Teufelhunden said:
We, as a profession, need to start evaluating OMT just as we're trained to evaluate the efficacy of any other treatment: evidence-based medicine. Most of what we're taught in our OMT classes is pure hocus-pocus, and it makes us a laughing stock. Perhaps someday the 90 year old dinasours that run the AOA (and the D.O. schools) will step aside and allow for the next generation of D.O.s to step in and put an end to this madness.
More fundamental questions come first. Before you begin labeling what is "evidence-based" you need an evidence base. That means that you need to begin with a population-based approach to defining what conditions and diagnoses are amendable to OMT, what factors influence response to treatment, what is the role of placebo, expectancy, and natural history in treating somatic dysfunction, etc before jumping into clinical trials.
Everyone wants to skip to clinical trials, but clinical trials is where scientific inquiry culminates not where it begins. Before a clinical trial can give a meaningful answer about a treatment, there needs to be quite a bit already known and understood about the basic science and biological mechanisms behind the treatment. Jumping to clinical trials without doing more fundamental science is inefficient and potentially unrewarding. To date, the clinical trials in manual medicine have not resulted in any meaningful culmination of an evidence base because of methodological problems and difficult to interpret results given a lack of basic science. Imagine if chemotherapy trials were done this way...
We need to better characterize what it OMT is trying to treat, what are its "active ingreedients" and who potentially benefits the most from it, under what conditions, and what doses and frequencies.
J Am Osteopath Assoc. 2005 Dec;105(12):537-44. Related Articles, Links
Osteopathic manipulative treatment of somatic dysfunction among patients in the family practice clinic setting: a retrospective analysis.
Licciardone JC, Nelson KE, Glonek T, Sleszynski SL, Cruser A.
Please address correspondence to John C. Licciardone, MBA, University of North Texas Health Science Center at Fort Worth-Texas College of Osteopathic Medicine, 3500 Camp Bowie Blvd, Fort Worth, TX 76107-2644.
[email protected].
CONTEXT: Relatively little has been published about contemporary use of osteopathic manipulative treatment (OMT) in family practice. OBJECTIVE: To provide an "epidemiology" of somatic dysfunction, assessing prevalence and severity of somatic dysfunction encountered in the family practice setting, also characterizing physician use of OMT. Design: Retrospective analysis of Outpatient Osteopathic SOAP Note Form data collected in 1998 and 1999 by 20 osteopathic medical trainee-investigators under the supervision of seven site-based osteopathic physicians. SETTING: Three university-based, osteopathic family practice clinics. RESULTS: The authors analyzed records for 1331 patient encounters and 424 adult patients. The mean (SD) age of patients was 56.9 years (16.2 years), and 71% were women. The median number of days between repeat encounters was 29 days. Somatic dysfunction was diagnosed in 418 (31%) patient encounters, affecting a total of 1199 anatomic regions (2.9+/-1.2 anatomic regions per patient). Investigators used OMT in 335 (25%) patient encounters to treat a total of 952 anatomic regions (2.8+/-1.2 anatomic regions per patient). For women, the odds ratio for receiving OMT was 1.4 (95% confidence interval [CI], 1.0-2.2); for patients using analgesics, anti-inflammatory agents, or muscle relaxants, the odds ratio was 2.2 (95% CI, 1.2-4.1). Immediately after OMT, investigators reported that patients' somatic dysfunction resolved or improved in a total of 747 (96%) anatomic regions and remained unchanged in 32 (4%) anatomic regions (P<.001). The authors used cluster analysis to classify anatomic regions by prevalence and severity of somatic dysfunction. CONCLUSION: Somatic dysfunction was diagnosed in almost one-third of patient encounters. In one-quarter of patient encounters, investigators used OMT.
J Am Osteopath Assoc. 2002 Oct;102(10):527-32, 537-40. Related Articles, Links
Conditions and diagnoses for which osteopathic primary care physicians and specialists use osteopathic manipulative treatment.
Johnson SM, Kurtz ME.
Department of Family and Community Medicine at the Michigan State University College of Osteopathic Medicine in East Lansing, USA.
