"What you feel under your hands": exploring professionals' perspective of somatic dysfunction in osteopathic clinical practice-a qualitative study.

BACKGROUND: Despite controversy regarding its validity and clinical usefulness, manual examination findings still have an important role for manipulative therapies. As an example, somatic dysfunction (SD) remains central to osteopathic practice.This study aims to explore the experienced osteopaths' attitudes concerning SD and its role in osteopathic practice. This qualitative research could contribute to building a consistent paradigm for manual intervention in all musculoskeletal manipulations. METHODS: A thematic analysis with grounded theory elements was used. Data were collected through semi-structured interviews carried out between February and April 2021. A purposive sample of twenty professional osteopaths with past experience in osteopathic care was chosen to reflect the phenomenon's variety. The data analysis was done inductively and in tandem with the recruiting to keep track of data saturation. RESULTS: Eleven osteopaths participated in the study. Three main themes emerged from the data analysis: (1) SD as a safe tissue-touch-based communication tool between operator and person complex adaptive health system; (2) The treatment of SD is shareable between osteopaths, other health professionals, and the patients involved in the therapeutic pathway improving body awareness and health; (3) The development of the SD concept in research and practice to better clarify osteopathic profession identity and definition. CONCLUSIONS: A panel of expert osteopaths consider the concept of SD as a valuable tool integrated into the osteopathic evaluation and treatment process. The shared concept and clinical application of SD is informed by person-centered care concepts and from the fields of neuroscience, cognitive and complexity science. Our study reports a common need among osteopaths to develop an evidence-based framework of SD to allow the best development of the osteopathic profession.

Evidence-based practice among Italian osteopaths: a national cross-sectional survey.

BACKGROUND: While evidence-based practice (EBP) is widely accepted across healthcare professions, research investigating its implementation in manual therapy professions such as osteopathy is limited. The primary aim of this study was to investigate Italian osteopaths' attitudes, skills, and use of EBP. A secondary purpose was to understand the obstacles and enablers to EBP adoption in the Italian osteopathic context. METHODS: A cross-sectional national survey was conducted (April to June 2020) among a sample of Italian osteopaths. Eligible participants were invited to complete the Italian-translated Evidence-Based practice Attitude and Utilization Survey (EBASE) anonymously online using various recruitment strategies, including email and social media campaigns. In addition to the three EBASE sub-scores (attitudes, skills and use), the demographic characteristics of the sample were considered. RESULTS: A total of 473 osteopaths responded to the survey. The sample appeared to represent the Italian osteopathic profession. The majority of participants had a favorable attitude toward EBP. Eighty-eight percent of respondents agreed that EBP was necessary for osteopathy practice and that scientific literature and research findings were beneficial to their clinical scenario (95%). Perceived skill levels in EBP were rated as moderate, with the lowest scores for items relating to clinical research and systematic review conduct. Apart from reading/reviewing scientific literature and using online search engines to locate relevant research papers, participant engagement in all other EBP-related activities was generally low. Clinical practice was perceived to be based on a very small proportion of clinical research evidence. The primary obstacles to EBP implementation were a dearth of clinical evidence in osteopathy, and poor skills in applying research findings. The primary enablers of EBP adoption were access to full-text articles, internet connectivity at work, and access to online databases. CONCLUSIONS: Italian osteopaths were largely supportive of evidence-based practice but lacked basic skills in EBP and rarely engaged in EBP activities. The updating of osteopathic training curriculum and professional formal regulation in Italy could provide a suitable framework to improve EBP skills and use.

Thematic Analysis of Attitudes Held by a Group of Italian Osteopaths Toward Osteopathic Evaluation, Treatment, and Management in the Neonatal and Pediatric Field: A Qualitative Study.

