Evidence-based OMT

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Pansit

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Can anyone point me to a link or a website that has credible scientific evidence for OMT. When ppl ask me if there is any evidence for it, I just say yes I am sure there has to be somehwere but I dont know where to look (or maybe there isnt any at all, which would be crazy seeing that it's taught in medical school)...Maybe JP can direct me? And I hope ppl dont say "oh its too hard to research or test for"...well in that case, if its a treatment we give patients than it shouldn't be part of the modern medical school curriculum right? Especially in today's evidenced-based world. What if I gave a patient a treatment and she gets hurt?...what happens when she questions the validity of the treatment, its effectiveness, and even it's safety if there is no literature to point at and say "look here, this is safe and it works".

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Can anyone point me to a link or a website that has credible scientific evidence for OMT. When ppl ask me if there is any evidence for it, I just say yes I am sure there has to be somehwere but I dont know where to look (or maybe there isnt any at all, which would be crazy seeing that it's taught in medical school)...Maybe JP can direct me? And I hope ppl dont say "oh its too hard to research or test for"...well in that case, if its a treatment we give patients than it shouldn't be part of the modern medical school curriculum right? Especially in today's evidenced-based world. What if I gave a patient a treatment and she gets hurt?...what happens when she questions the validity of the treatment, its effectiveness, and even it's safety if there is no literature to point at and say "look here, this is safe and it works".

This is one of those threads that pops up every few months...someone requesting links that will give scientific validation to OMT. Well...there is quite a bit of OMT research going on. It's been done for years, but it is difficult to design credible studies sometimes just like in other modalities. For instance, you CAN'T design a double-blind study comparing a surgical and pharmacological solution to the same problem. Everyone knows who got what treatment. OMT is similar in that way. A lot of studies have tried OMT vs sham techniques, but you still run into multiple problems there as well.

Another point...when some type of treatment other than OMT fails you don't go running to the patient with literature and say, "look here, this is safe and it works", so why would you do that with OMT? In any treatment plan you discuss the details and risks with a patient before you begin and you get the patient's consent. You don't just do something and explain the problems later. Patients getting sicker AFTER your treratemnt is a fact of life and it occurs with ALL modalities of treatment, not just OMM. You'll learn more about that when yoiu get into medical school. Remember the word "iatrogenic"...you'll hear it over and over.

Also, there are some pretty common misconceptions about evidence-based medicine. EBM is not just about studies. It's about using ALL available information to come up with a diagnosis or treatment plan that will fit the individual patient. You use a wealth of information in making these decisions including past experience and intuition at some points. Remember that every time you prescribe a drug off-label that you are doing it because it has worked in the past for either you or a colleague but NOT because there are a bunch of studies that prove it works. The essential point in ANY treatment plan is that the patient be well informed of the possibilities and you make the decision to do it TOGETHER.

Lastly, there are a lot of things taught in medical school that no one has any idea why they work, but they don't stop teaching them. Drugs are the worst culprits. Yet, people still prescribe them year after year.

It's good that you want to look up some studies, but try not to get hung up on it. You'll have plenty of time to see it in action in your life. Just keep an open mind. :luck::luck:
 
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Can anyone point me to a link or a website that has credible scientific evidence for OMT. When ppl ask me if there is any evidence for it, I just say yes I am sure there has to be somehwere but I dont know where to look (or maybe there isnt any at all, which would be crazy seeing that it's taught in medical school)...Maybe JP can direct me? And I hope ppl dont say "oh its too hard to research or test for"...well in that case, if its a treatment we give patients than it shouldn't be part of the modern medical school curriculum right? Especially in today's evidenced-based world. What if I gave a patient a treatment and she gets hurt?...what happens when she questions the validity of the treatment, its effectiveness, and even it's safety if there is no literature to point at and say "look here, this is safe and it works".

www.pubmed.gov

There is evidence OMT benefits painful musculoskeletal conditions, mostly by reducing pain and reducing need for medication. The latter is a significant benefit given the adverse effects of long term NSAIDS or narcotics.

some poorly designed studies show potential benefit for otitis media, asthma, pneumonia. They should be improved upon before they are accepted as "evidence".

