Portal de Periódicos da CAPES

Results, solutions, and learning: The continuing maturation of osteopathy

2014; Elsevier BV; Volume: 17; Issue: 3 Linguagem: Inglês

10.1016/j.ijosm.2014.07.001

1746-0689

Steven Vogel,

Musculoskeletal Disorders and Rehabilitation

In the last issue of the International Journal of Osteopathic Medicine (IJOM), we reprinted an editorial from the Archives of Physical Medicine and Rehabilitation.1Chan L. Heinemann A.W. Roberts J. Elevating the quality of disability and rehabilitation research: mandatory use of the reporting guidelines.Arch Phys Med Rehabil. 2014; 95 (Available from:): 415-417http://www.sciencedirect.com/science/article/pii/S0003999313013075Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar It described the launch of an initiative by which 28 journals, including IJOM, will more aggressively promote the use of reporting guidelines in an effort to improve the quality of reporting. An extensive range of reporting guidelines are now available (see www.equator-network.org) for a large number of designs (from clinical trials to case studies and qualitative approaches). The use of guidelines will enable editors and reviewers to more systematically appraise the quality of manuscripts and give helpful and specific feedback to authors. More importantly, better quality in the reporting of research should lead to more accessibility to readers who are keen to judge whether the research is relevant to their practice, valid and has transferability into action in the clinical or educational setting. Although many of the key guidelines have been part of our Instructions to Authors for several years, authors contributing manuscripts for review can expect more attention and direction in this area in the coming months. Using research and applying the best evidence along with a practitioner's expertise and drawing on patients' preferences may have a familiar ring to it.2Sackett D.L. Rosenberg W.M. Gray J.A. Haynes R.B. Richardson W.S. Evidence based medicine: what it is and what it isn't.BMJ. 1996 Jan; 312: 71-72Crossref PubMed Google Scholar Evidence informed practice appears to be an expectation of osteopathic regulators.3OBA. Code of conduct for registered health practitioners. Osteopathy Board of Australia; ://www.osteopathyboard.gov.au/Codes-Guidelines.aspx.Google Scholar, 4GOsC Osteopathic practice standards. General Osteopathic Council, 2011http://www.osteopathy.org.uk/practice/standards-of-practice/Google Scholar IJOM has increased its efforts to provide effective summaries of evidence and best practise with its Masterclass section, as well as continuing to publish original research and the reporting of clinical case studies. In this current issue, Thomson et al. introduce qualitative research and specifically offer an in-depth description of grounded theory methodology in a Masterclass paper.5Thomson O.P. Petty N.J. Scholes J. Grounding osteopathic research: introducing grounded theory.Int J Osteopath Med. 2014; 17 (Available from:): 167-186http://www.sciencedirect.com/science/article/pii/S1746068913001247Abstract Full Text Full Text PDF Scopus (22) Google Scholar This will be helpful to readers wanting to understand and appraise this type of research, but will also provide useful guidance to those engaging in such research. Accompanying the Masterclass is an original study by some of the same authors, which explores osteopaths' professional views, identities and conceptions.6Thomson O.P. Petty N.J. Moore A.P. Osteopaths' professional views, identities and conceptions - a qualitative grounded theory study.Int J Osteopath Med. 2014; 17 (Available from:): 146-159http://www.sciencedirect.com/science/article/pii/S1746068913001715Abstract Full Text Full Text PDF Scopus (38) Google Scholar The paper offers a challenge as to the extent and appropriateness of osteopaths' focussing on their own views and priorities as opposed to a more patient centred model. It questions the extent to which mechanistic biomedical models of practice dominate some osteopathic thinking at the expense of considering social, psychological and behavioural factors of health pain and disability. Readers may like to reflect on their own practice in the context of Thompson et al.'s categorisations of practice. Whilst their work used UK osteopaths as participants, it is of interest to consider the similarities and differences between the flavours of osteopathy in different countries and the extent Thomson et al.'s analysis is