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2003—Timothy S. Carey, MD, MPH
Do Osteopathic Physicians Differ in Patient Interaction From Allopathic Physicians? An Empirically Derived Approach
Colleges of osteopathic medicine teach osteopathic principles, which
provide a different approach to and interaction with patients than principles
taught in allopathic medical schools. The authors examined whether osteopathic
primary care physicians' interactions with patients reflect the principles of
osteopathic medicine when compared with allopathic physicians' interactions.
The principles of osteopathic medicine were adapted to elements that could be
measured from an audio recording. This 26-item index was refined with two
focus groups of practicing osteopathic physicians. Fifty-four patient visits
to 11 osteopathic and 7 allopathic primary care physicians in Maine for
screening physicals, headache, low back pain, and hypertension were recorded
on audiotape and were dual-abstracted. When the 26-item index of osteopathic
principles was summed, the osteopathic physicians had consistently higher
scores (11 vs 6.9; P=.01) than allopathic physicians, and visit
length was similar (22 minutes vs 20 minutes, respectively). Twenty-three of
the 26 items were used more commonly by the osteopathic physicians.
Osteopathic physicians were more likely than allopathic physicians to use
patients' first names; explain etiologic factors to patients; and discuss
social, family, and emotional impact of illnesses. In this study, osteopathic
physicians were easily distinguishable from allopathic physicians by their
verbal interactions with patients. Future studies should replicate this
finding as well as determine whether it correlates with patient outcomes and
satisfaction.
Carey TS, Motyka TM, Garrett JM, Keller RB. J Am Osteopath Assoc. 2003; 103:313-318. Full text pdf available at: http://www.jaoa.org/cgi/reprint/103/7/313.
2002—Russell G. Gamber, DO
Osteopathic Manipulative Treatment in Conjunction With Medication Relieves Pain Associated With Fibromyalgia Syndrome: Results of a Randomized Clinical Pilot Project
Osteopathic physicians caring for patients with fibromyalgia syndrome (FM)
often use osteopathic manipulative treatment (OMT) in conjunction with other
forms of standard medical care. Despite a growing body of evidence on the
efficacy of manual therapy for the treatment of selected acute musculoskeletal
conditions, the role of OMT in treating patients with chronic conditions such
as FM remains largely unknown. Twenty-four female patients meeting American
College of Rheumatology criteria for FM were randomly assigned to one of four
treatment groups: (1) manipulation group, (2) manipulation and teaching group,
(3) moist heat group, and (4) control group, which received no additional
treatment other than current medication. Participants' pain perceptions were
assessed by use of pain thresholds measured at each of 10 bilateral tender
points using a 9-kg dolorimeter, the Chronic Pain Experience Inventory, and
the Present Pain Intensity Rating Scale. Patients' affective response to
treatment was assessed using the Self-Evaluation Questionnaire. Activities of
daily living were assessed using the Stanford Arthritis Center Disability and
Discomfort Scales—Health Assessment Questionnaire. Depression was
assessed using the Center for Epidemiological Studies Depression Scale.
Significant findings between the four treatment groups on measures of pain
threshold, perceived pain, attitude toward treatment, activities of daily
living, and perceived functional ability were found. All of these findings
favored use of OMT. This study found OMT combined with standard medical care
was more efficacious in treating FM than standard care alone. These findings
need to be replicated to determine if cost savings are incurred when
treatments for FM incorporate nonpharmacologic approaches such as OMT.
Gamber RG, Shores JH, Russo DP, Jimenez C, Rubin BR. J Am Osteopath Assoc. 2002;102:321-325. Full text pdf available at: http://www.jaoa.org/cgi/reprint/102/6/321.
2001—Thomas Breithaupt, PhD
Thoracic Lymphatic Pumping and the Efficacy of Influenza Vaccination in Healthy Young and Elderly Populations
The authors investigated whether thoracic lymphatic pumping (TLP) after
FluShield vaccination enhanced the production of anti-influenza
immunoglobulins in elderly individuals, who are at particular risk for
influenza. Osteopathic students and non–TLP-treated elderly subjects
served as controls. Serum antibody titers were quantified with enzyme-linked
immunosorbent assay, and hemagglutination inhibition assay, both of which
generated comparable results. While approximately 70% of the younger controls
had increased anti-influenza immunoglobulin production on vaccination, only
30% to 35% of the aged population had increased antibody production. There was
no significant enhancement in anti-influenza immunoglobulin production in the
TLP-treated subjects. The authors' findings suggest that TLP in conjunction
with influenza vaccination does not enhance immunization against influenza in
otherwise healthy and active populations. However, such techniques may be of
value when applied in conjunction with vaccination to nonambulatory patients
or on actual influenza exposure of at-risk individuals.
