptions of the profession, education) influences that underpin the theory of a professions' identity. Our work demonstrates that the Australian osteopathy profession exhibits an identity similar to other manual therapies - the profession is somewhat fragmented in its views about its practice. Additional research is required to explore whether other manual therapy techniques used by osteopaths elicit similar responses and how those external to the profession perceive it.

Pain knowledge, attitudes and beliefs of Australian osteopaths drawn from a nationally representative sample of the profession.

BACKGROUND: Pain has been identified as a global health issue with substantial effects on individuals and society. Health professionals managing pain complaints must have appropriate knowledge of pain neurophysiology, and attitudes and beliefs towards pain management that align with current practice guidelines. OBJECTIVES: Evaluate Australian osteopaths' current level of knowledge of pain neurophysiology and their beliefs and attitudes towards pain, and explore associations with demographic variables. METHOD: Australian osteopaths drawn from a nationally representative practice-based research network received the questionnaire. The questionnaire included demographic information, Neurophysiology of Pain Questionnaire (NPQ), Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) and the Attitudes to Back Pain Scale in Musculoskeletal Practitioners (ABS-mp). RESULTS: Complete responses were received from 211 osteopaths (21.3% response rate). The mean total NPQ score was equivalent to 72.2% correct responses. The PABS-PT Biomedical scale mean score was 38.8 ( ±9.1, α = 0.81) and the Biopsychosocial scale was 22.3 ( ±3.3, α = 0.38). ABS-mp mean factor scores suggest osteopaths support psychological approaches (22.1, ±3.3, α = 0.71) but endorsed more treatment sessions for those with back pain (15.9, ±4.7, α = 0.71). Trivial correlations between measures and most demographic variables were observed. Osteopaths who undertook further studies in pain had higher mean NPQ scores, with moderate negative correlations with a lower PABS-PT Biomedical subscale score (ρ = -0.45, p < 0.01). CONCLUSIONS: Australian osteopaths demonstrate a range of pain neurophysiology knowledge, and beliefs and attitudes towards pain. The findings support the positive impact of professional development for improving pain knowledge in this population.

Australian osteopaths as non-medical prescribers: comparison of healthcare practitioner characteristics from a nationally representative survey.

The study aimed to compare the characteristics of Australian osteopaths who definitely agree that prescribing scheduled medicines is part of their future scope of practice with those who do not. A secondary analysis of a cross-sectional survey of osteopaths from an Australian practice-based research network was undertaken. Demographic, practice and treatment characteristics were identified using inferential statistics and backward linear regression modelling. Over one-quarter (n=257, 25.9%) of the total participants (n=992) indicated that they 'definitely' agree that osteopaths should seek prescription rights. Adjusted odds ratios (OR) suggested these osteopaths were more likely to engage in medication discussions with patients (OR 1.88), frequently manage migraines (OR 1.68) and seek increased practice rights for referrals to medical specialists (OR 2.61) and diagnostic imaging (OR 2.79). Prescribing as part of the future scope of practice for Australian osteopaths is associated with patient management (medication discussions) and practice characteristics (increased referral rights for specialists and diagnostic imaging) that warrant additional investigation. Understanding of the practice, clinical and patient management characteristics of Australian osteopaths who see prescribing as part of the future scope of practice informs the case for regulatory and health policy changes for prescribing scheduled medicines.

The Impact of Three-Dimensional Printed Anatomical Models on First-Year Student Engagement in a Block Mode Delivery.

Student engagement is known to have several positive effects on learning outcomes and can impact a student's university experience. High levels of engagement in content-heavy subjects can be difficult to attain. Due to a major institutional restructure, the anatomy prosection laboratory time per subject was dramatically reduced. In response, the authors set out to redesign their anatomy units with a focus on engaging the learning activities that would increase time-on-task both within and outside of the classroom. One of these curriculum changes was the implementation of a suite of anatomy learning activities centered on sets of three-dimensional printed upper limb skeleton models. A two-part mixed-method sequential exploratory design was used to evaluate these activities. Part one was a questionnaire that evaluated the students' engagement with and perceptions of the models. Part two involved focus groups interviews, which were an extension of the survey questions in part one. The results of the study indicated that the majority of students found the models to be an engaging resource that helped improve their study habits. As a result, students strongly felt that the use of the models inspired greater academic confidence and overall better performance in their assessments. Overall, the models were an effective way of increasing the engagement and deep learning, and reinforced previous findings from the medical education research. Future research should investigate the effects of these models on student's grades within osteopathy and other allied health courses.