distinct to osteopathy. Of course osteopathy is much more than the application of particular techniques, and is more accurately described by the values and principles that are considered key to osteopathic practice. The special issue on this topic identified a wide range of issues and perspectives.7McChesney B.D. Principle driven osteopathy.Int J Osteopath Med. 2013; 16 (Special Issue: Osteopathic Principles. Available from:): 62-63http://www.sciencedirect.com/science/article/pii/S1746068912000296Abstract Full Text Full Text PDF Scopus (5) Google Scholar, 8McGrath M.C. From distinct to indistinct, the life cycle of a medical heresy. Is osteopathic distinctiveness an anachronism?.Int J Osteopath Med. 2013; 16 (Special Issue: Osteopathic Principles. Available from:): 54-61http://www.sciencedirect.com/science/article/pii/S1746068912000715Abstract Full Text Full Text PDF Scopus (11) Google Scholar, 9Evans D.W. Osteopathic principles: more harm than good?.Int J Osteopath Med. 2013; 16 (Special Issue: Osteopathic Principles. Available from:): 46-53http://www.sciencedirect.com/science/article/pii/S1746068912000739Abstract Full Text Full Text PDF Scopus (13) Google Scholar, 10Tyreman S. Re-evaluating osteopathic principles.Int J Osteopath Med. 2013; 16 (Special Issue: Osteopathic Principles. Available from:): 38-45http://www.sciencedirect.com/science/article/pii/S1746068912000727Abstract Full Text Full Text PDF Scopus (28) Google Scholar, 11Penney J.N. The biopsychosocial model: redefining osteopathic philosophy?.Int J Osteopath Med. 2013; 16 (Special Issue: Osteopathic Principles. Available from:): 33-37http://www.sciencedirect.com/science/article/pii/S1746068912001071Abstract Full Text Full Text PDF Scopus (29) Google Scholar, 12Thomson O.P. Petty N.J. Moore A.P. Reconsidering the patient-centeredness of osteopathy.Int J Osteopath Med. 2013; 16 (Special Issue: Osteopathic Principles. Available from:): 25-32http://www.sciencedirect.com/science/article/pii/S1746068912000223Abstract Full Text Full Text PDF Scopus (39) Google Scholar, 13Cotton A. Osteopathic principles in the modern world.Int J Osteopath Med. 2013; 16 (Special Issue: Osteopathic Principles. Available from:): 17-24http://www.sciencedirect.com/science/article/pii/S1746068912000764Abstract Full Text Full Text PDF Scopus (20) Google Scholar, 14Stark J.E. An historical perspective on principles of osteopathy.Int J Osteopath Med. 2013; 16 (Special Issue: Osteopathic Principles. Available from:): 3-10http://www.sciencedirect.com/science/article/pii/S1746068912000752Abstract Full Text Full Text PDF Scopus (18) Google Scholar, 15Paulus S. The core principles of osteopathic philosophy.Int J Osteopath Med. 2013; 16 (Special Issue: Osteopathic Principles. Available from:): 11-16http://www.sciencedirect.com/science/article/pii/S1746068912000703Abstract Full Text Full Text PDF Scopus (27) Google Scholar Osteopathic manual techniques, however, do appear to be central to the therapeutic interventions that osteopaths use. Groisman et al. examine the effect of high-velocity low-amplitude manipulation on H-reflex responses and found variable responses in individuals.16Groisman S. Silva L. Rocha N. Hoff F. Rodrigues M.E. Ehlers J.A. et al.H-reflex responses to high-velocity low-amplitude manipulation in asymptomatic adults.Int J Osteopath Med. 2014; 17 (Available from:): 160-166http://www.sciencedirect.com/science/article/pii/S1746068914000261Abstract Full Text Full Text PDF Scopus (5) Google Scholar Understanding the physiologic effects of individual techniques used in osteopathic manual treatment is important as it can provide information that helps tailor interventions to the presentations of patients. This is particularly the case when the mechanism of dysfunction or injury is understood and our treatments can thus be intentionally directed at the underlying mechanisms that are contributing to an individual patients' presentation. Some might argue that it is the whole individualised osteopathic approach to the patient that is key, and that any attempt to disaggregate individual techniques from the whole approach not only misrepresents osteopathy, but is so lacking in external validity as to be almost useless. The challenge remains, however, to distinguish between specific effects of osteopathic manual therapy and the non-specific or contextual effects of interpersonal and other elements of practice such as time spent with patients. To illustrate this point, the recent revision of the NICE