OMT Research

[HealingDoc]

I posted the following information on the Pre-Osteopathic Medicine thread but I thought it would also be useful here. I have been able to keep up my OMT skills while on my predominantly MD rotations by teaching my patients and preceptors about OP&P and referring to these studies below. I choose about 2-3 techniques that I want to focus on per rotation, perform a very quick structural exam along with my regular PE, and if I feel that OMT might be useful and there is time for it, I'll ask for permission to treat. If the answer is "no," then at least I will have kept up my palpatory skills by performing a structural exam. So far I have found the best rotation for OMT to be FM- lymphatic techniques for respiratory illnesses and muscle energy and indirect techniques for pain patients. I have also found that when I treat office staff and nurses on the wards, my preceptors become much more interested in considering OMT for their patients. Word gets around!

There is no doubt that the very nature of OMT makes it impossible to perform a double blind randomized control trial. That said, we do not discount the results of surgical studies with similar design. The leaders of the profession have deemed these studies below to be excellent support for OMT. More research is currently being done around the nation. We're finally reaching a saturation point where there are enough people performing this research to justify funding for it. Look out for many more OMT studies in the near future with larger N, multi-site, etc. It is a very exciting time for the profession.

Evidence Based Medicine for OMT in Musculoskeletal System Complaints:
• Gunnar B.J. Andersson, M.D., Ph.D., Tracy Lucente, M.P.H., Andrew M. Davis, M.D., M.P.H., Robert E. Kappler, D.O., James A. Lipton, D.O., and Sue Leurgans, Ph.D. A Comparison of Osteopathic Spinal Manipulation with Standard Care for Patients with Low Back Pain N Engl J Med 1999; 341:1426 1431
• John C. Licciardone, DO,* Scott T. Stoll, DO,† Kimberly G. Fulda, MPH, David P. Russo, DO,‡ Jeff Siu, BA,† William Winn, DO,§ and Jon Swift Jr, DO Osteopathic Manipulative Treatment for Chronic Low Back Pain A Randomized Controlled Trial SPINE Volume 28, Number 13, pp 1355–1362
• RUSSELL G. GAMBER, DO; JAY H. SHORES, PHD; DAVID P. RUSSO, BA; CYNTHIA JIMENEZ, RN; BENARD R. RUBIN, DO Osteopathic manipulative treatment in conjunction with medication relieves pain associated with fibromyalgia syndrome: Results of a randomized clinical pilot project J AOA • Vol 102 • No 6 • June 2002
• JANICE A. KNEBL, DO, MBA; JAY H. SHORES, PHD; RUSSELL G. GAMBER, DO; WILLIAM T. GRAY, DO; KATHRYN M. HERRON, MPH Improving functional ability in the elderly via the Spencer technique, an osteopathic manipulative treatment: A randomized, controlled trial JAOA • Vol 102 • No 7 • July 2002


Evidence Based Medicine for OMT in Pulmonary and Infectious Disease:
• Donald R. Noll, DO; Brian F. Degenhardt, DO; Christian Fossum, DO (Norway); and
Kendi Hensel, DO Clinical and Research Protocol for Osteopathic Manipulative
Treatment of Elderly Patients With Pneumonia JAOA • Vol 108 • No 9 •
September 2008
• Peter A. Guiney, DO; Rick Chou, DO; Andrea Vianna, MD; Jay Lovenheim, DO
Effects of Osteopathic Manipulative Treatment on Pediatric Patients With
Asthma: A Randomized Controlled Trial JAOA • Vol 105 • No 1 • January 2005
• Brian F. Degenhardt, DO, Michael L. Kuchera, DO Osteopathic Evaluation and
Manipulative Treatment in Reducing the Morbidity of Otitis Media: A Pilot Study
JAOA • Vol 106 • No 6 • June 2006


Evidence Based Medicine for OMT in Cardiology:
• Albert H. O Yurvati, DO; Michael S. Carnes, DO; Michael B. Clearfield, DO; Scott T.
Stoll, DO, PhD; and Walter J. McConathy, PhD Hemodynamic Effects of
Osteopathic Manipulative Treatment Immediately After Coronary Artery Bypass
Graft Surgery JAOA • Vol 105 • No 10 • October 2005
• Patricia A. Gwirtz, Jerry Dickey, David Vick, Maurice A. Williams, and Brian
Foresman Viscerosomatic interaction induced by myocardial ischemia in conscious
dogs J Appl Physiol 103: 511–517, 2007.
• E. Marty Knott, OMS V; Johnathan D. Tune, PhD; Scott T. Stoll, DO, PhD; and H.
Fred Downey, PhD Increased Lymphatic Flow in the Thoracic Duct During
Manipulative Intervention JAOA • Vol 105 • No 10 • October 2005


