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PubMed2006

Interexaminer reliability of three methods of combining test results to determine side of sacral restriction, sacral base position, and innominate bone position.

CONTEXT: Sacroiliac joint dysfunction is diagnosed based on the combined results of several palpatory examinations. Previous studies have compared the interexaminer reliability of only one of these methods of diagnosis. OBJECTIVE: To compare the interexaminer reliability of three methods of combining palpatory examinations to determine the side of sacroiliac joint dysfunction, sacral base position, and innominate bone position. DESIGN: Blinded single-cohort reliability study. METHODS: Patients with low back pain underwent two identical sets of palpatory examinations given by two physicians, separately, at a university spine center. The results of each set were compiled and interpreted by three methods: using the test result with the highest interexaminer reliability (method 1), requiring at least one test result to be abnormal for the variable to be abnormal (method 2), and requiring all test results to be abnormal for the variable to be abnormal (method 3). The kappa was calculated for each method. RESULTS: There were 24 subjects (mean age, 68.3 years), of which 15 (62%) were women. The kappa was consistently higher with method 1, at 0.47, 0.08, and 0.32 for the sacral position, innominate bone position, and side of sacroiliac joint dysfunction, respectively. Corresponding values for method 2 were 0.09, 0.4, and 0.16, and for method 3 were 0.16, 0.1, and -0.33. CONCLUSION: Using the results of the most reliable examination consistently has the best interexaminer reliability.

Aged↗
PubMed2003

The passive straight leg raising test in the diagnosis and treatment of lumbar disc herniation: a survey of United kingdom osteopathic opinion and clinical practice.

STUDY DESIGN: Postal questionnaire survey. OBJECTIVES: To carry out a confidential postal survey of United Kingdom osteopaths in order to record and assess their use of the passive straight leg raising test in the diagnosis of, and choice of, manipulation for lumbar disc herniation. The study also sought to determine whether an association existed between osteopaths' manipulation of suspected lumbar disc herniation and their use of the straight leg raising test, the length of their working hours, and their use of manipulation for the treatment of other lumbar conditions. SUMMARY OF BACKGROUND DATA: The literature is not agreed on important aspects of the straight leg raising test, or on the use of spinal manipulation for suspected lumbar disc herniation. This is thought to be the first study to investigate opinion and practice in a large group of spinal manipulators, in this case United Kingdom osteopaths. METHODS: A questionnaire was sent to all 1030 United Kingdom osteopaths registered with the General Osteopathic Council in January 2000. It comprised four sections: personal characteristics, professional characteristics, background to low back pain cases, details of straight leg raising test understanding and use within the diagnosis and treatment of lumbar disc herniation. RESULTS: A response rate of 44% was achieved. United Kingdom osteopaths' opinions of low back pain and lumbar disc herniation clinical presentations, details of straight leg raising test mode of action, procedure, and interpretation were in keeping with the literature. Fifty-four percent of respondents sometimes employed manipulation in the treatment of lumbar disc herniation, but most of the others described the practice as "dangerous." The literature is similarly divided on the practice. Chi-square and Cramer V analysis implied that respondents were not influenced in choosing manipulation for lumbar disc herniation by their use of the straight leg raising test (chi2 = 4.002, df = 3, Cramer V = 0.0959, P = 0.261, alpha 0.05, n = 435). A moderate association implied that the frequency of use of such manipulation for all lumbar conditions influenced the choice of that treatment for lumbar disc herniation (chi2 = 81.808, df = 4, Cramer V = 0.4302, P < 0.001, alpha = 0.05, n = 442). There was also a weak association suggesting that hours worked per week influenced the choice of manipulation for lumbar disc herniation (chi2 = 9.840, df = 3, Cramer V = 0.1499, P = 0.020, alpha = 0.05, n = 438). CONCLUSIONS: Respondents to this survey frequently treated low back pain and often employed the straight leg raising test in its diagnosis. Their recognition of the clinical presentation of lumbar disc herniation and their use and understanding of the straight leg raising test were in keeping with the literature. Respondents were divided nearly equally between those who would expect patient benefit from the use of manipulation for lumbar disc herniation and those who criticized the practice. There is a need for further research into the clinical reasoning employed for the manipulative treatment of lumbar disc herniation.