Breithaupt T, Harris K, Ellis J, Purcell E, Weir J, Clothier M, Boesler D. J Am Osteopath Assoc. 2001;101:21-25. Full text pdf available at: http://www.jaoa.org/cgi/reprint/101/1/21.
2000—Donald R. Noll, DO
Benefits of Osteopathic Manipulative Treatment for Hospitalized Elderly Patients With Pneumonia
While osteopathic manipulative treatment (OMT) is thought to be beneficial
for patients with pneumonia, there have been few clinical
trials—especially in the elderly. The authors' pilot study suggested
that duration of intravenous antibiotic use and length of hospital stay were
promising measures of outcome. Therefore, a larger randomized controlled study
was conducted. Elderly patients hospitalized with acute pneumonia were
recruited and randomly placed into two groups: 28 in the treatment group and
30 in the control group. The treatment group received a standardized OMT
protocol, while the control group received a light touch protocol. There was
no statistical difference between groups for age, sex, or simplified acute
physiology scores. The treatment group had a significantly shorter duration of
intravenous antibiotic treatment and a shorter hospital stay.
Noll DR, Shores JH, Gamber RG, Herron KM, Swift J Jr. J Am Osteopath Assoc. 2000;100:776-782. Full text pdf available at: http://www.jaoa.org/cgi/reprint/100/12/776.
1999—Michael P. Wells, PhD
Standard Osteopathic Manipulative Treatment Acutely Improves Gait Performance in Patients With Parkinson's Disease
Patients with Parkinson's disease exhibit a variety of motor deficits which
can ultimately result in complete disability. The primary objective of this
study was to quantitatively evaluate the effect of osteopathic manipulative
treatment (OMT) on the gait of patients with Parkinson's disease. Ten patients
with idiopathic Parkinson's disease and a group of eight age-matched normal
control subjects were subjected to an analysis of gait before and after a
single session of an OMT protocol. A separate group of 10 patients with
Parkinson's disease was given a sham-control procedure and tested in the same
manner. In the treated group of patients with Parkinson's disease,
statistically significant increases were observed in stride length, cadence,
and the maximum velocities of upper and lower extremities after treatment.
There were no significant differences observed in the control groups. The data
demonstrate that a single session of an OMT protocol has an immediate impact
on parkinsonian gait. Osteopathic manipulation may be an effective physical
treatment method in the management of movement deficits in patients with
Parkinson's disease.
Wells MR, Giantinoto S, D'Agate D, Areman RD, Fazzini EA, Dowling D, Bosak A. J Am Osteopath Assoc.1999 ;99:92 -98.[Abstract]
1998—Joan M. Radjieski, DO
Effect of Osteopathic Manipulative Treatment on Length of Stay for Pancreatitis: A Randomized Pilot Study
There have been few randomized, controlled studies of the effects of
osteopathic manipulative treatment (OMT). In this outcomes research study, the
authors randomly assigned patients with pancreatitis to receive standard care
plus daily OMT for the duration of their hospitalization (n=6) or to receive
only standard care (n=8). Osteopathic manipulative treatment involved 10 to 20
minutes daily of a standardized protocol, using myofascial release, soft
tissue, and strain-counterstrain techniques. Attending physicians were blinded
as to group assignment. Results indicated that patients who received OMT
averaged significantly fewer days in the hospital before discharge (mean
reduction, 3.5 days) than control subjects, although there were no significant
differences in time to food intake or in use of pain medications. These
findings suggest the possible benefit of OMT in reducing length of stay for
patients with pancreatitis.
Radjieski JM, Lumley MA, Cantieri MS. J Am Osteopath Assoc. 1998;98(5):264 -272. Erratum in: J Am Osteopath Assoc. 1998;98:408.[Abstract]
1997—Brian H. Hallas, PhD
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 hind legs, 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.
