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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.
Effects of osteopathic manipulative treatment and bio-electromagnetic energy regulation therapy on lower back pain
The Journal of the American Osteopathic Association
Lower back pain (LBP) is prevalent and is a leading contributor to disease burden worldwide. Osteopathic manipulative treatment (OMT) can alleviate alterations in the body that leads to musculoskeletal disorders such as LBP. Bio-electromagnetic Energy Regulation (BEMER; BEMER International AG), which has also been shown to relieve musculoskeletal pain, is a therapeutic modality that deploys a biorhythmically defined stimulus through a pulsed electromagnetic field (PEMF). Therefore, it is possible that combined OMT and BEMER therapy could reduce low back pain in adults more than the effect of either treatment modality alone.
The objective of this study was to investigate the individual and combined effects of OMT and BEMER therapy on LBP in adults.
Employees and students at a medical college were recruited to this study by email. Participants were included if they self-reported chronic LBP of 3 months’ duration or longer; participants were excluded if they were experiencing acute LBP of 2 weeks’ duration or less, were currently being treated for LBP, were pregnant, or had a known medical history of several conditions. Ultimately, 40 participants were randomly assigned to four treatment groups: an OMT only, BEMER only, OMT+BEMER, or control (light touch and sham). Treatments were given regularly over a 3 week period. Data on LBP and quality of life were gathered through the Visual Analog Scale (VAS), Short Form 12 item (SF-12) health survey, and Oswestry Low Back Pain Questionnaire/Oswestry Disability Index prior to treatment and immediately after the 3 week intervention protocol. One-way analysis of variance (ANOVA) was performed retrospectively and absolute changes for each participant were calculated. Normal distribution and equal variances were confirmed by Shapiro–Wilk test (p>0.05) and Brown-Forsythe, respectively. Significance was set at p<0.05.
Despite a lack of statistical significance between groups, subjective reports of pain reported on the VAS showed a substantial mean percentage decrease (50.8%) from baseline in the OMT+BEMER group, compared with a 10.2% decrease in the OMT-only and 9.8% in BEMER-only groups when comparing the difference in VAS ratings from preintervention to postintervention. Participants also reported in quality of life assessed on the Oswestry Low Back Pain Questionnaire/Oswestry Disability Index, with the OMT+BEMER group showing a decrease of 30.3% in score, the most among all groups. The OMT+BEMER group also reported the greatest improvement in score in the physical component of the SF-12, with an increase of 21.8%.
The initial data from this study shows a potential additive effect of combination therapy (OMT and BEMER) for management of LBP, though the results did not achieve statistical significance.
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Osteopaths' perspectives on patient adherence to self-management strategies: A qualitative content analysis
International Journal of Osteopathic Medicine
Self-management strategies (SMS) have been found to positively affect healthcare outcomes. However, clinicians often encounter patients with differing levels of adherence to SMS, making it an imperative to recognize and manage the factors underpinning patient adherence to such strategies. To this end, this study explored practitioner-perceived barriers and enablers that affect patient adherence to SMS.
This study explored 14 osteopathic clinicians’ perceptions of factors affecting patient adherence to SMS. Semi-structured interviews underwent qualitatively content analyzed using a deductive approach, whereby the data were categorized according to a pre-existing framework.
Five overarching factors affecting patient adherence to SMS were categorized from the data: healthcare team and system-related; patient-related; social and economic-related; therapy-related; and condition-related. Each category consisted of an enabler and barrier sub-category.
Patient education and its effect on patient empowerment was reported to be an important driver in SMS adherence, and hence may contribute to an effective healthcare team. Patient lack of time and negative expectations may stem from patient passivity, but also could have been over-represented due to unconscious practitioner bias. Identification of practitioner views on barriers and enablers to SMS adherence may provide insight into how to mitigate factors that can affect patient health outcomes.
Clinician perceived barriers and enablers to SMS span across several categories, underpinned by both patient and practitioner behavior and attitudes. Understanding and addressing the barriers and enablers to SMS can aid adherence within clinical practice, ultimately improving patient outcomes.
(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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The rationale for including osteopathic manipulative treatment in the management of infections: A hermeneutic Review
Expert Review of Anti-infective Therapy
As the prevalence of drug-resistant infections continues to outpace the development of new antibiotics, we must explore all reasonable options for enhancing the effectiveness of existing anti-infectives. The emergence of novel pathogens without initial drug treatments or vaccines, typified by the severe acute respiratory syndrome coronavirus-2 pandemic, further underscores the need for non-pharmacologic adjunctive measures for infection management. Osteopathic manipulative treatment (OMT) may represent such an adjunct.