Evidence Based Medicine for OMT in OB-Gyn/Urology:
• John C. Licciardone, DO, MS, MBA; Steve Buchanan, DO; Kendi L. Hensel, DO,
PhD; Hollis H. King, DO, PhD; Kimberly G. Fulda, DrPH; Scott T. Stoll, DO, PhD
Osteopathic manipulative treatment of back pain and relatedsymptoms during
pregnancy: a randomized controlled trial JANUARY 2010 American Journal of
Obstetrics & Gynecology
• Marx S, Cimniak U, Beckert R, Schwerla F, Resch KL. Chronic prostatitis/chronic
pelvic pain syndrome. Influence of osteopathic treatment a randomized
controlled study Urologe A. 2009 Nov;48(11):1339 45.
• Weiss JM. Pelvic floor myofascial trigger points: manual therapy for interstitial
cystitis and the urgency frequency syndrome. J Urol. 2001 Dec;166(6):2226 31.


Evidence Based Medicine for OMT in Surgical Patients:
• W. Thomas Crow, Lilia Gorodinsky Does osteopathic manipulative treatment
(OMT) improves outcomes in patients who develop postoperative ileus: A
retrospective chart review International Journal of Osteopathic Medicine 12
(2009) 32e3
• JM Radjieski; MA Lumley; and MS Cantieri Effect of osteopathic manipulative
treatment of length of stay for pancreatitis: a randomized pilot study J Am
Osteopath Assoc, May 1998; 98: 264.
• Frederick J. Goldstein; Saul Jeck; Alexander S. Nicholas; Marvin J. Berman; and
Marilyn Lerario Preoperative Intravenous Morphine Sulfate With Postoperative
Osteopathic Manipulative Treatment Reduces Patient Analgesic Use After Total
Abdominal Hysterectomy J Am Osteopath Assoc, Jun 2005; 105: 273 279.

Special thanks to Millicent King Channell, DO, MA of UMDNJ-SOM for giving us the
encouragement and resources we need to succeed!

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[facetguy]

As it relates to MSK conditions, particularly of the spine, do you place any value in the much larger volume of literature on 'spinal manipulation'? I understand OMT encompasses more techniques than just HVLA, but you only mentioned 4 studies in your MSK references, the most recent of which is 2003.

 

[HealingDoc]

As it relates to MSK conditions, particularly of the spine, do you place any value in the much larger volume of literature on 'spinal manipulation'? I understand OMT encompasses more techniques than just HVLA, but you only mentioned 4 studies in your MSK references, the most recent of which is 2003.

I have not looked into those studies. You are referring to chiropractic spinal manipulation, correct? If there are some you want to share, you can post on here. I don't think that the Osteopathic profession generally supports the use of spinal manipulation papers because many feel that its only a small fraction of what we do. Most research studies are not geared at the treatment, but rather the condition the patient has and the efficacy of using OMT combined with standard of care treatments.

 

[Styria]

That was a great lecture at Convo.

 

[facetguy]

I have not looked into those studies. You are referring to chiropractic spinal manipulation, correct? If there are some you want to share, you can post on here. I don't think that the Osteopathic profession generally supports the use of spinal manipulation papers because many feel that its only a small fraction of what we do. Most research studies are not geared at the treatment, but rather the condition the patient has and the efficacy of using OMT combined with standard of care treatments.

While some of the studies I'm referring to do specifically study 'chiropractic spinal manipulation', many study simply 'spinal manipulation'. As such, they can apply to anyone trained in spinal manipulation, including DOs (of course, the vast majority of SMT is performed by DCs). In almost all cases, SMT refers to HVLA in these studies. While HVLA may be only a small fraction of what DOs do, I would think DOs would still take an interest in the SMT literature. For the moment, spinal manipulation and mobilization are way more researched than other OMT components.

 

[HealingDoc]

While some of the studies I'm referring to do specifically study 'chiropractic spinal manipulation', many study simply 'spinal manipulation'. As such, they can apply to anyone trained in spinal manipulation, including DOs (of course, the vast majority of SMT is performed by DCs). In almost all cases, SMT refers to HVLA in these studies. While HVLA may be only a small fraction of what DOs do, I would think DOs would still take an interest in the SMT literature. For the moment, spinal manipulation and mobilization are way more researched than other OMT components.

Good timing, the American Academy of Osteopathy just E-mailed us this study in the newsletter today: http://www2.cochrane.org/reviews/en/ab008112.html. This study in particular does not support the use of SMT over other therapies for treating LBP, and deems SMT just as effective. Do you have any others to share?

 

[HealingDoc]

That was a great lecture at Convo.

Definitely- I talked to Dr. Millicent King Channell at the beginning of my 3rd year and she gave me the same advice. That one of the best things I could have done to ensure my success on rotations! After going to her lecture, I had to share some of these ideas.

 

[Old Grunt]

Without sounding like a jerk, I am surprised that anyone would let a medical student "treat" a patient.