Hallas B, Lehman S, Bosak A, Tierney S, Galler R, Jacovina P, Scandalis TA, Wells M. J Am Osteopath Assoc.1997 ;97:207 -214.[Abstract]
1996—W. Randolph Purdy, DO
Suboccipital Dermatomyotomic Stimulation and Digital Blood Flow
The effect of gentle, soft tissue manipulation in the suboccipital region
on digital blood flow, as a measure of sympathetic nervous system activity,
was studied. Digital strain gauge plethysmography was used to measure the
changes in pulse contour during (1) a normative test period with the subject
in the supine position, (2) after a control interval (placebo) during which
the investigator placed his hands under the suboccipital region, and (3) after
an interval during which the investigator's fingers applied slow, steady,
circular kneading in the suboccipital triangle region. Twenty-five studies
were performed in a crossover design with the patient as his or her own
control. Total pulse amplitude (Y) and the height from the dicrotic notch to
the peak (X) were measured. Examination of the total data of all subjects
revealed the occurrence of a significant change in X and Y with simply
touching the suboccipital region with the hands. An even more favorable
response ensued when suboccipital manipulation was applied. Those subjects
reporting comfort or neutral responses had larger significant changes with
manipulation when compared with the group reporting the experience as
uncomfortable. The response within each group suggests that favorable
autonomic changes (sympathetic dampening) occur with specific suboccipital
manipulation as well as, indeed, the simple touching of the suboccipital
triangle.
Purdy WR, Frank JJ, Oliver B. J Am Osteopath Assoc. 1996;96:285 -289.[Abstract]
1995—William L. Johnston, DO
Changes in Presence of a Segmental Dysfunction Pattern Associated With Hypertension
The short-term portion of this study (part 1) showed an association between
somatic dysfunction and the regulation of blood pressure. To study long-term
relationships, follow-up examinations were made of 61 subjects studied 3 to 10
years earlier. They were heterogeneous Family Practice Clinic patients with a
mean age of 45 years. By methods used in part 1 and in our previous studies of
systemic interactions, palpatory examination was done to support presence or
absence of a C6T2T6 pattern of segmental motion dysfunctions, and blood
pressure status was established by the medical history. The C6T2T6 pattern
persisted in 16 of 16 subjects with grade 2 or greater hypertension and 4 of 9
normotensive subjects who had shown the pattern initially. At follow-up, the
pattern first appeared in 7 subjects who had hypertension previously diagnosed
and who remained hypertensive; the pattern disappeared in 5 normotensive
subjects who remained normotensive. The C6T2T6 pattern's long-term persistence
in hypertensive subjects and changes in its presence corresponding to the
subjects' hypertensive status indicate an important relationship between this
pattern of segmental motion dysfunctions and disturbances in regulation of
blood pressure.
Johnston WL, Kelso AF. J Am Osteopath Assoc. 1995;95(5):315 -318.[Abstract]
1994—Benjamin M. Sucher, DO
Palpatory Diagnosis and Manipulative Management of Carpal Tunnel Syndrome
Carpal tunnel syndrome was studied by use of supplemental palpatory
diagnosis in 20 abnormal wrists. Restriction in motion at the carpal tunnel
was quantified with a rating system. All wrists with carpal tunnel syndrome
revealed at least moderate restriction to motion, as compared with only mild
or no restriction in 20 wrists in normal, symptom-free subjects. Several
participants (16 abnormal wrists) underwent osteopathic manipulative
treatment, including a new "opponens roll" maneuver, and
self-stretching, or a similar treatment accomplished by use of a
self-treatment accomplished by use of a self-treatment appliance. In those
treated, palpatory restriction decreased into the normal range, often before
symptoms decreased. Improvement in nerve conduction studies usually followed
within 1 to 3 months. Palpatory diagnosis is a useful adjunctive method of
assessing patient status in carpal tunnel syndrome and helpful in
prognosticating outcome. The modified manipulative technique described for the
treatment of mild to moderate carpal tunnel syndrome may be effective in more
severe cases.
