Defining the landscape of patient harm after osteopathic manipulative treatment: synthesis of an adverse event model.

BACKGROUND: In the United States, osteopathic manipulative treatment (OMT), is a popular complementary physical health approach for the treatment of neuromusculoskeletal disorders. However, post-OMT adverse events (AEs) are poorly defined in terms of frequency, severity, and temporal evolution. To date, no benchmark for patient safety exists. To improve understanding in this field, we set out to model the landscape of patient harm after OMT. METHODS: We conducted a comprehensive search of all available primary clinical research studies reporting on the occurrence of post-OMT AEs in nonpregnant, adult outpatients treated by an osteopathic physician in the United States. The methodology of eligible studies was then reviewed to select those containing the minimum required dataset to model the post-OMT AEs. The minimum required dataset consisted of four model parameters: 'post-OMT interval', 'OMT encounters with post-OMT interval assessment', 'AEs preceded by an OMT encounter', and 'AE severity.' We used the dataset extracted from selected studies to calculate a patient safety benchmark defined as the incidence rate of AEs per 100 post-OMT interval-days. RESULTS: From 212 manuscripts that we identified, 118 primary clinical research studies were assessed for eligibility. A total of 23 studies met inclusion criteria for methodological review, of which 13 studies passed and were selected for modeling. Mild AEs were the most frequent, accounting for n = 161/165 (98%) of total AEs observed in the literature. The cumulative incidence of mild AEs was also significantly greater (P = 0.01) than both moderate and severe grades. The benchmark incidence rate was 1.0 AEs per 100 post-OMT interval-days. CONCLUSIONS: The majority of post-OMT AEs observed in the primary clinical literature were of mild severity. Modeling of the combined dataset on post-OMT AEs allowed for the derivation of a patient safety benchmark that, to date, has not been established in the field of osteopathic manipulative medicine. Additional research is needed to improve model resolution during the post-OMT period. This work conceptualized a model for identifying and grading post-OMT AEs, which should facilitate future comparisons between institutions in order to continually improve patient safety standards in the field of osteopathic manipulative medicine.

Incidence Rate of Somatic Dysfunction in Previously Undiagnosed Spotted Fever Rickettsiosis: A Case Report.

Spotted Fever Rickettsiosis (SFR) is a systemic vasculopathy due to tick-borne rickettsial infection. Presenting symptoms and signs may be nonspecific or include the triad of fever, headache, and a rash. Established long-term complications of SFR include debilitating neuromusculoskeletal sequelae; however, no reports describe the incidence of somatic dysfunction (SD) in SFR. We present the first description of SD in previously undiagnosed SFR. Incidence of SD before diagnosis and after antibiotic therapy was assessed every seven weeks throughout 28 weeks of Osteopathic Neuromusculoskeletal Medicine (ONMM) care, including osteopathic manipulative treatment (OMT) administered twice a month on average. The patient presented with the chief complaint of worsening neck and back pain interfering with sleep. Other symptoms included blurry vision, right-hand weakness, a truncal rash, and absence of fevers. A 14-week trial of OMT failed to significantly decrease the incidence of SD compared to baseline. Extensive workup for an underlying condition revealed moderate axonal sensorimotor polyneuropathy and elevated rickettsial IgG titers. Doxycycline therapy was initiated alongside ongoing ONMM care. Incidence of SD over the 14-week post-antibiotic OMT period was significantly less than that assessed at baseline and during the OMT-only period. This case highlights the utility of periodic graphical assessment for monitoring SD response to OMT.

Iliacus tender points in young adults: a pilot study.

CONTEXT: Recent studies have assessed iliacus tender point prevalence in outpatient clinics. However, studies on the prevalence of iliacus tender points in the young adult population and the correlation of its prevalence with daily activities are lacking. OBJECTIVES: (1) To determine the prevalence of low back pain, iliacus tender points, and positive results of Thomas tests (ie, hypertonic iliopsoas muscles) in young adult participants. (2) To evaluate daily activities including prolonged sitting, exercise, and running or biking as predictive factors for low back pain, iliacus tender points, and positive Thomas test results. (3) To examine the relationship between iliacus tender points and positive Thomas test results. METHODS: Healthy students aged 18 to 30 years at Edward Via College of Osteopathic Medicine-Virginia Campus were recruited using e-mail, class announcements, and flyers. Data were collected for age, sex, amount of time spent sitting in a 24-hour period, type and frequency of exercise performed, and low back pain in the past 7 days. Patients underwent an iliacus tender point assessment and a Thomas test; results of each were recorded for the right and left sides. RESULTS: Twenty-five women and 24 men aged 22 to 30 years (mean, 24.39 years) were analyzed. Twenty-four participants (49%) had low back pain, 46 (94%) had an iliacus tender point, and 25 (51%) had a positive Thomas test result. There was no statistically significant difference between men and women with regard to low back pain, tender point presence, or a positive Thomas test result (P=.26, .99, and .78, respectively). Participants who reported sitting for 8 or more hours in a 24-hour period or who reported running or biking more than 3 times per week were more likely to have an iliacus tender point (P=.001 and .028, respectively). CONCLUSION: The prevalence of iliacus tender points was high in the study population. Prolonged sitting and running or biking was associated with an increased risk of developing low back pain or an iliacus tender point.