Attitude of Health Personnel↗
PubMed2002

Training family medicine residents for assessment and advocacy of older adults.

A review of the Basic Standards for Residency Training in Osteopathic Family Practice and Manipulative Treatment by the American Osteopathic Association and the American College of Osteopathic Family Physicians revealed that the family medicine residency curriculum in place at Riverside Osteopathic Hospital in Trenton, Mich, lacked formal didactic and clinical teaching in geriatric medicine. Therefore, a geriatric curriculum focusing on functional assessment strategies was developed and implemented. A three-part, 6-hour educational series was delivered to family medicine residents, interns, and medical students at Riverside Osteopathic Hospital. Content for the sessions addressed a variety of assessment and screening tools; concepts of abuse, neglect, and guardianship; available community resources to support the independent functioning of older adults; and, application of knowledge and skills. The geriatric medicine series concluded with a working session to prepare an individualized management plan for each of the patients evaluated. Each family medicine resident, the target learners, demonstrated his skill at performing a functional assessment of a geriatric patient at the community-based Horizon Family Medical Center in Taylor, Mich. Peers and faculty provided feedback. Family medicine residents were able to transfer knowledge and skills from the classroom to a geriatric patient. This teaching curriculum is the starting point for further development of clinical and community-based geriatric experiences for the family medicine residents at Riverside Osteopathic Hospital.

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PubMed1992

The crisis in osteopathic medicine.

During the last 30 years the osteopathic profession has undergone a remarkable transformation from osteopathy, characterized by manipulative therapy, to osteopathic medicine, characterized by full-service health care, and in the process it has won acceptance from the government, the military, and physicians. These changes in status have resulted in new problems for the profession, because D.O. graduates are turning increasingly toward M.D. programs for residency training, and osteopathic medicine's primary care orientation is being replaced by an emphasis on specialty training. The authors advocate that osteopathic medicine return to its original mission of primary care, abandon specialty training or restrict it to those who have completed primary care residencies, abolish its separate-but-equal posture, and establish lines of communication with allopathic medicine and the American Medical Association to facilitate the development of a rational national policy for primary care that considers the potential osteopathy has to offer in meeting the nation's primary care needs.

Education, Medical, Graduate↗
PubMed1991

Osteopathic research: the needed paradigm shift.

The purposes of this article are twofold: (1) To assist scientists on the faculties of colleges of osteopathic medicine in the design of research projects relevant to osteopathic medical theory and practice; and (2) to assist clinical investigators in the development of research protocols that are best suited to the assessment of clinical outcomes of osteopathic medical practice. Toward this end, the central osteopathic medical principles are heuristically interpreted and elaborated, with the intention of facilitating the formulation of fundamental questions by researchers in the various biomedical disciplines and the design of clinical research projects by osteopathic physicians. A few of the questions evoked by such elaboration of the osteopathic medical principles and awaiting study are suggested for consideration by researchers. Such research questions require and, in part, compose a research paradigm that differs basically from, yet complements and "completes," the prevailing and highly productive reductionist paradigm. It is, in the original sense of the word, a "holistic" paradigm that places emphasis on the organismic context in which the biological mechanisms exist and operate. Conventional clinical research protocols for the assessment of efficacy of most chemical and physical therapeutic agents are ill-suited for the assessment of osteopathic medical care, of manipulative treatment in particular. It is emphasized that osteopathic medical care must be evaluated as it is practiced and not as a contrived, unreal version; and that it must be tested as a derivative of, and in the context of, that philosophy by criteria consonant with that philosophy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Physiological↗
PubMed1997

Establishment of behavioral parameters for the evaluation of osteopathic treatment principles in a rat model of arthritis.

