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International Journal of Osteopathic Medicine - Articles in Press
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International Journal of Osteopathic Medicine RSS feed: Articles in Press. The International Journal of Osteopathic Medicine is a peer-reviewed journal that provides for the publication of high quality
research articles and review papers that are as broad as the many disciplines that influence and underpin the principles and practice
of osteopathic medicine. Particular emphasis is given to basic science research, clinical epidemiology and health social science in
relation to osteopathy and neuromusculoskeletal medicine. The Editorial Board encourages submission of articles based on both quantitative
and qualitative research designs. The Editorial Board also aims to provide a forum for discourse and debate on any aspect of osteopathy
and neuromusculoskeletal medicine with the aim of critically evaluating existing practices in regard to the diagnosis, treatment and management of patients with neuromusculoskeletal disorders and somatic dysfunction. All manuscripts submitted to the IJOM are subject
to a blinded review process. The categories currently available for publication include reports of original research, review papers,
commentaries and articles related to clinical practice, including case reports. Further details can be found in the IJOM Instructions
for Authors. Manuscripts are accepted for publication with the understanding that no substantial part has been, or will be published
elsewhere.
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Is the methodological quality of trials on spinal manipulative therapy for low-back pain improving? - Corrected Proof
Abstract: Background: Spinal manipulative therapy (SMT) is an intervention practiced worldwide by a variety of professionals. Numerous randomized controlled trials (RCTs) have examined the effectiveness of SMT; however, interpretation of those treatment effects can be hampered by a high risk of bias and poor reporting as well as small sample sizes.Objective: To provide a descriptive overview of RCTs on SMT for low-back pain as well as an analysis of the trends with time in relation to risk of bias and sample size.Methods: Descriptive data on 61 RCTs of SMT for low-back pain were extracted. RCTs published prior to March 31, 2011, which fulfilled the inclusion criteria, were included. Publication date of the individual RCTs was used in the analyses. Linear regression was conducted to test trends in sample size; however, trends in risk of bias was not formally tested due to insufficient data.Results: Of the included RCTs, SMT was delivered by either a chiropractor or manual therapist in most (68%), and approximately half (49%) examined a high-velocity thrust. Sufficient data are available for the outcomes, pain and functional status, but lacking for other outcomes. Overall, 28% of the RCTs met the criteria for a low risk of bias and the median sample size for SMT (interquartile range) was 60 (34, 90). There is a positive trend over time in studies with a low risk of bias, in addition to improvements in reporting of specific items related to selection bias and selective reporting bias as well as intention to-treat. Despite this trend, many items were fulfilled by less than half of the studies published in the last decade. In addition, there is a trend towards larger studies for SMT as the intervention, although this also demonstrates variation with time.Conclusions: The continuing uncertainty regarding the effect of SMT for low-back pain is hampered by too many studies with a high risk of bias, which in some cases, are too small to detect clinically-relevant differences. It is our wish that the lessons learned from this analysis be applied in the design of future trials of SMT as well as other non-pharmacological therapies.
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Reconsidering the patient-centeredness of osteopathy - Corrected Proof
Abstract: The widespread use of the biopsychosocial model amongst various health professions, all of which claim to take a patient-centred approach to their practise, challenges what has been considered a unique and defining feature of osteopathy. This paper discusses the complexity of what is meant by patient-centeredness, and how it is practised and researched by other health professions. The assumption that osteopathy has always taken a patient-centred approach is questioned, and directions for further research are highlighted so that the profession can have a comprehensive working knowledge of its practise, thereby helping to define itself within the broad and competitive healthcare environment.
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Consent, competence and confidentiality for children and young people: Case problems from osteopathic practice - Corrected Proof
Abstract: Consent and confidentiality are important elements of osteopathic care, but for children and young people these issues are often more complicated. The ethics and law of consent and confidentiality for children are different from adults and they are often contradictory and counterintuitive. We present four clinical scenarios drawn from clinical experience to help illustrate the common difficulties of competence, consent and confidentiality for children. These include: an 11 year old boy consenting for himself; a 13 year old girl who discloses that she is sexually active; a 5 year old boy presenting with his father; and a 15 year old boy who requests information is not shared with his mother. Each case is followed by questions relating to the case, and the essential points of competence, consent and confidentiality for children and adolescents are discussed. In osteopathy all children who are mature enough to understand the diagnosis and osteopathic treatment and make reasoned decisions about their care should be considered Gillick competent and be able to consent to treatment, refuse treatment, and have a right to confidentiality.