We don't have practice rights and any negative consequences from an un-licensed provider treating patients will fall on the license of your attending.

Ironically, if I am outside the hospital and happen to have a bottle of Tylenol in my pocket and someone has a headache, I can give them some. If I am seeing a patient, and they have a headache, I can't write an order for Tylenol, nor can nurses who are licensed. How many times have you been around a resident whose gotten a page for Tylenol? We don't have the latitude to treat patients on our own. We can make suggestions at rounds, but ultimately a physician has to put the order in.

I might be misunderstanding your post, but it seems to me that you could potentially be putting your preceptors in legal jeopardy if any patient you saw and used OMT/OMM on had an adverse outcome and the medical records were subpoenaed and it came out that they approved an unlicensed practitioner to treat a patient (even if the adverse outcome had absolutely nothing to do with OMM/OMT).

Correct me if I am wrong, but just some food for thought.

 

[HealingDoc]

Without sounding like a jerk, I am surprised that anyone would let a medical student "treat" a patient.

We don't have practice rights and any negative consequences from an un-licensed provider treating patients will fall on the license of your attending.

Ironically, if I am outside the hospital and happen to have a bottle of Tylenol in my pocket and someone has a headache, I can give them some. If I am seeing a patient, and they have a headache, I can't write an order for Tylenol, nor can nurses who are licensed. How many times have you been around a resident whose gotten a page for Tylenol? We don't have the latitude to treat patients on our own. We can make suggestions at rounds, but ultimately a physician has to put the order in.

I might be misunderstanding your post, but it seems to me that you could potentially be putting your preceptors in legal jeopardy if any patient you saw and used OMT/OMM on had an adverse outcome and the medical records were subpoenaed and it came out that they approved an unlicensed practitioner to treat a patient (even if the adverse outcome had absolutely nothing to do with OMM/OMT).

Correct me if I am wrong, but just some food for thought.

Definitely, good post. This comes up for second years before they leave for rotations.

Basically, I can only treat patients under a supervising D.O. or M.D. who is comfortable with me treating. Legally, I am treating under their licenses, so I understand entirely when a preceptor decides not to let me help. When I am rotating with M.D.'s I usually only perform OMT on staff and physicians, in the form of cervical muscle energy for headaches or sinusitis techniques. The only rotation that I have been able to peform OMT under an MD on my own so far has been FM because there is a D.O. on staff whom the MD and I consulted with (and I had to reference some of the literature I posted above). Many D.O. students do this, and it is the only way we really can build up our experience with OMT during medical school.

When I treat at my D.O. preceptors' offices, it usually starts with a co-treatment, then I treat in front of the preceptor, and eventually the preceptor seems to leave the room at the end to allow me to finish up (usually with lymphatic pump techniques, which take longer) while they give any final remarks on the chart. The lymphatic techniques for respiratory illnesses, muscle energy and indirect techniques for pain patients are very benign treatments, especially when I only treat after taking a full H&P, determining a detailed ddx, and considering any contraindications there may be in a situation. I would not use muscle energy for the spine on a patient with a possible compression fracture, I would stay away from lymphatic techniques for a person in heart failure, etc. I have not heard of any legal issues regarding this kind of learning, but if anyone has feel free to share.

 

[Old Grunt]

Definitely, good post. This comes up for second years before they leave for rotations.

Basically, I can only treat patients under a supervising D.O. or M.D. who is comfortable with me treating. Legally, I am treating under their licenses, so I understand entirely when a preceptor decides not to let me help. When I am rotating with M.D.'s I usually only perform OMT on staff and physicians, in the form of cervical muscle energy for headaches or sinusitis techniques. The only rotation that I have been able to peform OMT under an MD on my own so far has been FM because there is a D.O. on staff whom the MD and I consulted with (and I had to reference some of the literature I posted above). Many D.O. students do this, and it is the only way we really can build up our experience with OMT during medical school.

When I treat at my D.O. preceptors' offices, it usually starts with a co-treatment, then I treat in front of the preceptor, and eventually the preceptor seems to leave the room at the end to allow me to finish up (usually with lymphatic pump techniques, which take longer) while they give any final remarks on the chart. The lymphatic techniques for respiratory illnesses, muscle energy and indirect techniques for pain patients are very benign treatments, especially when I only treat after taking a full H&P, determining a detailed ddx, and considering any contraindications there may be in a situation. I would not use muscle energy for the spine on a patient with a possible compression fracture, I would stay away from lymphatic techniques for a person in heart failure, etc. I have not heard of any legal issues regarding this kind of learning, but if anyone has feel free to share.

Thanks for the response. As an MD med student, I fully admit ignorance in how DO students implement OMT treatment into their rotations (if they choose to do so), so my comments were more out of curiosity than trying to raise a stink over OMT being used as a treatment.

 

[Tenacious DO]

Needs to be updated, but some nice resources

ManualMedicine