Unilateral arthritis was produced in rats by use of methylated bovine serum albumin in a model of antigen-induced arthritis. The progression of arthritis was measured by computerized motion analysis, bilateral joint circumference, voluntary extension force of the hindlegs, and length of ankle extension. Animals with induced arthritis were assigned to treated and untreated groups on the basis of approximately equal deficits by the parameters measured. A third group of rats, which did not have arthritis induced and received no treatment, served to establish mean normal parameters. Modified techniques of muscle energy, passive movement of the ankle and knee, and passive myofascial stretch were applied to the animals, and the animals were exercised in a mechanized exercise wheel. Parameters associated with gait were examined by computerized motion analysis of walking. Animals treated with manipulation and exercise improved significantly relative to untreated animals with antigen-induced arthritis in vertical ankle lift, ankle-based and foot-based stride lengths, knee circumference, and normalized extension of the ankle. The results demonstrate that the parameters identified can be used to detect functional deficits and significant improvement from those deficits can be derived from a nonpharmacologic treatment paradigm that includes osteopathic manipulation and exercise in an animal model of arthritis. These parameters may be useful in the identification of the relative benefits of independent treatment variables including frequency of osteopathic manipulation and exercise and the relative benefits of each in this model. Also, they may elucidate how these treatments produce their beneficial effects clinically.

Animals↗
PubMedDate not supplied

Spinal manipulative therapy for low back pain.

Growing interest in complementary and alternative medicine in the United States has been paralleled by increased use of spinal manipulative therapy in an attempt to manage symptoms of low back pain, spinal stenosis, and spondylolisthesis. Chiropractors have been the main practitioners of spinal manipulative therapy, with osteopaths and physical therapists providing a smaller fraction of these services. Theories explaining the mode of action of spinal manipulative therapy are largely preliminary and have focused on the mechanical effects of manipulative forces on the spine and neurologic responses to manipulation. The effects of spinal manipulation on patients with both acute and chronic low back pain have been investigated in randomized clinical trials. Most reviews of these trials indicate that spinal manipulative therapy provides some short-term benefit to patients, especially with acute low back pain.

Acute Disease↗
PubMed2004

The unique role of osteopathic physicians in treating patients with low back pain.

Low back pain is a common and costly condition in industrialized nations. Consequently, a variety of treatment modalities and providers are available. A widely recognized clinical practice guideline states that spinal manipulation, as potentially provided by various types of practitioners, can be helpful for patients with acute low back problems without radiculopathy when used within the first month of symptoms. The underlying principles of osteopathic manipulative treatment (OMT) suggest the potential utility of OMT in both acute and chronic low back pain. The author summarizes the methodologic characteristics and results of the three major clinical trials of OMT for low back pain conducted in the United States and discusses their implications for osteopathic medicine.

Humans↗
PubMed2004

Do primary-care clinicians think that nonspecific low back pain is one condition?

STUDY DESIGN: Postal survey. OBJECTIVES.: To determine whether Australian primary-care clinicians think that nonspecific low back pain (NSLBP) is one condition or a number of conditions (subgroups), and whether this belief influences their management of NSLBP. SUMMARY OF BACKGROUND DATA: Most low back pain (LBP) remains a diagnostic enigma and results in approximately 80% of primary care LBP presentations being most accurately labeled as "nonspecific LBP." Manual therapy clinicians (chiropractors, osteopaths, physiotherapists) are trained to think that subgroups exist within the NSLBP population. This research sought to identify the extent to which these beliefs are widely held in primary care. METHODS: A survey was conducted of 1,093 primary-contact clinicians from six professional disciplines (physiotherapists, manipulative physiotherapists, chiropractors, osteopaths, general medical practitioners, and musculoskeletal medicine practitioners). RESULTS: Completed questionnaires were returned by 651 (60%) clinicians. Of the primary-contact clinicians who responded, 93% do not think NSLBP is one condition. Seventy-four percent think that it is currently possible to recognize NSLBP subgroups. Ninety-three percent treat NSLBP differently based on patterns of signs and symptoms. The proportions of clinicians who hold these views were highest for physiotherapists and manipulative physiotherapists, and smallest for general medical practitioners and musculoskeletal medicine practitioners. CONCLUSIONS: Although assigning NSLBP patients to subgroups has not been validated, it is common in primary-care settings and influences case management. If subgroups exist within the NSLBP population, there are implications for research into the effects of treatment. Further research into the validity of subgroups is warranted.

Adult↗