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.

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.

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.

Clinical assessment during a global pandemic - Transitioning to a COVID safe hybrid OSCE.

Objective structured clinical examinations (OSCEs) are often used to assess the clinical competence of students in preprofessional osteopathy training. During the COVID-19 global pandemic, the final year OSCE in the RMIT University osteopathy program was redeveloped leveraging online technologies within COVID-19 guidelines such as hygiene and occupancy limitations. Final year osteopathy students were assessed using a hybrid ten station OSCE, comprising both online and face-to-face components. The examination was led by a pre-recorded narrated PowerPoint video. The video contained instructions, case information for five cases and prompts for the practical stations. A student model stepped into the room as needed for practical stations. The examiner assessed students from another room via video streaming, with limited interaction with students. The hybrid OSCE was conducted safely during Stage 4 restrictions adhering to COVID Safe guidelines, allowing robust competency assessment of final year students, enabling timely graduation and transition to practice. Institutional support, technology infrastructure, clear communication and stakeholder collaboration are key to successful implementation. The hybrid OSCE format offers a potential solution for institutions delivering high-stakes assessment in the continuing challenges of clinical assessment in the post COVID landscape. Adopting hybrid assessment formats may facilitate remote assessment of students in clinical placements.

A Mokken analysis of the literacy in musculoskeletal problems questionnaire.

BACKGROUND: Limited health literacy is known to impact on medication adherence, hospital readmission and potentially poorer health outcomes. The literature on the health literacy of those with musculoskeletal conditions suggests greater functional limitations and increased pain levels. There are a number of measures of health literacy. One that specifically relates to musculoskeletal complaints is the Literacy in Musculoskeletal Problems (LiMP) questionnaire. The LiMP contains 9 multiple choice items that cover anatomy, musculoskeletal conditions and the diagnosis of musculoskeletal complaints. The aim of the study was to evaluate the dimensionality and internal structure of the LiMP in patients attending for osteopathy care at a student-led clinic, as a potential measure of musculoskeletal health literacy. METHOD: Three hundred and sixty-one (n = 361) new patients attending the Victoria University Osteopathy Clinic completed the LiMP and a demographic and health information questionnaire prior to their initial consultation. Mokken scale analysis, a nonparametric item response theory approach, was used to evaluate the dimensionality and structure of the LiMP in this population, to ascertain whether the questionnaire was measuring a single latent construct - musculoskeletal health literacy. McDonald's omega and Cronbach's alpha were calculated as the reliability estimations. The relationship between the LiMP and a single item screen of health literacy was also undertaken. RESULTS: The 9 items on the LiMP did not form a Mokken scale and the reliability estimations were below an acceptable level (alpha and omega <0.45). LiMP items 5 and 8 were more likely to be answered correctly by those with higher health literacy (p < 0.05), however the effect sizes were small (<0.20). CONCLUSION: Calculation of a total score for the LiMP, as advocated by the original authors, is not supported based on data in the present study. Further research is required to explore the relationship of the LiMP items to demographic and clinical data, and to other broader measures of health literacy. Further research may also develop a health literacy measure that is specific to patients seeking manual therapy care for musculoskeletal complaints.

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.

No gain without pain education: Improving knowledge and biopsychosocial attitudes and beliefs in a predominantly non-health-related undergraduate target audience.

OBJECTIVES: Chronic pain (CP) impacts individuals and society and is the leading cause of disability globally. Pain education interventions are often evaluated in patients and health professional students, but not in non-health student groups. Increasing knowledge of pain may facilitate shifts in attitudes and beliefs towards sufferers. We report on changes in pain knowledge, attitudes and beliefs of predominantly non-health-related tertiary degree students participating in online education. METHODS: Quantitative cohort study design. Students reported demographics and completed the Chronic Pain Myth Scale and 12-item Neurophysiology of Pain Questionnaire (NPQ) before (T1) and after (T2) the 7-week online module at The University of Sydney in 2020. RESULTS: Twenty-two students undertaking predominantly non-health-related bachelor's degrees (16.5% response rate, 90.9% female, mean = 19.5 years) participated. NPQ scores increased from 47.3% to 62.9%. Attitudes and beliefs towards biopsychosocial impact improved (p < 0.027) but not towards individuals suffering from CP or treatment of CP. A negative correlation was found between age and people suffering from CP (ρ = -0.437, p < 0.042) and age and towards treatment of CP; ρ = -0.556, p < 0.007) at T2. CONCLUSION: Completing the elective online module resulted in improved knowledge and biopsychosocial attitudes towards CP in this predominantly non-health cohort, as reported in health and patient cohorts.

Educating and engaging a new target audience about the problem of pain for society.