OBJECTIVE: The purpose of this study was to investigate the attitudes held by a group of Italian osteopaths toward osteopathic evaluation, treatment, and management in the neonatal and pediatric field. METHODS: A thematic analysis with elements of grounded-theory approaches was used. Purposive sampling was used to recruit expert osteopaths in the neonatal and pediatric field. Data were gathered from July 2017 to January 2018 by individual semistructured interviews and transcribed verbatim. A thematic analysis of the data was then performed. The Consolidated Criteria for Reporting Qualitative Research checklist was used to structure the design of this qualitative study. RESULTS: Eight osteopaths participated. Data analysis generated 3 main themes: the role of the osteopath in the collaborative process of care, osteopathic diagnostic-clinical reasoning in the neonatal and pediatric field, and osteopathic treatment in the neonatal and pediatric field. CONCLUSION: The present study highlights that Italian osteopaths may prefer interprofessional and integrative activities aimed at supporting adaptive capacity and resilience for pediatric patients.

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 Italian Osteopathic Practitioners Estimates and RAtes (OPERA) study: How osteopaths work.

The scope of practice of the osteopathic profession in Italy is underreported. The first part of the present study investigated the Italian osteopaths' profile, focusing on the socio-demographic information and geographical distribution together with the main characteristics of their education. The OPERA-IT study highlighted that the majority of respondents declared to work as sole practitioners (58.4%), while the remaining declared to work as part of a team. Since teamwork and networking are recognized as fundamental aspects of healthcare, the present study aims to compare the osteopathic practice, diagnostic and treatment modalities of osteopaths who work as a sole practitioner and osteopaths who work as part of a team to highlight possible differences. Moreover, patients' characteristics will be presented. The OPERA-IT study population was chosen to provide a representative sample. A web campaign was set up to inform the Italian osteopaths before the beginning of the study. The OPERA IT study used a previously tested questionnaire. The questionnaire was translated into Italian following the World Health Organization recommendation. The questionnaire was composed of 57 items grouped in five sections, namely: socio-demographics, osteopathic education and training, working profile, organization, and management of the clinical practice and patient profile. The survey was delivered online through a dedicated platform. The survey was completed by 4,816 individuals. Osteopaths who work as sole practitioners represented the majority of the sample (n = 2814; 58.4%). Osteopaths who work as part of a team declared to collaborate mostly with physiotherapists (n = 1121; 23.3%), physicians with speciality (n = 1040; 21.6%), and other osteopaths (n = 943; 19.6%). The two groups showed heterogeneous characteristics. Significative differences were observed in all the factors, namely: geographical distribution, age, gender, training, working contract and working place, daily consultations and time for each consultation, fees, and the average waiting period to book an appointment. The principal component analysis supported a ten-component model and explained 80.5% of the total variance. The analysis showed that osteopaths working as sole practitioners have an increased probability (OR = 0.91; CI 95%: 0.88-0.94; p<0.01) of using systemic diagnostic and treatment techniques and have distinct clinical features with higher probability (OR = 0.92; 0.88-0.96; p<0.01) of spending less time with patients, being paid less but treating a higher number of patients per week. The most represented patients' age groups were 41-64 years old (n = 4452; 92.4%) and 21-40 years old (n = 4291; 89.1%). Similarly, the most reported new patients' age groups were 41-64 years old (n = 4221; 87.7%) and 21-40 years old (n = 3364; 69.9%). The most common presenting complaints were back pain, neck pain, cervical radiculopathy, sciatica, shoulder pain, and headaches. Osteopathic practice in Italy seems to be characterised by interprofessional collaboration, mostly with physiotherapists. Our results highlighted two different profiles in terms of sociodemographic characteristics and work modalities between osteopaths who work as sole practitioners and those who work as part of a team. Although according to the respondents, people of all ages consult Italian osteopaths, the majority of patients are adults. Most of them have been referred to osteopathy by other patients or acquaintances. Patients seek osteopathic care mostly for musculoskeletal related complaints.

Empathy in Medicine Osteopathic and Allopathic Physician Interpersonal Manner, Empathy, and Communication Style and Clinical Status of Their Patients: A Pain Registry-Based Study.

