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The National Center for Complementary and Integrative Health recommends that research be judged on the merit of scientific findings rather than on the basis of professional degrees held by investigators.
In this spirit, the American Academy of Osteopathy provides OsteoBlast citations that are likely to be of interest to AAO members. The AAO offers these items from peer-reviewed journals without comment, and it endorses neither the research nor the advertisements contained in OsteoBlast.
Occipitoatlantal decompression and noninvasive vagus nerve stimulation slow conduction velocity through the atrioventricular node in healthy participants
The Journal of the American Osteopathic Association
Management of atrial fibrillation includes either rhythm control that aims at establishing a sinus rhythm or rate control that aims at lowering the ventricular rate, usually with atrioventricular nodal blocking agents. Another potential strategy for ventricular rate control is to induce a negative dromotropic effect by augmenting cardiac vagal activity, which might be possible through noninvasive and nonpharmacologic techniques. Thus, the hypothesis of this study was that occipitoatlantal decompression (OA-D) and transcutaneous auricular vagus nerve stimulation (taVNS) not only increase cardiac parasympathetic tone as assessed by heart rate variability (HRV), but also slow atrioventricular conduction, assessed by the PQ-interval of the electrocardiogram (EKG) in generally healthy study participants without atrial fibrillation.
The objective of this study was to test whether OA-D and/or transcutaneous taVNS, which have been demonstrated to increase cardiac parasympathetic nervous system activity, would also elicit a negative dromotropic effect and prolong atrioventricular conduction.
EKGs were recorded in 28 healthy volunteers on three consecutive days during a 30 min baseline recording, a 15 min intervention, and a 30 min recovery period. Participants were randomly assigned to one of three experimental groups that differed in the 15 min intervention. The first group received OA-D for 5 min, followed by 10 min of rest. The second group received 15 min of taVNS. The intervention in the third group that served as a time control group (CTR) consisted of 15 min of rest. The RR- and PQ-intervals were extracted from the EKGs and then used to assess HRV and AV-conduction, respectively.
The OA-D group had nine participants (32.1%), the taVNS group had 10 participants (35.7%), and the CTR group had nine participants (32.1%). The root mean square of successive differences between normal heartbeats (RMSSD), an HRV measure of cardiac parasympathetic modulation, tended to be higher during the recovery period than during the baseline recording in the OA-D group (mean ± standard error of the mean [SEM], 54.6 ± 15.5 vs. 49.8 ± 15.8 ms; p<0.10) and increased significantly in the taVNS group (mean ± SEM, 28.8 ± 5.7 vs. 24.7 ± 4.8 ms; p<0.05), but not in the control group (mean ± SEM, 31.4 ± 4.2 vs. 28.5 ± 3.8 ms; p=0.31). This increase in RMSSD was accompanied by a lengthening of the PQ-interval in the OA-D (mean ± SEM, 170.5 ± 9.6 vs. 166.8 ± 9.7 ms; p<0.05) and taVNS (mean ± SEM, 166.6 ± 6.0 vs. 162.1 ± 5.6 ms; p<0.05) groups, but not in the control group (mean ± SEM, 164.3 ± 9.2 vs. 163.1 ± 9.1 ms; p=0.31). The PQ-intervals during the baseline recordings did not differ on the three study days in any of the three groups, suggesting that the negative dromotropic effect of OA-D and taVNS did not last into the following day.
The lengthening of the PQ-interval in the OA-D and taVNS groups was accompanied by an increase in RMSSD. This implies that the negative dromotropic effects of OA-D and taVNS are mediated through an increase in cardiac parasympathetic tone. Whether these findings suggest their utility in controlling ventricular rates during persistent atrial fibrillation remains to be determined.
(This is a hyperlink to the abstract for this article. To view the full article, you will need to log in to the journal's website.)