Like anything in medicine, OMT studies should be scrutinized, questioned, and evaluated for ways to improve on the design or replicated to verify the results.

You can always state that there is an underlying plausibility for effectiveness of treatments that have not been evaluated in randomized controlled trials. When applicable, of course.
 
When you prescribe a medication off-label, you are not doing so based on anecdotal evidence such as "it worked for me or my colleague in the past." You do it because there are published studies and literature to back up the efficacy of the drug for such purpose. However, it does not financially make sense for the drug companies to spend a bunch of money trying to get their drug approved for a new indication when it has already been approved for another indication and is thus legal to prescribe.

Basing your decisions on what seems like should work or has worked in personal experience absolutely is not EBM and is exactly what EBM seeks to correct.
 
When you prescribe a medication off-label, you are not doing so based on anecdotal evidence...You do it because there are published studies and literature to back up the efficacy of the drug for such purpose....

This is the real world and it happens every day. Yes, there are many cases where studies exist, but you would be fooling yourself if you think that's the only time it happens.


Basing your decisions on what seems like should work or has worked in personal experience absolutely is not EBM and is exactly what EBM seeks to correct.

EBM is a decision process that you make based on ALL available evidence-- not just a drug company study. You must synthesize the available information as well as rely on your own personal experience to determine the best possible choice to make. If it were as simple as you seem to think, then computers would be doctors and we wouldn't need humans anymore. Besides, every situation is different. What works for one person will not necessarily work for another. Because Verapimil works best in African Americans in many hypertension studies, would you hesitate to use it in a Caucasion male? I can tell you from personal experience that it works better for me than anything else (I'm about as white as a sheet) and I wouldn't hesitate to try it as a first line therapy. There is still something to be said for the "art" of medicine. That comes from experience-- not from an electronic journal.
 
This is one of those threads that pops up every few months...someone requesting links that will give scientific validation to OMT. Well...there is quite a bit of OMT research going on. It's been done for years, but it is difficult to design credible studies sometimes just like in other modalities. For instance, you CAN'T design a double-blind study comparing a surgical and pharmacological solution to the same problem. Everyone knows who got what treatment. OMT is similar in that way. A lot of studies have tried OMT vs sham techniques, but you still run into multiple problems there as well.

Another point...when some type of treatment other than OMT fails you don't go running to the patient with literature and say, "look here, this is safe and it works", so why would you do that with OMT? In any treatment plan you discuss the details and risks with a patient before you begin and you get the patient's consent. You don't just do something and explain the problems later. Patients getting sicker AFTER your treratemnt is a fact of life and it occurs with ALL modalities of treatment, not just OMM. You'll learn more about that when yoiu get into medical school. Remember the word "iatrogenic"...you'll hear it over and over.

Also, there are some pretty common misconceptions about evidence-based medicine. EBM is not just about studies. It's about using ALL available information to come up with a diagnosis or treatment plan that will fit the individual patient. You use a wealth of information in making these decisions including past experience and intuition at some points. Remember that every time you prescribe a drug off-label that you are doing it because it has worked in the past for either you or a colleague but NOT because there are a bunch of studies that prove it works. The essential point in ANY treatment plan is that the patient be well informed of the possibilities and you make the decision to do it TOGETHER.

Lastly, there are a lot of things taught in medical school that no one has any idea why they work, but they don't stop teaching them. Drugs are the worst culprits. Yet, people still prescribe them year after year.

It's good that you want to look up some studies, but try not to get hung up on it. You'll have plenty of time to see it in action in your life. Just keep an open mind. :luck::luck:

so by your reasoning, we should start requiring acupuncture as part of the osteopathic medical school curriculum. It has plenty of anecdotal evidence that it works, and it's too hard to research effectively but we know it works somehow. If I go to pubmed and type in acupuncture I am sure I will see somer research article backing up some effectiveness for it. My question is, why is such a class required, when it doesnt have straightforward credible medical evidence (whether you can or cant test it) and just offer the course as an elective. This takes me back into the early 1900's when AOA refused to acknowledge that drugs were an effective type of treatment, until it was like the 1930's. It seems like to me the same thing is going on with OMM...There has been years of research, and no ground-breaking results have really surfaced that made people say, "this treatment really works", and the Osteopathic community is again stubborn in acknowledging that because without OMM, what is Osteopathic Medicine?

