Osteopathic Medical Student Practice of Osteopathic Manipulative Treatment During School Break.

CONTEXT: Osteopathic manipulative treatment (OMT) is integral in osteopathic medical education. The timing of the loss of interest, leading to decreasing clinical use, is unclear. Osteopathic medical students' activities during laboratories or rotations are determined by laboratory or preceptor requirements and do not characterize students' interest in or how they value OMT. Students who practice OMT when they are not required to may demonstrate that they are interested in, perceive a positive value of, and have confidence in using OMT. OBJECTIVE: To characterize preclinical students practicing OMT during their school break. METHODS: First- and second-year students at the Touro University College of Osteopathic Medicine-CA and the University of New England College of Osteopathic Medicine were surveyed about whether they practiced OMT during winter break, types of conditions addressed, OMT technique(s) used, their practice partners' response to OMT, and reasons for not practicing OMT, if applicable. Students were also asked if they would have practiced more OMT if they had setups similar to those of the practice environment at school. RESULTS: Of the 499 surveys sent, 407 (81.6%) were returned. Of 407 students, 269 (66.1%) reported that they practiced OMT during winter break, and they used a full range of OMT techniques. Students reported a total of 551 practice partners and 602 complaints. Overall, 429 of 497 practice partners (86.3%) reported they were much improved or improved, and 6 of 497 (1.2%) felt worse or much worse. The most common reasons for not practicing OMT were that no one had complaints (56.3%) and that there was no place to practice (37.3%). CONCLUSION: More than half of surveyed students showed an interest in practicing OMT when it was not required of them. These findings may imply the need for curriculum changes at osteopathic medical schools to ensure student competency with using OMT techniques that take less time and can be done in a variety of settings and with discussing OMT with practice partners.

Preliminary findings on the use of osteopathic manipulative treatment: outcomes during the formation of the practice-based research network, DO-Touch.NET.

CONTEXT: Few studies have assessed the use of osteopathic manipulative treatment (OMT) and subsequent patient-reported outcomes. OBJECTIVE: To assess the current use of OMT and associated patient-reported outcomes. DESIGN: A retrospective medical record review and a prospective observational study. SETTING: Two university-based sites and their clinics associated with the practice-based research network DO-Touch.NET. PARTICIPANTS: Patients aged 18 years or older who received OMT. MAIN OUTCOME MEASURES: Medical records from 2007 were retrospectively reviewed to identify conditions being managed with OMT. From 2008 to 2010, patients were recruited before seeing their physicians. Questionnaires were distributed to patients and physicians, and information including demographics, chief complaints, symptom severity, current and past treatments, interference of symptoms with quality of life, physical examination findings, diagnoses, OMT performed, and immediate patient response to OMT was collected. A subset of patients provided data on symptom severity and frequency and other treatments daily for the 7 days after OMT. On day 7, symptom interference with quality of life was reassessed. RESULTS: Retrospective data were collected from 2569 office visits, and prospective data were collected from 299 office visits (patient age range, 18-93 years). In the medical record review, 17 of the top 25 diagnoses (68%) were related to musculoskeletal conditions. In the prospective study, 18 of the top 24 medical diagnoses (75%) were related to musculoskeletal conditions. Immediately after OMT, patients at 271 of 296 office visits (92%) felt better or much better; those at 5 (<2%) felt worse. After 7 days, patients at 126 of 175 office visits (72%) felt better or much better, and those at 10 (6%) felt worse. Average and worst symptom severity decreased until post-OMT days 4 and 5, respectively, when severity leveled off. There was decreased interference of symptoms with quality of life from before OMT to 7 days after OMT in usual/general activities, sleep, mood, and relationships (all P≤.05). CONCLUSION: These preliminary results suggest that for adults, OMT is predominantly used for managing musculoskeletal pain conditions and is effective for short-term symptom relief. Continued surveillance of DO-Touch.NET member practice outcomes may help identify priorities for osteopathic research and define evidence-based standards for OMT practice and training.

Osteopathic manipulative treatment for the treatment of hospitalized premature infants with nipple feeding dysfunction.

Premature newborns and infants are usually required to successfully transition from gavage to nipple feeding using breast or bottle before discharge from the hospital. This transition is frequently the last discharge skill attained. Delayed acquisition of this skill may substantially prolong hospital length of stay. The authors describe a case of hospitalized premature twins who had considerable delays in attaining nipple-feeding skills. Because of their inability to take all feedings by nipple, preparation for surgical placement of gastrostomy tubes was initiated. Before the surgeries were scheduled, the inpatient osteopathic manipulative medicine service was consulted, and the twins received a series of evaluations and osteopathic manipulative treatment (OMT) sessions. During the OMT course, the twins' nipple feeding skills progressed to full oral feeding, which allowed them to be discharged to home without placement of gastrostomy tubes. The authors also review the literature and discuss the development of nipple feeding in premature newborns and infants and the use of OMT in the management of nipple feeding dysfunction.

Characteristics of pediatric patients seen in medical school-based osteopathic manipulative medicine clinics.

CONTEXT: Manual medicine--specifically osteopathic manipulative treatment (OMT)--is commonly used in treating patients aged 18 years or younger. However, no published reports have described characteristics of this patient population or the conditions for which OMT is used with these patients. To better counsel parents, train physicians and other healthcare providers, and prioritize research, an improved understanding of the use of OMT in children is needed. OBJECTIVE: To characterize pediatric patients and their conditions as seen in a medical school-based osteopathic manipulative medicine clinic. STUDY DESIGN: Retrospective analysis of administrative data on the use of OMT. SETTING: Faculty osteopathic manipulative medicine specialty clinics associated with the University of New England College of Osteopathic Medicine. PATIENTS: Data were analyzed from patients seen in the clinics from January 1, 2007, through December 31, 2007, if they were younger than 19 years at their first visit during that period. OUTCOMES MEASURES: Factors included in the data analysis were patient age at first visit, age at time of visit, number of visits during the study period, types of clinical diagnoses, and visits with nonmusculoskeletal diagnoses. RESULTS: A total of 407 patients generated 1500 clinic visits. Data showed a mean of 3.7 visits per patient (25th-75th percentiles = 2-5 visits) during the 1-year study period. The mean age at the first clinic visit was 7 years, 3 months, with the 25th-to-75th percentile being 1 year, 9 months, to 12 years, 3 months. Clinic visits by age group (ie, age at time of visit) as percentages of total visits were as follows: 0 to 11 months, 13.7%; 1 to 4 years, 33.3%; 5 to 12 years, 28.9%, older than 12 years, 24.2%. Diagnoses provided in visits covered a wide variety of common pediatric conditions. For the entire study population, 43.5% of visits included nonmusculoskeletal diagnoses. The percentages of visits with nonmusculoskeletal diagnoses for each age group were as follows: 0 to 11 months, 33.7%; 1 to 4 years, 64.0%; 5 to 12 years, 48.8%; older than 12 years, 17.7%. CONCLUSION: Pediatric patients seen in the faculty osteopathic manipulative medicine specialty clinic included the entire pediatric age range and a wide range of common pediatric conditions. A substantial number of visits involved treatment for nonmusculoskeletal conditions. Further investigation is needed to determine if the patient sample of the present study is representative of other clinical settings or geographic regions.