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Gut microbiome changes with osteopathic treatment of constipation in Parkinson's disease: A pilot study
EC Neurology
The gut microbiome appears to be predictive of Parkinson’s disease (PD) with constipation. Chronic constipation frequently manifests prior to motor symptoms and impairs quality of life. An osteopathic manipulative medicine (OMM) sequence used physical exam assessment and manual treatment of neuromusculoskeletal dysfunctions pertinent to constipation in PD for this prospective ABA-design study, IRB-NYITBHS1065. The effects of 4 weekly treatments on the gut microbiome among men and women over 40 years old with chronic constipation and PD were investigated. Severity of PD was rated with the Movement Disorders Society-Unified PD rating scale (UPDRS) in six subjects with constipation. Also, the Bristol stool scale and questionnaires validated for constipation were administered for diagnosis, symptom severity, and quality of life during a 4-week control-period (A), 4-weekly OMM-treatments (B), and 2-weeks no-intervention (A). Biweekly stool samples were assessed for normalized microbiota abundance.
The mean Bristol rating improved from type 2 (± 1) Pre-OMM to 3 (± 1; p = .167; d = 0.677) Post-OMM. Mean constipation severity significantly decreased (p = .010; d = 1.508) Post-OMM. Mean quality of life significantly improved (p = .041; d = 1.072) Post-OMM. The Pre-OMM mean number of families within the phylum Firmicutes decreased by 3 (p = .043; d = 1.177) Post-OMM. There were significant changes in the normalized abundance of phyla Actinobacteria (p = .040; d = 0.845) and Verrucomicrobia (p = .024; d = 0.675) as well as in genus Roseburia (p = .033; d = 1.109), Intestinimonas (p = .035; d = 0.627) and Anaerotruncus (p = .004) Post-OMM.
The gut microbiome shifted among individuals with constipation and PD after four weekly treatments with the OMMsequence. Changes in the gut microbiome Post-OMM were associated with UPDRS results and constipation measures. Clinical trials and studies to develop the gut microbiome into a validated biomarker for PD are necessary to understand the impact of OMM in patients with PD and constipation.
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An international profile of the practice of osteopaths: A systematic review of surveys
International Journal of Osteopathic Medicine
Osteopathic healthcare exists globally but is not well described. We aimed to provide an overview to describe international osteopathic practice delivered by osteopaths.
We searched PubMed and EMBASE and used peer network contacts to identify surveys describing and profiling osteopathic practitioners, osteopathic patients, practice and care. We included the most current data from surveys conducted at a national or regional level since 2012.
Osteopathic practitioners in the 30-50-year-old age bracket were the most likely to respond to the surveys, with equal gender representation. Responders were more likely to be experienced practitioners with 8 years or more in practice and work in one location.
Patients were mostly seen within one week from initial contact (mean 54%, range 19-75%). Patients were most commonly employed/self-employed adults and twice-as-likely to be women than men, 66% of patients were aged between 21 and 65 years, around 5-10% of patients were under 6 months old. The majority of patients (52-73%) sought care for sub-acute and chronic conditions. Low back and neck pain accounted for the highest proportion of patient complaints. In central Europe, osteopaths used more gentle techniques (cranial, visceral and functional), compared with the UK and Australia where structural techniques such as soft tissue manipulation and spinal manipulation were preferred.
Osteopaths are well educated, independent healthcare practitioners treating people with predominantly musculoskeletal complaints, mainly spinal, that have persisted for longer than four weeks. They deliver manual therapy as part of a package of care that includes exercise/physical activity and lifestyle advice.
(This is a hyperlink to the abstract for this article. To view the full article, you will need to log in to the journal's website.)
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Effectiveness of non-surgical interventions for hallux valgus: A systematic review and meta-analysis
Arthritis Care & Research
The objective of this study was to conduct a systematic review and meta‐analysis investigating the effectiveness of non‐surgical interventions for hallux valgus (HV).
The review protocol was registered with PROSPERO (CRD42019111711). Medline, CINAHL, Embase, and the Cochrane Library were searched to April 2020, including parallel‐group and crossover studies investigating non‐surgical interventions for HV. Two reviewers independently screened articles for inclusion, extracted data, performed risk of bias and GRADE assessments. Risk of bias was assessed using version 2 of the Cochrane risk of bias tool. Effect sizes (mean differences or risk ratios, and 95% confidence intervals) were calculated and pooled where possible for the primary outcomes, foot pain and HV angle.