CONTEXT: Comparisons of osteopathic physicians (ie, DOs) and allopathic physicians (ie, MDs) on interpersonal manner, including empathy and communication style, have been limited by such methodologic issues as self-assessment and a focus on medical students rather than practicing physicians. OBJECTIVE: To compare perceptions of the interpersonal manner, empathy, and communication style of DOs and MDs and corresponding clinical measures reported by their patients. METHODS: A cross-sectional study of adults with subacute or chronic low back pain was conducted within the PRECISION Pain Research Registry from April 2016 through December 2018. A total of 313 patients having their physician for 1 year or longer reported sociodemographic and clinical characteristics, including use of nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids for low back pain. Using validated research instruments, they also reported perceptions of their physician's interpersonal manner, empathy, and communication style and clinical measures of pain catastrophizing, pain self-efficacy, low back pain intensity, back-related disability, and deficits in quality of life relating to sleep disturbance, pain interference with activities, anxiety, depression, and low energy/fatigue. RESULTS: Patients treated by DOs were less likely to be using NSAIDs (odds ratio [OR], 0.60; 95% CI, 0.36-0.997) or opioids (OR, 0.57; 95% CI, 0.32-0.998) than patients treated by MDs. Patients treated by DOs reported lesser pain catastrophizing (mean, 12.5; 95% CI, 10.1-15.0 for DOs vs 18.1; 95% CI, 16.3-19.9 for MDs; P<.001) and greater pain self-efficacy (mean, 39.5; 95% CI, 36.3-42.8 for DOs vs 35.3; 95% CI, 33.4-37.3 for MDs; P=.03). Correspondingly, patients treated by DOs reported lesser back-related disability (mean, 11.2; 95% CI, 9.9-12.5 for DOs vs 13.5; 95% CI, 12.8-14.3 for MDs; P=.002) and a trend toward lesser deficits in quality of life. Patients reported more favorable perceptions of DOs on interpersonal manner (mean, 4.3; 95% CI, 4.2-4.5 for DOs vs 4.0; 95% CI, 3.9-4.2 for MDs; P=.01) and empathy (mean, 41.2; 95% CI, 39.1-43.3 for DOs vs 38.0; 95% CI, 36.5-39.5 for MDs; P=.02). CONCLUSION: The mechanisms underlying lesser use of NSAIDs and opioids, superior clinical status measures, and more favorable perceptions of physician interpersonal manner and empathy reported by patients treated by DOs warrant further investigation.

Australian osteopathic practitioners' perceptions of the clinical relevance of anatomy / Percepciones de los practicantes de osteopatía australianos de la relevancia clínica de la anatomía

SUMMARY: Anatomy is a foundational discipline in the training of health care professionals. However, there is a paucity of literature on the relative importance of anatomy, especially in relation to the other biomedical sciences and clinical domains, in preparing osteopathic practitioners for clinical practice. This study aimed to examine Australian osteopathic practitioners' perceptions of the relative importance of anatomy in their professional training and clinical practice, especially in relation to other biomedical sciences and clinical domains within osteopathic curricula. The study also examined the perceived importance of the sub-disciplines of anatomy to professional practice. A questionnaire-based survey was carried out among Australian osteopathic practitioners at several national meetings in 2014 and 2015. Using a five-point Likert scale, all respondents were asked to rate the relevance of the following thirteen disciplines and subdisciplines to clinical practice: biomechanics, biochemistry, embryology, histology, gross anatomy, microbiology, neuroanatomy, neurology, pathology, pharmacology, physical examination, physiology and radiology. Out of 175 practitioners surveyed, 169 responded (i.e., 96.6 % response rate). Two of the sub-disciplines of anatomy were among the highest rated, with 98.2 % perceiving gross anatomy as "very important" while neuroanatomy being rated as "very important" by 84.6 % and "quite important" by 14.2 %. Similar high rating was also given to biomechanics and physical examination while the other two sub-disciplines, embryology and histology received lower ratings. No significant difference in ratings were identified with regard to participants' year and place of graduation. However, there was an association between gender and rating on Pathology and Pharmacology respectively, as well as age effects on the ratings of several sub-disciplines. These findings are generally consistent with the results from similar surveys carried out on the clinical importance of anatomy in other medical and allied health professionals in different countries. Overall, osteopathic practitioners have a positive perception of the relevance of anatomy, particularly gross and neuroanatomy, to clinical practice, and this should be taken into account when developing osteopathic curricula.