Background: Pain education initiatives are typically targeted at health professionals, with less attention being placed on the education of other target audiences. Recent curriculum changes across undergraduate liberal studies degree programs at The University of Sydney presented an opportunity to develop an online course entitled Health Challenges: Pain and Society, which was aimed at a non-traditional target audience. To promote student engagement about the problem of pain for society, the course was designed using the Community of Inquiry framework. Research Design: This paper reports on an Educational Design Research study, investigating the effectiveness of the course in engaging students across two cohorts, in 2019 and 2020. Data Collection: Learning analytics were collected from the Learning Management System each year. The level of student engagement in non-assessable tasks was measured using multiple linear regression. Students' degree type and majors were recorded. In 2020, the quality of student workbook responses was recorded. Results: In both cohorts, engagement with the workbooks was a predictor of academic achievement. In 2020, a significant interaction effect between quantity and quality of engagement was observed. Conclusions: Our findings highlight the importance of designing online learning to facilitate successful engagement for non-traditional target audiences about the issue of chronic pain for society.

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.

Insights into the complexity of presentation and management of patients: the Sport and Exercise Physician's perspective.

OBJECTIVES: Sport and Exercise Physicians represent a relatively new specialty focusing on exercise in complex diseases including musculoskeletal diseases. Our objective was to describe the characteristics, type and complexity of patient presentations, their management strategies and referral information in Australian practice. METHODS: A cross-sectional study including a cohort of 11 senior Sport and Exercise Physicians in Australia studied all new patient consultations within an 8-week period. Data were analysed relating to presentation, referral source, follow-up referrals, and patient management strategies. RESULTS: Data from 419 patients were recorded. The majority, 97% (n=406), had musculoskeletal conditions, 53% (n=222) had one or more associated comorbidities and 47% (n=195) had ongoing symptoms for >12 months. Most patients, 82% (n=355), were referred by general practitioners. Prior consultations included physiotherapy 72% (n=301) and orthopaedic 20% (n=85). A multidisciplinary network of referrals from Sport and Exercise Physicians was observed, including 210 referrals to 9 allied health specialities and 61 referrals to 17 medical specialities. Over 74% (n=311) of patients received exercise-based intervention as part of the treatment plan, including 57% (n=240) physician managed exercise interventions. CONCLUSION: Our work shines a light on the nature and complexity of the role of Sport and Exercise Physicians in an Australian practice context. Findings will assist in implementing measures to promote patient care at the community level in managing musculoskeletal conditions. Sport and exercise medicine stakeholders and government policy makers can use this information in developing appropriate programmes to support patients and create integrated sport and exercise medicine services for the community.

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.

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.

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.

PROMIS® General Life Satisfaction scale: construct validity in musculoskeletal pain patients.

BACKGROUND: Life satisfaction is part of subjective well-being. Measurement of life satisfaction is undertaken using self-report measures. This study aimed to evaluate the structural validity, concurrent validity, and internal structure of the PROMIS® General Life Satisfaction Scale (GLSS) in a musculoskeletal pain cohort. METHOD: Consecutive new patients attending the Victoria University Osteopathy Clinic (Melbourne, Australia) were invited to complete the GLSS prior to their initial consultation. Structural validity and internal structure were explored using confirmatory factor analysis and Mokken scale analysis. Concurrent validity was evaluated against a single-item measure of life satisfaction. RESULTS: The PROMIS® GLSS comprised a single factor and formed an acceptable Mokken scale in this population. No differential item functioning was observed. A large positive correlation (r = 0.70) was observed between the General Life Satisfaction scale and a single-item measure of life satisfaction. CONCLUSIONS: The PROMIS® General Life Satisfaction scale demonstrated acceptable internal structure and structural validity in a musculoskeletal pain population. Additional research is required to explore concurrent validity and other measurement properties, however initial data suggests the measure could be a feasible screen of life satisfaction for Australian osteopathic 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.

Life satisfaction and musculoskeletal complaints in a population seeking osteopathy care: consecutive sample of 611 patients.

BACKGROUND: Life satisfaction is a component of the subjective well-being construct. Research consistently suggests that life satisfaction is associated with enhanced social benefits and improved health outcomes. However, its relationship to musculoskeletal health outcomes is underexplored. This study evaluates the life satisfaction of a patient population presenting with musculoskeletal complaints, and the relationship of life satisfaction with other health demographics and behaviours. METHOD: The study used a consecutive sampling design. Patients attending the Victoria University Osteopathy Clinic (Melbourne, Australia) were invited to complete the PROMIS® General Life Satisfaction scale (GLSS) along with questions related to health demographics and behaviours. RESULTS: The GLSS T-score was not significantly different for gender, being born outside of Australia, speaking English at home, or complaint chronicity. CONCLUSIONS: Life satisfaction did not appear to be related to a range of health and demographic variables in the current musculoskeletal pain cohort. The PROMIS® General Life Satisfaction scale could prove useful to explore the relationship between life satisfaction and treatment outcomes for musculoskeletal complaints.