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Pudendal nerve entrapment in a bareback rodeo cowboy: A case study - Corrected Proof
Abstract: The case of a 31 year-old bareback rodeo cowboy who suffered from pelvic floor pain and spasm is presented. The clinical care pathway for this case was not simple and in fact, misdiagnosed for months prior to seeking the care of an osteopathic manual therapist. The pelvic floor muscle spasm was presumably caused by pudendal nerve entrapment even though there were no diagnostic tests such as EMG to confirm it. The entrapment was thought to be from the abdominal viscera (mesentery and sigmoid colon) being adhered to peritoneal tissue in the small pelvis. Treatment consisted of four consecutive days of osteopathic manual therapy treatment due to special patient availability and circumstances. The treatment focused on a release of the root of the mesentery and ischial intraosseous lesions, the release of the sigmoid colon from posterior abdominal wall and iliopsoas muscle, myofascial release of the thoraco-lumbar fascia, and myofascial release of pelvic floor musculature including balancing of three diaphragms, and harmonizing the primary respiratory mechanism within the cranial-sacral system. The etiology is thought to occur due to the sport's natural ptosis forces on the viscera. The patient returned to bareback riding without any issue and on follow-up five years later, did not report any symptoms.
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Research and treatment bulletin - Corrected Proof
Brett Vaughan, Osteopathy Unit, Victoria University, Melbourne, Australia. At present, whilst the prevalence of cervical spine pain in the general population is high, the current Cochrane reviews for management of cervical spine complaints do not report a single ideal approach to managing these problems. Continuing the investigations around the use of manual therapy for acute and subacute neck pain, Bronfort et al. conducted a randomised controlled trial to determine if spinal manipulation is more effective than medication or home exercise (combined with advice).1
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Application of osteopathic manipulative treatment to a patient with unremitting chest pain and shortness of breath undergoing ?Rule-Out Myocardial Infarction? protocol for one week - Corrected Proof
Abstract: Chest pain and shortness of breath are both common complaints of patients presenting to an emergency room (ER) or urgent care facility. A 67-year-old married white female was seen in the ER complaining of chest pain and shortness of breath. Our education and training has us admit these patients where they may be monitored and assessed according to protocols developed to rule-out serious etiologies. Accordingly, the patient was admitted to the cardiac care unit and placed on the ?Rule-Out Myocardial Infarction? protocol. The patient?s symptoms persisted despite adherence to rigorous diagnostic and therapeutic regimens and which stymied attempts to arrive at a definitive diagnosis and provide care. The case presented here demonstrates how an osteopathic approach can enable us to provide appropriate care and resolve some problems that appear to be otherwise unremitting. There is potential for savings in terms of actual costs and utilization of resources. The use of an osteopathic structural exam identified an abnormality that could be easily treated with Osteopathic Manipulative Treatment (OMT), which completely resolved the patient?s presenting complaints. Had this been done earlier in the course of managing this patient, preferably as part of the admission work-up, the patient?s confinement would have been drastically reduced, and repeated expensive tests would not have had to have been performed. The application of OMT to reducing patient morbidity is instructive of the efficacy of the osteopathic approach in this case and suggests that further research is warranted.
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A consideration of the elbow as a tensegrity structure - Corrected Proof
Abstract: The elbow is conventionally described as a uniaxial hinge joint and the pivot of proximal forearm rotation; the joint surfaces guide motion, the ligaments maintain joint integrity and the muscles cause motion. However, this simplicity is less clear on detailed examination and masks uncertainties over its component structures and their functions.Elbow anatomy is examined from a tensegrity perspective with a re-assessment of these functions. Tensegrity structures, like the elbow, are inherently stable and maintain a balanced equilibrium during changes in shape because of ?continuous tension?. Connective tissues mechanically integrate local and distantly related components into a single functional unit while proprioceptive sensors neurally influence motor activity; both control joint dynamics.It is suggested that this has relevance to understanding the commonly encountered but vague pathologies such as ?tennis elbow? and ?repetitive strain injury?; the aetiologies of these conditions continue to be the subject of debate.
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[R-DO.org]