And it's hard to keep an open mind when 95% of DO's dont even use it, students that I talk to say, yeah some stuff are good but also a lot of very very questionable things (like how they try to explain how cranial works, and it jquestionable and again they have no evidence that cranium "pulsations" occur, even though this seems like an objective thing that can be tested for), and let alone the "cultist" nature that some students describe with the OMM department.

When 95% of the physician drop it by the wayside, would you not think that the Osteopathic community might want to reevaluate its standing? What if 95% of allopathic physicians dropped the use of drugs in their practice...there would be a complete revamp in the medical school curriculum, to acccount for why that is? Why do DO schools seem to just ignore the fact that when an OMM professor looks up at a class of 200, only 10 people are going to actually use what is taught. Seems like a lot of money can be saved by making it an elective, and those 10 people can sign up.
 
...My question is, why is such a class required, when it doesnt have straightforward credible medical evidence (whether you can or cant test it) and just offer the course as an elective...


I don't know if you are like this, but what usually happens when this thread is re-incarnated every couple of months is that the OP doesn't really ever have any intention of reading the available literature. S/he simply wants to argue that no literature exists, even though people like Jack Daniel post plenty of websites with information. Tons of studies exist and more are going on every day. You've got to begin reading that stuff before you can really argue effectively on it.


...And it's hard to keep an open mind when 95% of DO's dont even use it...

That 95% figure usually gets brought up too, but it's ironic because it's based on flawed studies that used a meta analysis of billing records to determine how many doctors used OMT. The problem is that many, many DOs either don't know how to bill correctly or have had problems getting reimbursed with the 25 modifier and OMT codes. So..they bill for a higher office visit instead. If you've ever been to an osteopathic convention you'll notice that the OMT sessions are some of the most well-attended and popular ones of all.

...Seems like a lot of money can be saved by making it an elective, and those 10 people can sign up.[/B]

There are already osteopathic schools you can attend without OMM. They are called allopathic schools. You are free to choose one of them if you wish and you don't have to campaign to eliminate any classes. You can choose to learn OMM on your own later that way-- if you want to. Really...if you don't want to learn OMM the simplest way is not to go to an osteopathic school. But, if you are really just interested in reading the literature and gaining a better understanding of it, then just read Jack's post and visit some of those sites.
 
:thumbdown:
I don't know if you are like this, but what usually happens when this thread is re-incarnated every couple of months is that the OP doesn't really ever have any intention of reading the available literature. S/he simply wants to argue that no literature exists, even though people like Jack Daniel post plenty of websites with information. Tons of studies exist and more are going on every day. You've got to begin reading that stuff before you can really argue effectively on it.




That 95% figure usually gets brought up too, but it's ironic because it's based on flawed studies that used a meta analysis of billing records to determine how many doctors used OMT. The problem is that many, many DOs either don't know how to bill correctly or have had problems getting reimbursed with the 25 modifier and OMT codes. So..they bill for a higher office visit instead. If you've ever been to an osteopathic convention you'll notice that the OMT sessions are some of the most well-attended and popular ones of all.



There are already osteopathic schools you can attend without OMM. They are called allopathic schools. You are free to choose one of them if you wish and you don't have to campaign to eliminate any classes. You can choose to learn OMM on your own later that way-- if you want to. Really...if you don't want to learn OMM the simplest way is not to go to an osteopathic school. But, if you are really just interested in reading the literature and gaining a better understanding of it, then just read Jack's post and visit some of those sites.

For one thing, just because there is literature on a particular subject doesnt mean it is validated as a scientifically-proven treatment. There is literature on acupuncture, like I said, but you dont see that being taught in medical school. The real problem I have is that despite the literature, it is still not something that is fully accepted in the medical circles, yet alone in the osteopathic circles (aka. cranial).

That remark about "allopathic schools" is pretty ridicolous. This isnt the 1960's when Osteopathic education and Allopathic education were markedly different. If I go to Osteopathic school, I am not going to go because I want to learn OMM, I am going to go because I want to be a physician. If my state only has two medical schools, and one happens to be osteopathic why would I not want to go there?...I am not going to apply to all 124 other allopathic schools because the DO school will get me to be a physician...it doesnt matter to me that I have to take OMM, but it would be great if it had more validation in the medical community and I might be motivated to learn it.