clinical guidelines on osteoarthritis highlight the importance of supporting evidence for the efficacy of specific interventions. The guideline development group decided that acupuncture was to be excluded from being recommended as a treatment despite there being evidence for its cost effectiveness. This decision was in part based on the lack of a sufficient difference between sham and true acupuncture and the difficulty deciding whether there was an effect beyond the contextual. The demonstrable clinical effect of both sham and true acupuncture being significantly larger than usual care was not sufficient to retain acupuncture in the guidance.17NCGC Osteoarthritis care and management in adults, clinical guideline CG177. National Clinical Guideline Centre, February 2014http://www.nice.org.uk/guidance/CG177Google Scholar This underlines the importance of having positive evidence of the underlying mechanisms of interventions as well as more pragmatic evidence from studies suggesting that clinical outcomes are better than “usual care”. The need for evidence underpinning practice is reflected in the expectations of osteopathic programmes of learning. Increasingly, continuing professional development programmes and pre-professional programmes have some expectation that there is a critical debate about the evidence and theory underpinning osteopathic approaches. The journal's education section is receiving a growing number of submissions after the successful special issues on the topic of education at the end of 2013 and the beginning of 2014. In this issue we are pleased to be publishing two papers that explore educational delivery. The first, by Moore et al.,18Moore K. Grace S. Orrock P. Coutts R. Blaich R. Vaughan B. Benchmarking the strategies for assessing clinical reasoning in osteopathic curricula.Int J Osteopath Med. 2014; 17 (Available from:): 187-198http://www.sciencedirect.com/science/article/pii/S174606891400025XAbstract Full Text Full Text PDF Scopus (8) Google Scholar focusses on the assessment of clinical reasoning and promotes a collaborative approach; while the second by Vaughan et al.,19Vaughan B. MacFarlane C. Florentine P. Clinical education in the osteopathy program at Victoria University.Int J Osteopath Med. 2014; 17 (Available from:): 199-205http://www.sciencedirect.com/science/article/pii/S1746068913001405Abstract Full Text Full Text PDF Scopus (20) Google Scholar describes clinical education at Victoria University. It is a sign of maturity within the profession that we are beginning to develop our own body of knowledge about osteopathic education and pedagogy. We very much hope that developing the education section further will provide opportunities for educators to share their practice and to enhance the adoption of good practice across different institutions and nations. In addition to the growth in the education section, we are delighted to be receiving more case report submissions. Lalonde20Lalonde F. The runner’s kidney: a case report.Int J Osteopath Med. 2014; 17 (Available from:): 206-210http://www.sciencedirect.com/science/article/pii/S1746068914000236Abstract Full Text Full Text PDF Scopus (3) Google Scholar reports the case of a middle aged female runner who presented with gluteal pain that involved visceral and musculoskeletal components. The author suggests ultrasound imaging could be used in the assessment of kidney somatic dysfunction. We wait with interest, whether a research team takes up this suggestion to explore the diagnostic accuracy of palpation of the viscera. The growing number of submissions across a diverse range of topics and methods requires a range of skilled peer reviewers. We are working hard to ensure that authors receive decisions about submissions as quickly as possible and a larger pool of reviewers contributes to faster decisions. We therefore invite expressions of interest from members of the profession who would be willing to give of their expertise and join our pool of reviewers. If you would like to review for the journal, please contact any of the editorial board or contact me directly ([email protected]). Finally, after calling for new reviewers the editors would like to extend their thanks to those who review for the journal and express their gratitude to Professor Stephen Tyreman and Dr Tyler Cymet for guest editing the recent education special issues. The author acknowledges the helpful comments received from Robert Moran and Dr Nic Lucas on a draft of this editorial.