Sucher BM. J Am Osteopath Assoc.1994 ;94(8):647 -663.[Abstract]
1993—Christopher T. Meyer, DO
Osteopathic Medicine: A Call for Reform
During the past 40 years, the osteopathic medical profession has undergone
a transformation from "osteopathy" to "osteopathic
medicine." The former was characterized by manipulative treatment; the
latter, by full-service healthcare. During this transformation, the profession
has won acceptance from the government, the military, and MDs. These changes
in status have resulted in new problems for the profession because DO
graduates are increasingly turning toward allopathic programs for residency
training. Thus, osteopathic medicine's primary care orientation is being
replaced by an emphasis on specialty training. The authors propose that
osteopathic medicine return to its original mission of primary care, abandon
or restrict specialty training to those who have completed primary care
residencies, and rethink its separate-but-equal posture. They also propose
that osteopathic medicine establish lines of communication with allopathic
medicine, the American Medical Association, and the government to facilitate
the development of a rational national policy for primary care that considers
the potential osteopathic medicine has to offer in meeting the nation's
primary care needs.
Meyer CT, Price A. J Am Osteopath Assoc. 1993;93(4):473 -485.[Abstract]
1992—Thomas Adams, PhD
Parietal Bone Mobility in the Anesthetized Cat
To quantify parietal bone motion in reference to the medial sagittal
suture, a newly developed instrument was attached to the surgically exposed
skull of anesthetized adult cats. The instrument differentiated between
lateral and rotational parietal bone movements around the fulcrum of the
suture. Bone movement was produced by external forces applied to the skull and
by changes in intracranial pressure associated with induced hypercapnia,
intravenous injections of norepinephrine, and controlled injections of
artificial cerebrospinal fluid into the lateral cerebral ventricle. Responses
varied considerably among test animals. Generally, lateral head compression
caused sagittal suture closure, small inward rotation of the parietal bones,
increased intraventricular pressure, transient apnea, and unstable systemic
arterial blood pressure. Graded increases in intracranial volume produced
stepped increases in pressure, lateral expansion at the sagittal suture, and
outward rotation of the parietal bones. We attribute variations in animal
response largely to differences in intracranial and suture compliance among
them. Cranial suture compliance may be an important factor in defining total
cranial compliance.
Adams T, Heisey RS, Smith MC, Briner BJ. J Am Osteopath Assoc. 1992;92:599 -600, 603-610, 615-622.[Abstract]
1991—Irvin M. Korr, PhD
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. Arguments are presented that conventional correction for the socalled placebo effect would render invalid the testing of osteopathic medicine as it is practiced.
Alternative designs and models are suggested. Most of them have been tested and reported in the clinical literature; others await careful trial and development under osteopathic auspices.
Korr IM. J Am Osteopath Assoc.1991 ;91: 156, 161-168, 170-171.[Abstract]
1990—Richard Van Buskirk, DO
Nociceptive Reflexes and the Somatic Dysfunction: A Model
A model of somatic dysfunction is developed in which restriction in
mobility and autonomic, visceral, and immunologic changes are produced by
pain-related sensory neurons and their reflexes. Nociceptors are known to
produce muscular guarding reactions, as well as autonomic activation, when
musculoskeletal or visceral tissue is stressed or damaged. This guarding
causes abnormal musculoskeletal position and range of motion. Local
inflammatory responses and autonomic reflexes further reinforce nociceptor
activity, maintaining restriction. Nociceptive autonomic reflexes also evoke
changes in visceral and immunologic function. Finally, maintenance of muscles,
joints, and related tissues in an abnormal guarding position causes changes in
the connective tissues, solidifying the abnormal position. Stretching these
tissues into a normal range of motion will restimulate the nociceptor,
reflexly reinforcing the somatic dysfunction. This model has evolved from
Korr's neurologic model but emphasizes the nociceptor and its reflexes as a
source of the connective tissue, circulatory, visceral, and immunologic
changes seen in the somatic dysfunction.
Van Buskirk RL. J Am Osteopath Assoc. 1990;90:792 -794, 797-809.[Abstract]
Footnotes
Awards are presented in the year following publication at the AOA
Annual Convention and Scientific Seminar. So the 2002 award, for example, was
presented at the 2003 convention, and the 2003 award will be presented at the
2004 convention.
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