Like I said before, Why teach a required course that only 5% of the class will care enough to put an effort into later in their practice (95% is the objective number, and that is all I can off of...but if you think the number is off because of billing and such, then fine, it might 85%...still pretty high). The AOA just seems to ignore this fact...why? Is this because without OMM, there really is no validation for Osteopathic medicine...that without OMM, DO's are really just MD's...I dont think that kind of reasoning justifies it being required. It seems more self-centered (based on history), than self-serving to the students. We all practice medicine, doesnt matter if you want to call osteopathic or allopathic, or get rid of those terms all together. It's this "backward" way of thinking that is the main reason as to why, people still dont know what a DO is...even though its been around for over 100 years....:thumbdown:
 
If I go to Osteopathic school, I am not going to go because I want to learn OMM, I am going to go because I want to be a physician. If my state only has two medical schools, and one happens to be osteopathic why would I not want to go there?...

The AOA just seems to ignore this fact...why? Is this because without OMM, there really is no validation for Osteopathic medicine...that without OMM, DO's are really just MD's...I dont think that kind of reasoning justifies it being required. It seems more self-centered (based on history), than self-serving to the students.

wow.. I guess I felt like you before getting to DO school, and I hope that you applied/got into MD schools because you will hate DO curriculum even more. Not only you will 'waste' time on OMM, but you will learn about principles and history of osteopathic medicine, which I ams sure you will hate. So, i suggest for your sanity and happiness look into allopathic schools.

With that said, DOs been around for 100 years, but MDs has been around for like couple thousand years. In the "early" history of medicine, even MDs were anecdotal based until past few hundred years at best (when was penicillin discovered?) that it has become 'more scientific.'

I do agree that there should be more concrete research and support for OMM, which hopefully some of our classmates and colleagues will pursue in the future. But some of the stuff taught in OMM are incredible tools for diagnosing and sometimes treating musculoskeletal dysfunction.( i heard/seen this from patients and physicians of both MD and DO background.) I think there is more to be learned about OMM and there is a lot of opportunity for future research if you are interested.

I only say this because I had the exact misgivings about OMM as you when I entered DO school, but some of the philosophy and techniques that I am learning has 'converted me.' (they pounded it into you.. u can't help it)

I hope you think about your school choices long and hard before attending DO school, but good luck to you nonetheless in becoming a physician.
 
Pansit, regarding allopathic an osteopathic educations, I think you proved his point. The educations are not very different except for OMM. If you are so against OMM, why not go to an allopathic school?
 
Pansit, regarding allopathic an osteopathic educations, I think you proved his point. The educations are not very different except for OMM. If you are so against OMM, why not go to an allopathic school?

I dont understand when people say this?...it's not as simple as "just go to an allopathic school"...first of all location is important (because of numerous other factors), second being accepted is important. If I dont get into my one state MD school, then my next choice is a DO school it's that simple. It has nothing to do with allopathic vs. osteopathic...I just see the two schools as medical schools. Maybe it's the people who view them as completely separate that may not understand. I just want to go to school, graduate, and practice...thats it...both ways do that for me. I am not going to apply to like 20 MD schools if I can get into a good DO school.

I dont hate OMM, I have seen it done, and it's great, but without scientific validation that's all it will ever be. That is probably why a lot of DO's just drop by the way side. Without the validity it's just another form of what chiropractors do. I have seen acupuncturists do the same thing as well, where people got better after a treatment...its all great..and its all anecdotal.
 
omm lab has alot of benefits aside from the techniques. i learned how to touch people, of all shapes and sizes, in a professional way and not feel uncomfortable, on DAY 1 of school. i learned bedside manner and how to clearly explain what im doing to a "lay person". i learned how to fall asleep with my eyes open while getting myofascial... :p im just saying, take it for what its worth. you may never use these techniques again, at least in your practice anyway. but you might come home and treat your family. and you learn alot of other doctor-y things that you may not realize at first.
 
omm lab has alot of benefits aside from the techniques. i learned how to touch people, of all shapes and sizes, in a professional way and not feel uncomfortable, on DAY 1 of school. i learned bedside manner and how to clearly explain what im doing to a "lay person". i learned how to fall asleep with my eyes open while getting myofascial... :p im just saying, take it for what its worth. you may never use these techniques again, at least in your practice anyway. but you might come home and treat your family. and you learn alot of other doctor-y things that you may not realize at first.