RESUMEN: La anatomía es una disciplina fundamental en la formación de profesionales de la salud. Sin embargo, hay poca literatura sobre la importancia relativa de la anatomía, especialmente en relación con las otras ciencias biomédicas y los dominios clínicos, en la preparación de profesionales de la osteopatía para la práctica clínica. Este estudio tuvo como objetivo examinar las percepciones de los médicos osteopáticos australianos sobre la importancia relativa de la anatomía en su formación profesional y práctica clínica, especialmente en relación con otras ciencias biomédicas y dominios clínicos dentro de los currículos osteopáticos. El estudio también examinó la importancia percibida de las subdisciplinas de la anatomía para la práctica profesional. Se realizó una encuesta basada en un cuestionario entre los profesionales osteopáticos australianos en varias reuniones nacionales en 2014 y 2015. Utilizando una escala Likert de cinco puntos, se pidió a todos los encuestados que calificaran la relevancia de las siguientes trece disciplinas y subdisciplinas para la práctica clínica: Biomecánica, bioquímica, embriología, histología, anatomía macroscópica, microbiología, neuroanatomía, neurología, patología, farmacología, exploración física, fisiología y radiología. De los 175 practicantes encuestados, 169 respondieron (es decir, una tasa de respuesta del 96,6 %). Dos de las subdisciplinas de la anatomía estaban entre las mejor calificadas, con un 98,2 % que percibían la anatomía general como "muy importante", mientras que la neuroanatomía se calificaba como "muy importante" en un 84,6 % y "muy importante" en un 14,2 %. También se dio una calificación alta similar a la biomecánica y el examen físico, mientras que las otras dos subdisciplinas, embriología e histología recibieron calificaciones más bajas. No se identificaron diferencias significativas en las calificaciones con respecto al año de los participantes y el lugar de graduación. Sin embargo, hubo una asociación entre el sexo y la calificación en Patología y Farmacología respectivamente, así como los efectos de la edad en las calificaciones de varias subdisciplinas. Estos hallazgos son generalmente consistentes con los resultados de encuestas similares realizadas sobre la importancia clínica de la anatomía, en otros profesionales de la salud médicos y afines en diferentes países. En general, los profesionales de la osteopatía tienen una percepción positiva de la relevancia de la anatomía, en particular la neuroanatomía general y la neuroanatomía, para la práctica clínica, lo que se debe tener en cuenta al desarrollar los currículos osteopáticos.

The perceptions and experiences of osteopathic treatment among cancer patients in palliative care: a qualitative study.

PURPOSE: This research aimed to explore the perceptions and experiences of cancer patients receiving osteopathic treatment as a complementary therapy when it is used in addition to conventional treatment for cancer pain. METHODS: This qualitative study employed semi structured interviews of cancer patients in a palliative care unit in Lyon, France, who received treatment from an osteopath alongside their conventional cancer treatment. We analysed data using grounded theory and qualitative methods. RESULTS: We interviewed 16 patients. The themes identified through the analysis included a low awareness of osteopathy among the population and an accompanying high level of misconceptions. The benefits of osteopathy were described as more than just the manual treatments with participants valuing osteopathy as a holistic, meditative, and non-pharmaceutical approach. Participants also described the osteopathic treatments as assisting with a range of cancer-related health complaints such as pain, fatigue, and sleep problems. Offering osteopathic treatment at an accessible location at low or no cost were identified by participants as enablers to the continued use of osteopathy. CONCLUSIONS: The findings of this study provides preliminary data which suggests, when delivered alongside existing medical care, osteopathy may have health benefits for patients with complex conditions such as cancer.

Enablers and barriers to the development of interprofessional collaboration between physicians and osteopaths: A mixed methods study.