Data presented in this study were gathered in 1998 through a national mail survey of 3000 randomly selected osteopathic physicians. Of 979 (33.4%) questionnaires returned, 955 (97.5%) were usable for analysis. The use of osteopathic manipulative treatment (OMT) was determined for primary care physicians and specialists. Osteopathic manipulative treatment specialists and family physicians provided OMT significantly more frequently than other primary care physicians and non-primary care specialists. More than 50% of respondents (513) administered OMT on less than 5% of their patients. Nevertheless, it should be noted that physicians from 40 of 46 specialties and subspecialties represented in the survey (678, 71%) identified an average of 3.3 conditions and diagnoses per physician that were managed with OMT. The conditions and diagnoses for which OMT is used have been enumerated and codified. More than 50% of conditions (1135) for which respondents treated patients with OMT related to the musculoskeletal system, but extensive overlap among other body systems and body regions attests to the continued incorporation of OMT into holistic patient care by a broad range of osteopathic physicians.
J Am Osteopath Assoc. 2002 Jan;102(1):13-20. Related Articles, Links
Patient satisfaction and clinical outcomes associated with osteopathic manipulative treatment.
Licciardone J, Gamber R, Cardarelli K.
Department of Family Medicine, University of North Texas Health Science Center, Fort Worth 76107, USA.
[email protected]
A patient survey was used to measure and explain patient satisfaction and clinical outcomes associated with osteopathic manipulative treatment (OMT). Participating in the survey were 459 people who attended an ambulatory OMT specialty clinic from March 1998 through September 1998 and who had received OMT there at least twice previously. Standardized patient satisfaction scores were greatest for overall performance (0.61 +/- 0.29) and interpersonal manner (0.61 +/- 0.24). Satisfaction with finances (0.11 +/- 0.31) was significantly lower than for all other global dimensions of care (P < .001). Subjects perceived OMT to be highly efficacious (0.74 +/- 0.34) and reported significant relief from pain or discomfort (P < .001) and improvement in mobility (P < .001). Of all the respondents, 8.6% attributed an adverse reaction to OMT. Perception of OMT efficacy was significantly associated with all dimensions of patient satisfaction (P values ranged from less than .001 to .003). Relief from pain or discomfort was significantly associated with overall satisfaction (P < .001). Females had greater reduction in pain or discomfort than males (P = .001). Respondents perceived significant community shortages of OMT services through primary care (-0.45 +/- 0.50; P < .001) and specialty (-0.35 +/- 0.54; P < .001) physicians, and reported significant dissatisfaction with insurance coverage for OMT services (-0.09 +/- 0.57; P = .001). These findings suggest the need for greater access to OMT services.
Quality of life in referred patients presenting to a specialty clinic for osteopathic manipulative treatment.
Licciardone JC, Gamber RG, Russo DP.
Department of Family Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center at Fort Worth, 76107-2644, USA.
[email protected]
Previous research has found that patients of osteopathic physicians tend to report poorer general health perceptions than persons in the general population or than patients of allopathic physicians. Quality of life and level of healthcare satisfaction in patients referred to a specialty clinic for osteopathic manipulative treatment (OMT) at a college of osteopathic medicine were measured in 1997. Data from the Medical Outcomes Study 36-Item Short Form (SF-36) were used to compute standardized scores in the following eight health scales: physical functioning, role limitations because of physical problems, bodily pain, general health perceptions, vitality, social functioning, role limitations because of emotional problems, and mental health. There were 185 patients who returned the survey (mean response rate, 90%), including 22 new and 163 established patients. Patients reported poorer health than the general population on all eight scales (P < .001). Patients frequently reported poorer quality of life than referents with hypertension, congestive heart failure, type 2 diabetes mellitus, recent acute myocardial infarction, or clinical depression. More than 97% of established patients were satisfied or very satisfied with the healthcare received at the clinic. This study suggests that referred patients presenting to osteopathic physicians for OMT may have poorer quality of life than is generally recognized when relying only on traditional diagnostic approaches. Early detection and treatment of musculoskeletal conditions may be important factors in preventing chronicity and its impact on quality of life.