Yes those are all positives, but is that enough to justify it's requirement? Do really need OMM to learn bedside manner or how to explain things to the "lay person"...I dont think so. And as for being comfortable with touching...thats great, seriously its a positive thing. But again, how much touching does an osteopathic physician do that an allopathic physician wouldnt do....especially with 95% of DO's not using OMM. I think the amount of "touching" is going to be pretty similar. And with 50% of DO's every year entering ACGME residencies, that 5% of DO's who practice OMT is only going to decline. And those 5% of DO's surveyed currently includes those from the 80's and 70's, where DO's weren't even prevalent in MD residencies as it is now. Whats going to happen when only .5% of DO's practice OMM. Are they going to keep it in the curriculum? There are already schools (specially overseas) that allow you to be a true osteopath if you really want that OMT background. Why pretend like there is nothing wrong, in how nobody uses it, and continue to teach it like it's the basis of the whole profession.
 
well it gives us tons of extra practice to say the least, and i think its safe to assume that DO students get alot more people exposure their first 2 years than MD students. ive rotated alongside some great MD students, and they have asked me for advice on how to be more comfortable in front of patients. i like to think that omm had something to do with that... but thats just my lowly osteopathic opinion:).
 
In the "early" history of medicine, even MDs were anecdotal based until past few hundred years at best (when was penicillin discovered?) that it has become 'more scientific.'

All of medicine (MD and DO) was largely anecdotally based until only recently. EBM is a VERY new concept that has really only seen widespread acceptance in the past 3 decades or so. Hell, the actual term of "evidence based medicine" wasn't even seen in a published work until the 1990's.

I just wanted to clarify that.
 
Neat, like what? You skip over this point as fast as you can, but it's really not difficult at all to compare a manipulative technique to sham techniques. I'd be interested to here about the "difficulties" such studies encounter. ****, we still do it in surgery.

Exactly...why isnt there a study done that compares an OMM technique vs. say an acupuncture technique for the same illness (ie. sinus problems). You get a huge sample size and see how much better OMM would fair. As a medical school course, OMM better destroy other sham techniques out of the water or else it itself is a sham technique....Whenever this question is asked I just get the excuses and cold shoulder...similar to when OMM professors are asked about research that proves cranial works...it works because they say it does and they try to tell the students and at least 5% of them believe it, which tells me quite a bit about how believable it really is.
 
You can show me all the OMT research you want, but once you start asking me to palpate a cranial rhythmic impulse and then tell me that a rotated frontal bone (oh yeah, not only do the sutures articulate but now a solid frontal bone flexes in the middle...) can be responsible for this huge array of symptoms...

Well, that's where my eyes blur and "research" no longer matters. I like OMT, but when I read in a JAOA article that after a century they finally managed to show in an animal model that lymphatic treatments actually mobilize lymph!! I am painfully aware that the whole body of research is lacking. And not all of it for a lack of effort.

Though I do concede that a lot of the aspects of OMT have been "proven" I haven't found any research that puts the whole story together. One article explores an articulation, another patient satisfaction with treatment of that articulation, and then a third reviews those two and makes a causative connection when no such thing was ever investigated let alone proven.

Don't take my attitude as too cynical... I think OMT has an important place and will continue to well into the future. I think a lot of modalities are very beneficial to a large number of patients, and that as a whole it is a subject area that every medical school (yes, allopathic too) should include in its curriculum at least in a basic format as it solidifies many knowledge areas and improves patient/physician interaction, physical exam skills, etc. But DO academia seems very reluctant to admit or acknowledge areas that are lacking in research for fear that people will reject the field in bulk. So they race to fill in gaps with research, and when they can't there are explanations or it simply goes unacknowledged.
 
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