Evaluating Patient's Understanding of Pain Neurophysiology: Rasch Analysis of the Neurophysiology of Pain Questionnaire.

OBJECTIVE: Educating patients about the neurobiologic basis of their pain experience is an important part of managing patients with pain disorders. The aim of this study was to evaluate the measurement properties of the Neurophysiology of Pain Questionnaire (NPQ) in a population seeking osteopathy treatment for both acute and chronic musculoskeletal pain symptoms. MATERIALS AND METHODS: Patients attending the Victoria University Osteopathy Clinic for their initial osteopathy consultation were recruited consecutively. Before their consultation patients were invited to complete a health information questionnaire and the NPQ. The measurement properties of the NPQ were evaluated using Rasch analysis. RESULTS: Two-hundred and ninety-four patients completed the NPQ (female, 51.7%; mean age, 35.5 y). Over two-thirds of these patients presented with a spinal symptoms and 53% of patient presentations were acute. Initial analysis suggested the NPQ responses did not fit the Rasch model. Modifications to the NPQ including removing items and removing person responses, resulted in the development of a 14-item unidimensional version of the NPQ that was free from differential item functioning. DISCUSSION: The study provides further evidence for the validity of the NPQ total score, derived from a population seeking care for an acute or chronic musculoskeletal pain complaint. The total score is interval-level data and can be used to evaluate changes in pain knowledge before, during, and after pain education interventions. Future studies could utilize this revised version of the NPQ in longitudinal designs and also evaluate pain knowledge changes in conjunction with other objective or subjective pain measures.

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.

Breast size, bra fit and thoracic pain in young women: a correlational study.

INTRODUCTION: A single sample study was undertaken to determine the strength and direction of correlations between: a) breast size and thoracic spine or posterior chest wall pain; b) bra fit and thoracic spine or posterior chest wall pain and; c) breast size and bra fit, in thirty nulliparous women (18-26 years), with thoracic spine or posterior chest wall pain, who wore bras during daytime. MEASURES: Pain (Short Form McGill Pain Questionnaire), bra size (Triumph International), bra fit (Triumph International). RESULTS: Most (80%) women wore incorrectly sized bras: 70% wore bras that were too small, 10% wore bras that were too large. Breast size was negatively correlated with both bra size (r = -0.78) and bra fit (r = -0.50). These results together indicate that large breasted women were particularly likely to be wearing incorrectly sized and fitted bras. Negligible relationships were found between pain and bra fit, and breast size and pain. Menstrual cycle stage was moderately positively correlated with bra fit (r = 0.32). CONCLUSION: In young, nulliparous women, thoracic pain appears unrelated to breast size. Bra fit is moderately related to stage of menstrual cycle suggesting that this research may be somewhat confounded by hormonal changes or reproductive stage. Further research is needed to clarify whether there is a relationship between breast size or bra fit and thoracic pain in women during times of hormonal change.

Learning through multiple lenses: analysis of self, peer, near-peer and faculty assessment of a clinical history taking task in Australia.

PURPOSE: Peer assessment may offer a framework for expected skill development and feedback appropriate to the learner level. Near-peer (NP) assessment may elevate expectations and motivate student learning. Feedback from peers and NPs may offer a sustainable approach to enhancing student assessment feedback. The aim was to analyze the relationship and attitudes of self, peer, NP and faculty marking of an assessment. METHODS: A cross sectional study design was used. Year 2 osteopathy students (n = 86) were invited to self and peer assess a clinical history-taking and communication skills assessment. Near-peers and faculty also marked the assessment. Year 2 students also completed a peer/NP attitudes questionnaire. Descriptive statistics and Spearman's rho were used to evaluate the relationships across marker groups. RESULTS: Year 2 students (n=9), near-peers (n=3) and faculty (n=5) were recruited. Correlations between self and peer (r=0.38) and self and faculty (r = 0.43) marks were moderate. A weak correlation was observed between self and near-peer marks (r = 0.25). Perceptions of peer and near-peer marking were varied with over half of the cohort suggesting peer or NP assessments marks should not contribute to a grade. CONCLUSION: Framing peer and NP assessment as another feedback source may offer a sustainable method for enhancing feedback without overloading faculty resources. Multiple sources of feedback may assist in developing assessment literacy and calibrate a students' self-assessment capability. The small number of students recruited may indicate some acceptability of peer and NP assessment however further work is required to increase its acceptability.