Osteopathy is a complementary and alternative medicine (CAM) that is growing in popularity. Increasing numbers of parents are seeking pediatric osteopathic care in addition to conventional medical care. Information about the development of interprofessional collaboration (IPC) between these practitioners is scarce. This explanatory sequential mixed methods study aimed to explore enablers of and barriers to the development of IPC between physicians and osteopaths involved with pediatric patients in primary care in Quebec, Canada. Postal questionnaires about collaborative practices were first sent to all physicians and osteopaths working with pediatric patients in Quebec. Semi-structured individual interviews were then conducted with a subset of 10 physicians and 11 osteopaths. A total of 274 physicians (14%) and 297 osteopaths (42%) completed the survey. Forty-five percent (n = 122) of physicians reported that they referred at least one pediatric patient per month to an osteopath. Thirty-six percent (n = 96) of physicians and 41% (n = 122) of osteopaths indicated having professional relationships. Personal consultation, professional relationship, perceived utility of osteopathy and community practice were positively associated with osteopathic referrals. According to participants, the strongest enabler of the development of collaboration was positive clinical results reported by parents. Additional enablers included the osteopath having previous health professionals training such as physiotherapist, pediatric experience, mutual respect for professional boundaries and complementarity, perceived safety of osteopathy, and parents' requests for collaboration. Barriers were the absence of a common language, the organizational and legal context, uncertainty regarding one another's roles, lack of interprofessional interactions, and limited scientific evidence. These results related to enablers of and barriers to collaboration between physicians and osteopaths and the illustration of their dynamic interaction could be used to guide efforts to promote productive collaboration and safe patient-oriented care.

Influence of perceived difficulty of cases on student osteopaths' diagnostic reasoning: a cross sectional study.

Background: Diagnostic reasoning refers to the cognitive processes by which clinicians formulate diagnoses. Despite the implications for patient safety and professional identity, research on diagnostic reasoning in osteopathy remains largely theoretical. The aim of this study was to investigate the influence of perceived task difficulty on the diagnostic reasoning of students osteopaths. Methods: Using a single-blinded, cross sectional study design, sixteen final year pre-registration osteopathy students diagnosed two standardized cases under two context conditions (complex versus control). Context difficulty was manipulated via verbal manipulation and case order was randomized and counterbalanced across subjects to ensure that each case was diagnosed evenly under both conditions (i.e. half of the subjects performed either case A or B first). After diagnosis, participants were presented with items (literal, inferred and filler) designed to represent analytical and non-analytical reasoning. Response time and error rate for each item were measured. A repeated measures analysis of variance (concept type x context) was performed to identify differences across conditions and make inferences on diagnostic reasoning. Results: Participants made significantly more errors when judging literal concepts and took significantly less time to recognize filler concepts in the complex context. No significant difference in ability to judge inferred concepts across contexts was found. Conclusions: Although speculative and preliminary, our findings suggest the perception of complexity led to an increased reliance on analytical reasoning at the detriment of non-analytical reasoning. To reduce the associated cognitive load, osteopathic educational institutions could consider developing the intuitive diagnostic capabilities of pre-registration students. Postgraduate mentorship opportunities could be considered to enhance the diagnostic reasoning of professional osteopaths, particularly recent graduates. Further research exploring the influence of expertise is required to enhance the validity of this study.

Measuring Multidimensional Empathy: Theoretical and Practical Considerations for Osteopathic Medical Researchers.

Osteopathic physicians are increasingly recognizing the importance of empathy for improving patient satisfaction and clinical outcomes. This review advocates for a multidimensional perspective of empathy, encompassing both affective and cognitive empathy, and highlights situational and dispositional factors relevant to the curtailment of empathy. A review of the utility of self-report, behavioral, and physiological measures that researchers may use to quantify empathy in further research is also provided. The authors encourage members of the osteopathic medical profession to embrace a fuller understanding of empathy.

Investigation of four self-report instruments (FABT, TSK-HC, Back-PAQ, HC-PAIRS) to measure healthcare practitioners' attitudes and beliefs toward low back pain: Reliability, convergent validity and survey of New Zealand osteopaths and manipulative physiotherapists.