Determinants of health, health behaviours and demographic profile of patients attending an Australian university student-led osteopathy clinic.

Background: Profiles of health professions practice can inform pre-professional education, provide evidence to assist with interprofessional practice, and inform policy development. An understanding of the profile of patients seeking osteopathy care is emerging. Current research suggests that musculoskeletal presentations predominate with approximately one-third of patients presenting with co-morbid diseases. There is little data on these presentations in Australian osteopathy practice. This study aimed to describe the patient demographics, clinical presentations, health behaviours and determinants of health, including health literacy, of those attending for care at an Australian student-led osteopathy clinic. Methods: A convenience sample design was utilised where consecutive patients presenting for their initial consultation were invited to complete a health information questionnaire during 2016-2017. The questionnaire explored a range of health behaviours and the patient's health status. Data from the clinical records were also extracted to establish the presenting complaint, duration of the complaint and pertinent demographics. Descriptive statistics were generated for each variable. Results: Data were available for 1617 patients presenting for their initial consultation. The mean age of patients was 33.7 (±13.1) years with 55% (n = 887) identifying as female. Acute presentations predominated (n = 840, 52%), with presentations affecting the spine being the most common (57.8%). Most patients rated their health status as good to very good (75%). Approximately 7.5% of patients were identified as having low health literacy and 55.9% were currently suffering from one or more co-morbid presentations. Conclusions: The demographic profile and presenting complaints of patients presenting to a student-led osteopathy clinic are largely consistent with other Australian private practice profiles. The current work also identified co-morbid presentations, and positive and negative health behaviours. Osteopaths may play a role in the management of, or referral for, these presentations where health behaviours require change, or management of co-morbid conditions is beyond the scope of practice. The increasing volume of patient profile literature globally suggests that osteopaths can play a substantial role in the management of musculoskeletal complaints. Further, osteopathy may play a role in screening determinants of health, and engage in multidisciplinary care to ensure those patients with co-morbid conditions or adverse health behaviours are managed appropriately.

Commentary: Statistical significance and clinical significance - A call to consider patient reported outcome measures, effect size, confidence interval and minimal clinically important difference (MCID).

In healthcare research an intervention may be statistically significant based on quantitative analysis; however, simultaneously it may be relatively insignificant to the health or quality of life of patients affected by a particular condition or disease being treated by the intervention - thus may be interpreted as having low clinical significance. An understanding of statistics is fundamental for evidence informed healthcare. Patient-reported outcome measures (PROMs) direct patients to evaluate aspects of their own health, including quality of life, disability and function. Data obtained from PROMs can be used to demonstrate the impact of healthcare interventions on these elements of a person's quality of life. To interpret outcome measure data for clinical decision making, a clinician must understand the concepts of statistical significance and clinical significance. This commentary explores the concepts of patient reported outcome measures (PROMs), their statistical and clinical significance, and explores their relationship with a practical example for the clinician. Limitations of research that only reports p-values and the need to consider effect size, confidence intervals, and minimal clinically important difference are also discussed. Together, these concepts can assist the clinician to evaluate whether an intervention may be suitable for their clinical practice.

Simulation can offer a sustainable contribution to clinical education in osteopathy.