Eighteen included studies investigated a wide range of non‐surgical interventions for HV. Most studies had small sample sizes and concerns regarding risk of bias. Five separate meta‐analyses for foot orthoses, splints, manual therapy, and taping added to foot exercises showed no significant effects on primary outcomes. However, results from eight studies showed a significant pain reduction with the use of foot orthoses, night splints, dynamic splints, manual therapy, taping added to foot exercises, multifaceted physical therapy program and Botox injections. Four studies reported a clinically significant reduction in HV angle with night splints, foot exercises, multifaceted physical therapy and Botox injections.
There is a low level of certainty surrounding the effectiveness of non‐surgical interventions for HV, however a reduction in pain appears more likely than improvement in HV angle.
(This is a hyperlink to the abstract for this article. To view the full article, you will need to log in to the journal's website.)
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Gait parameters and functional performance following multi-factorial treatment among degenerative joint disease patients
Biomedicine
Degenerative Joint Disease (DJD) poses a challenge to manage and restore functional capabilities among patients. Incorporation of structured exercises, manual therapy and patient education had a significant impact on clinical and functional status of patients. Past research hasexplored benefits of therapy on functions and gait. Although, such studies did not address the functional restoration. Hence, present study was aimedto address the lacunae.
100 patients with mean age and SD; 51.61(5.4) were included. Participants had knee Degenerative Joint Disease (DJD); grade 2 or 3 on Kellgren and Lawrence scale, were allocated to Experimental Group (EG) and Comparative Group (CG). EG received joint mobilization and Muscle Energy Technique (MET). CG received Interferential therapy (carrier frequency 4 kHz; beat frequency 100 Hz; and sweep frequency 150 Hz). Strengthening exercises and patient education were common for both groups. Intervention lasted two weeks, the post-intervention metrics included; stride length, step length, and cadence for gait and knee injury and osteoarthritis outcome score.
Data obtained was subjected to statistical analysis. Frequency and percentage were used for categorical variables; mean andstandard deviation (SD) were used for continuous variables. Post-intervention, there was a significant improvement of gait parameters and Knee Injury and Osteoarthritis Outcome Score (KOOS) in both groups. CG had a better improvement in STL, SL, CAD with mean of 39.84(5.68), 20.22(2.84), 97.16(3.75) and EG with mean of 44.36(4.48), 22.30(3.75), 92.82(3.75) and p < .0005. However, it was evident that the proportion of functional improvement among CG was lesser.
Inclusion of structured exercises, manual therapy and patient education in intervention would be effective and improve the functional status of DJD patients.
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Effect of finding-oriented manual therapy techniques on muscle activity and postural control in patients with chronic ankle instability — a randomized controlled feasibility study
Journal of Bodywork and Movement Therapies
Previous studies have analyzed the effects of manual therapy techniques (MTT) in patients with chronic ankle instability (CAI). Clinicians treat patients according the finding-oriented MTT approach. This approach is seldom pursued in research. The purpose of this study was to evaluate the feasibility and efficacy of finding-oriented MTT applications in patients with CAI.
In this randomized controlled, blinded assessor crossover feasibility trial , participants were randomized to receive nine finding-oriented MTT treatments or no treatment during a three-week period, followed by a six-day washout period after which participants were crossed-over. Criteria under evaluation were adherence and attrition rates, safety (adverse events (AEs)) and acceptability and preliminary effects of finding-oriented MTT on muscular activity (measured by surface Electromyography (sEMG)) and on dynamic balance (measured by time to stabilization (TTS) and the modified Star Excursion Balance Test (modified STBT)).
Seven women and two men (mean age: 26 ± 6.1 years) with CAI enrolled in this feasibility study. Success criteria showed a high adherence (90%) and low attrition rate (10%). All data could be used for analysis. AEs such as tingling in the foot during a short time frame were reported after four finding-oriented MTT interventions. Preliminary effect sizes showed divergence and few statistically significant results for sEMG.
The participants were adherent to the finding-oriented MTT intervention. The acceptability of data recording and data analysis was good. In addition, the study protocol should be adapted by adding a ten-minute warm up period, a participant familiarization to TTS and modified STBT, and test repetitions. (This is a hyperlink to the abstract for this article. To view the full article, you will need to log in to the journal's website.)
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