PubMed, CINAHL, Google Scholar, Cochrane databases and relevant chapters of major osteopathic texts were searched for animal experiments, case reports, observational studies, non-randomized, and randomized trials pertaining to infection, OMT, and the complications or safety of OMT. OMT was associated with one or more of the following: decreased bacterial colony counts in lung tissue; changes in immunologic profiles manifested by significant differences dendritic cells and levels of IL-8, MCP-1, MIP-1a, and G-CSF; shorter durations of IV antibiotics; decreased length of hospitalization; decreased rates of respiratory failure and death; decreased post-surgical lengths of stay; and enhanced patient satisfaction.
Preliminary, lower-grade evidence suggests that OMT can improve some infection-related outcomes, and is safe. The role of OMT in infection management should undergo further controlled trials without delay. (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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Exploring the utility of motion analysis in osteopathic clinical trials; a school-based pilot study on jaw and cervical range of motion
International Journal of Osteopathic Medicine
This study explores the interest of using motion analysis to evaluate cervical and jaw ROM on students with or without bruxism when comparing Osteopathic manipulative treatment (OMT) to sham in school settings.
A feasibility study was run with 48 volunteer students from an osteopathic training institution. Random sequence for allocation was generated using a 1:1 ratio and block size of four to either OMT or sham treatment (control group). The chosen motion outcomes of interest were the lateral jaw range of motion, jaw opening, cervical rotation and side-bending. ROM was measured averaging over three repeated movements at baseline, immediately after the 1st treatment, one week before the 2nd treatment, and immediately after second treatment using video-based analysis with 15 body landmarks.
Repeated measures of joint motion at baseline showed high levels of reliability (ICC ranging from 0.953 to 0.985). Motion analysis detected clinically important differences between OMT and sham one-week post-treatment for jaw lateral ROM (3.3°; p=0.018) and cervical rotation ROM (12.0°; p=0.003) on participants with bruxism but not on those without. Magnitude of differences were increased for all parameters following the second treatment (lateral jaw movement; 4.8°, p=0.005; jaw opening; 5.5°, p=0.002; cervical side-bending; 9.2°, p=0.023; cervical rotation; 18.2°, p<0.001).
Motion analysis is capable of detecting the effects of OMT on cervical and jaw ROM in students with bruxism but not without. Finally, the study showed the feasibility of introducing usual standards for clinical trials and sham treatment in school led studies with students.
(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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Determinants of clinical practice guidelines' utilization for the management of musculoskeletal disorders: A scoping review
BMC Musculoskeletal Disorders
Many clinical practice guidelines have been developed for the management of musculoskeletal disorders (MSDs). However, there is a gap between evidence-based knowledge and clinical practice, and reasons are poorly understood. Understanding why healthcare providers use clinical practice guidelines is essential to improve their implementation, dissemination, and adherence.
The aim of this study was to identify determinants of clinical practice guidelines’ utilization by health care providers involved in the assessment and management of MSDs.
A scoping review of the literature was conducted. Three databases were searched from inception to March 2021. Article identification, study design, methodological quality, type of healthcare providers, MSDs, barriers and facilitators associated with guidelines’ utilization were extracted from selected articles.
8,671 citations were retrieved, and 43 articles were selected. 51% of studies were from Europe, and most were quantitative studies (64%) following a cross-sectional design (88%). Almost 80% of articles dealt with low back pain guidelines, and the most studied healthcare providers were general practitioners or physiotherapists. Five main barriers to guideline utilization were expressed by providers: 1) disagreement between recommendations and patient expectations; 2) guidelines not specific to individual patients; 3) unfamiliarity with “non-specific” term, or with the bio psychosocial model of MSDs; 4) time consuming; and 5) heterogeneity in guideline methods. Four main facilitators to guideline utilization were cited: 1) clinician’s interest in evidence-based practice; 2) perception from clinicians that the guideline will improve triage, diagnosis and management; 3) time efficiency; and 4) standardized language.
Identifying modifiable determinants is the first step in developing implementation strategies to improve guideline utilization in clinical practice.
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Evaluating the effectiveness of patient tailored treatment for patients with non-specific low back pain: A systematic review
Musculoskeletal Care
This systematic review summarizes the relevant literature on the effectiveness of tailored interventions in non-specific low back pain (NSLBP).
The search strategy has been executed in December 2019 in the electronic databases PubMed, Web of Science and Embase. Study selection, data extraction and quality assessment were done independently by two authors.
A total six eligible studies were identified. Five out of six articles used a classification system to subgroup patients. All active patient tailored interventions had similar or better results than the non-patient tailored interventions, most importantly on pain (short- and mid-term, not for long term follow-up). Two motor control interventions revealed sustained or increased effects at 12 months follow-up for disability. For cost-effectiveness, medication use and work absenteeism, results were inconclusive. Global rating of change evaluation confirmed significant between-group results at 10 weeks to 4 months follow-up, but results were not maintained at 12-month evaluation.
Our findings support the preliminary evidence for the use of patient tailored treatment for reductions in pain and disability. However, our results are of very low to moderate quality evidence and the observed effects strongly depend on the subgroups and the chosen interventions. More high-quality RCT's with homogenous designs and larger sample sizes are needed.
(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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