BACKGROUND: Healthcare practitioner beliefs influence advice and management provided to patients with back pain. Several instruments measuring practitioner beliefs have been developed but psychometric properties for some have not been investigated. AIMS: To investigate internal consistency, test-retest reliability and convergent validity of the Fear Avoidance Beliefs Tool (FABT), the Tampa Scale of Kinesiophobia for Health Care Providers (TSK-HC), the Back Pain Attitudes Questionnaire (Back-PAQ), and the Health Care Pain and Impairment Relationship Scale (HC-PAIRS). A secondary aim was to explore beliefs of New Zealand osteopaths and physiotherapists regarding low back pain. METHOD: FABT, TSK-HC, Back-PAQ, and HC-PAIRS were administered twice, 14 days apart. RESULTS: Data from 91 osteopaths and 35 physiotherapists were analysed. The FABT, TSK-HC and Back-PAQ each demonstrated excellent internal consistency, (Cronbach's α = 0.92, 0.91, and 0.91 respectively), and excellent test-retest reliability (lower limit of 95% CI for intraclass correlation coefficient >0.75). Correlations between instruments (Pearson's r = 0.51 to 0.77, p < 0.001) demonstrated good convergent validity. There was a medium to large effect (Cohen's d > 0.47) for mean differences in scores, for all instruments, between professions. CONCLUSIONS: This study found excellent internal consistency, test-retest reliability and good convergent validity for the FABT, TSK-HC, and Back-PAQ. Previously reported internal consistency, test-retest and convergent validity of the HC-PAIRS were confirmed, and test-retest reliability was excellent. There were significant scoring differences on each instrument between professions, and while both groups demonstrated fear avoidant beliefs, physiotherapist respondent scores indicated that as a group, they held fewer fear-avoidant beliefs than osteopath respondents.

Experiences of intervertebral motion palpation in osteopathic practice - A qualitative interview study among Swedish osteopaths.

BACKGROUND: Assessment in manual therapy includes quantitative and qualitative procedures, and intervertebral motion palpation (IMP) is one of the core assessment methods in osteopathic practice. The aim of this study was to explore osteopathic practitioners' experiences of clinical decision-making and IMP as a diagnostic tool for planning and evaluation of osteopathic interventions. METHOD: The study was conducted with semi-structured interviews that included eight informants. Content analysis was used as the analytical procedure. RESULT: In total, three categories emerged from the analysis: strategic decision-making, diagnostic usability of IMP, and treatment applicability of IMP. CONCLUSION: The study indicated that IMP was considered relevant and was given particular importance in cases where IMP findings confirmed clinical information attained from other stages in the diagnostic process as a whole. However, IMP findings were experienced as less important if they were not correlated to other findings.

Quiet dissent: The attitudes, beliefs and behaviours of UK osteopaths who reject low back pain guidance - A qualitative study.

INTRODUCTION: Clinical guidelines are derived from best research evidence and aim to: improve quality of non-specific low back pain (nsLBP) management and identify patients at risk of suffering chronic pain. However, guideline discordant attitudes and beliefs have been identified in healthcare students and practitioners, including osteopaths. DESIGN: A qualitative approach with elements of grounded theory was used to explore underlying attitudes and beliefs of practitioners/students working in a British osteopathic education institution. All participants rejected guideline recommendations for managing nsLBP. A constant comparative method was used to code and analyse emergent themes from transcript data. SUBJECTS: Purposive sampling identified 5 clinic tutors and 7 students; all participated in semi-structured interviews. INTERPRETATION: Our central theme was a 'Precedence of Osteopathy' over medicine and other manual therapies. Three subthemes were: 1) beliefs about self; 2) perceptions of others; 3) attitudes to guidelines and research. CONCLUSION: Participants possess a strong professional identity fostered by their education. This bestows autonomy, authority and distinctness upon them. The central theme was modelled as a lens through which participants viewed research: the evidence pyramid appears inverted, explaining why participants value expert opinion above all other evidence. Guidelines and research are perceived to threaten professional identity. In contractual situations that oblige practitioners to follow guidelines management, perhaps reflecting a pragmatic response to health-care market forces, clinical practice is modified. Developing further understanding of osteopaths' attitudes and beliefs and behaviour in respect of evidence-based guidance in education is important to enhance the quality of clinical practice in osteopathy.

Osteopathic educators' attitudes towards osteopathic principles and their application in clinical practice: A qualitative inquiry.