Background: Clinical education forms a substantial component of health professional education. Increased cohorts in Australian osteopathic education have led to consideration of alternatives to traditional placements to ensure adequate clinical exposure and learning opportunities. Simulated learning offers a new avenue for sustainable clinical education. The aim of the study was to explore whether directed observation of simulated scenarios, as part replacement of clinical hours, could provide an equivalent learning experience as measured by performance in an objective structured clinical examination (OSCE). Methods: The year 3 osteopathy cohort were invited to participate in replacement of 50% of their clinical placement hours with online facilitated, video-based simulation exercises (intervention). Competency was assessed by an OSCE at the end of the teaching period. Inferential statistics were used to explore any differences between the control and intervention groups as a post-test control design. Results: The funding model allowed ten learners to participate in the intervention, with sixty-six in the control group. Only one OSCE item was significantly different between groups, that being technique selection (p = 0.038, d = 0.72) in favour of the intervention group, although this may be a type 1 error. Grade point average was moderately positively correlated with the manual therapy technique station total score (r = 0.35, p < 0.01) and a trivial relationship with the treatment reasoning station total score (r = 0.17, p = 0.132). Conclusions: The current study provides support for further investigation into part replacement of clinical placements with directed observation of simulated scenarios in osteopathy.

Prevalence and profile of Australian osteopaths treating older people.

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.

Changes in pain knowledge, attitudes and beliefs of osteopathy students after completing a clinically focused pain education module.

Background: Chronic pain is a substantial burden on the Australian healthcare system with an estimated 19.2% of Australians experiencing chronic pain. Knowledge of the neurophysiology and multidimensional aspects of pain is imperative to ensure health professionals apply a biopsychosocial approach to pain. Questionnaires may be used to assess learner changes in neurophysiology knowledge and beliefs and attitudes towards pain after education interventions.The aim of this study was to evaluate changes in pain neurophysiology knowledge, beliefs and attitudes following a 12 week clinically-focused pain module in year 3 osteopathy students as measured by the Neurophysiology of Pain (NPQ) Questionnaire and Health Care Providers Pain and Impairment Relationship scale (HC-PAIRS). Methods: A pre-post design was utilised. Learners completed a demographic information survey pre-module, and completed the NPQ & HC-PAIRS prior to undertaking, and after completing, a twelve week clinically-focused pain module. Results: Learners (n = 55) completed the NPQ & HC-PAIRS at both time points. The median NPQ score was significantly increased with a large effect size (p < 0.001, z = - 5.71, r = 0.78) following the completion of the module. In contrast, the HC-PAIRS total score was significantly increased after the completion of the module (p < 0.01, z = - 6.95, r = 0.91) suggesting an increase in negative pain attitudes and beliefs. Results indicate that a clinically-focused pain module can increase pain neurophysiology knowledge. However the HC-PAIRS results suggest an increase in negative pain attitudes and beliefs. The HC-PAIRS questionnaire was developed for use with chronic low back pain attitudes & beliefs in practitioners, rather than pre-clinical students. Students were provided with general principles of pain management, rather than condition specific pain management. This study is the first comparing pain neurophysiology knowledge and changes in attitudes and beliefs towards pain pre-post a clinically-focused pain module using the NPQ & HC-PAIRS. Conclusions: There was a significant improvement in NPQ score after the 12 week clinically-focused pain module. The HC-PAIRS result was paradoxical and may reflect issues with the module design or the measurement tool. The module duration is longer than that reported in the literature and demonstrates effectiveness in increasing pain neurophysiology knowledge.

Assessment of the impact of shared brain imaging data on the scientific literature.

Data sharing is increasingly recommended as a means of accelerating science by facilitating collaboration, transparency, and reproducibility. While few oppose data sharing philosophically, a range of barriers deter most researchers from implementing it in practice. To justify the significant effort required for sharing data, funding agencies, institutions, and investigators need clear evidence of benefit. Here, using the International Neuroimaging Data-sharing Initiative, we present a case study that provides direct evidence of the impact of open sharing on brain imaging data use and resulting peer-reviewed publications. We demonstrate that openly shared data can increase the scale of scientific studies conducted by data contributors, and can recruit scientists from a broader range of disciplines. These findings dispel the myth that scientific findings using shared data cannot be published in high-impact journals, suggest the transformative power of data sharing for accelerating science, and underscore the need for implementing data sharing universally.