RATIONALE: The implicit use of overarching osteopathic principles (OP) in clinical practice is a regulatory requirement; agreed definition of what constitutes such principles remains elusive. The profession currently faces questions of identity and relevance in the face of evidence-informed healthcare. OBJECTIVE: This study sought to investigate the opinions and experiences of practising osteopathic educators as to how OP are relevant to clinical practice in isolation and to the profession as a whole. DESIGN: A qualitative approach employing grounded theory to explore the views of current practitioners involved in osteopathic education. SUBJECTS: Nine practising osteopaths were selected for the study using initially purposive then theoretical sampling. METHODOLOGY: Semi-structured interviews were used to gather data, audio-recorded, transcribed verbatim and anonymised. Data was analysed and interpreted using a thematic framework approach and conceptually modelled. Triangulation was completed; peer corroboration for high-level themes and participant confirmation for transcript authenticity was obtained. RESULTS: Two polarised concepts emerged: (1) OP benefit the profession and (2) OP limit or jeopardize the profession. These emanated from different perceptions of the identity of osteopathy: (1) osteopathy as a philosophy or (2) osteopathy as a manual therapy with a philosophical background. CONCLUSION: The osteopathic profession faces the danger of being divided on the basis of ideological differences from within. The increasing criticality applied to UK healthcare behoves the osteopathic profession to clarify its aims, guiding 'principles' and underlying values. This could be problematic in light of the divergence of views, leading to a situation of either settling these differences or irrevocably fracturing the profession.

Comprehensive Osteopathic Medical Licensing Examination-USA level 1 and level 2-cognitive evaluation preparation and outcomes.

The Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) assesses the competence of osteopathic physicians in training. It is designed to protect the public by setting minimum competence standards. All osteopathic medical students must pass COMLEX-USA Level 1, Level 2-Cognitive Evaluation, and Level 2-Performance Evaluation before being allowed to graduate from an osteopathic medical school. Residency training programs use COMLEX-USA scores as a major factor in deciding whom they will interview and admit into their programs. In addition, colleges of osteopathic medicine use student COMLEX-USA scores as an external assessment of their success in educating students. Because COMLEX-USA is a high-stakes examination series, it is important to understand predictive factors for performance. The authors review the literature on the relationship between COMLEX-USA scores and correlated student variables. Results from the Council on Osteopathic Student Government Presidents' survey on students' preparation methods and performance are also provided.

Investigation into factors influencing roles, relationships, and referrals in integrative medicine.

INTRODUCTION: Integrative medicine (IM) is a recent phenomenon within primary care practice. It is defined variously as a process of integration or convergence of complementary and alternative medicine (CAM) with mainstream medicine or as the incorporation of alternative therapies into mainstream medical practice. Little is known about the attitude of complementary medicine practitioners regarding their place within this model or the factors that influence referral between them and medical practitioners. OBJECTIVES: The aim of this research was to explore practitioners' perspectives of the theory and practice of the IM model, relevant to factors influencing referral among them. DESIGN: This research applied a qualitative method with semi-structured interviews to determine practitioner perspectives of factors influencing referral in the IM setting. One family practice physician (called a general practitioner [GP] in Australia), one osteopath, and one naturopath were interviewed at each of two IM clinics in regional Australia. Thematic analysis was used to identify themes and concepts. RESULTS: Thematic analysis of the transcribed data allowed for an in-depth understanding of themes and concepts surrounding practitioner perceptions of IM. Predominant themes centered on the notion of interpractitioner relationships and collaborations. Insight into these relationships within IM revealed concepts of interpractitioner trust and respect. In addition, sharing a philosophy of care and a common understanding pertaining to scope of practice and area of expertise appeared to support the IM framework. These concepts and themes were determined as important factors influencing referrals between GPs, osteopathic physicians, and naturopathic practitioners in the IM clinics studied. CONCLUSION: This research has highlighted the significance of interprofessional relationships and multidisciplinary referral networks as pivotal in the efficacy of the IM clinics represented in this sample. Further research is needed to define the practitioner roles and the factors influencing referrals within IM.

Patients' expectations of private osteopathic care in the UK: a national survey of patients.

BACKGROUND: Patients' expectations of osteopathic care have been little researched. The aim of this study was to quantify the most important expectations of patients in private UK osteopathic practices, and the extent to which those expectations were met or unmet. METHODS: The study involved development and application of a questionnaire about patients' expectations of osteopathic care. The questionnaire drew on an extensive review of the literature and the findings of a prior qualitative study involving focus groups exploring the expectations of osteopathic patients. A questionnaire survey of osteopathic patients in the UK was then conducted. Patients were recruited from a random sample of 800 registered osteopaths in private practice across the UK. Patients were asked to complete the questionnaire which asked about 51 aspects of expectation, and post it to the researchers for analysis.The main outcome measures were the patients-perceived level of expectation as assessed by the percentage of positive responses for each aspect of expectation, and unmet expectation as computed from the proportion responding that their expectation "did not happen". RESULTS: 1649 sets of patient data were included in the analysis. Thirty five (69%) of the 51 aspects of expectation were prevalent, with listening, respect and information-giving ranking highest. Only 11 expectations were unmet, the most often unmet were to be made aware that there was a complaints procedure, to find it difficult to pay for osteopathic treatment, and perceiving a lack of communication between the osteopath and their GP. CONCLUSIONS: The findings reflected the complexity of providing osteopathic care and meeting patients' expectations. The results provided a generally positive message about private osteopathic practice. The study identified certain gaps between expectations and delivery of care, which can be used to improve the quality of care. The questionnaire is a resource for future research.

Are low income patients receiving the benefits of electronic health records? A statewide survey.

There are concerns that physicians serving low-income, Medicaid patients, in the United States are less likely to adopt electronic health records and, if so, that Medicaid patients will be denied the benefits from electronic health record use. This study seeks to determine whether physicians treating Medicaid patients were less likely to have adopted electronic health records. Physician surveys completed during physicians' license renewal process in Arizona were merged with the physician licensing data and Medicaid administrative claims data. Survey responses were received from 50.7 percent (6,780 out of 13,380) of all physicians practicing in Arizona. Physician survey responses were used to identify whether the physician used electronic health records and the degree to which the physician exchanged electronic health records with other health-care providers. Medicaid claims data were used to identify which physicians provided health care to Medicaid beneficiaries. The primary outcome of interest was whether Medicaid providers were more or less likely to have adopted electronic health records. Logistic regression analysis was used to estimate average marginal effects. In multivariate analysis, physicians with 20 or more Medicaid patients during the survey cycle were 4.1 percent more likely to use an electronic health record and 5.2 percent more likely to be able to transmit electronic health records to at least one health-care provider outside of their practice. These effects increase in magnitude when the analysis is restricted to solo practice physicians This is the first study to find a pro-Medicaid gap in electronic health record adoption suggesting that the low income patients served by Arizona's Health Care Cost Containment System are not at a disadvantage with regard to electronic health record access and that Arizona's model of promoting electronic health record adoption merits further study.

Advising people with back pain to take time off work: a survey examining the role of private musculoskeletal practitioners in the UK.

Research has demonstrated that health care practitioners' adherence to guidelines for managing low back pain (LBP) remain suboptimal in recommending work absence, but specific beliefs about their role in maintaining patients at work have not been adequately researched. We examined private musculoskeletal practitioners' (chiropractors, osteopaths, and physiotherapists) beliefs and reported clinical behaviours in reference to patients' work. A cross-sectional postal questionnaire of 900 musculoskeletal practitioners included the Attitudes to Back pain in musculoskeletal practitioners questionnaires, reported frequency of four work-related behaviours, and a new measure of practitioners' work-related beliefs. Data from 337 respondents (37%) were analysed. Eighty percent of respondents reported recommending work absence to patients with LBP sometimes, and 14% recommended a work absence often or always. Seventy percent of practitioners never visit the patient's workplace. Most practitioners report that they prescribe exercises that can be carried out at work. Physiotherapists visited the workplace more frequently and gave less sick leave certification than either of the other groups. They also regarded work as more beneficial and less of a threat to exacerbate patients' LBP. There were small but significant correlations between work-related beliefs and reported behaviours. Our study confirms that, in contrast to current guidelines, many practitioners believe that LBP necessitates work absence. Overall, practitioners perceived their role in returning patients to work as limited, and believed that direct contact with employers was beyond their remit. In the UK, physiotherapists appear to be better placed to liaise with work in terms of both their beliefs and activities.