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Review as guest. Osteopathic Techniques. Add to cart. Add to Favorite. Gustowski Seals Gentry. Publication Date:.
Sacroiliac joint pain provocation tests, procedures intended to reproduce the patient's familiar pain by stressing the sacroiliac joint and thus implicating it as a pain generator, were used by just over half the respondents. The most popular test, the active straight leg raise, is rarely referred to in the osteopathic literature, and some respondents may have confused it with the straight leg raise for nerve root irritation.
ASIS compression performed in a similar way to the motion test but intended to provoke the complaint was also reportedly used by nearly half of respondents. These two tests are rarely mentioned in osteopathic texts, but their reliability and validity are supported by the scientific literature [ 30 , 31 ]. Given these circumstances, it is interesting that they are used by a substantial proportion of respondents. An Australian survey of osteopaths found a comparable use of pain provocation tests [ 17 ], which suggests that both groups use a pragmatic approach to patient care that includes procedures other than those typically recommended by the profession.
Female respondents reported more frequent use of soft tissue technique, muscle energy, and strengthening exercises for treatment of the spine and pelvis, whereas male respondents more frequently used HVLA. Similarly, Johnson et al [ 14 ] found that female respondents were more likely than men to use indirect techniques.
These gender preferences may reflect the physical strength required to perform direct techniques, such as HVLA. Alternatively, it is possible that the patient populations seen by male and female practitioners are different, and that the patients seen by female practitioners who may comprise more women and children may prefer and request more gentle treatment approaches. While most respondents in the present study reported that they document physical findings and the type of OMT delivered, a substantial minority do not frequently document their findings or treatment.
This represents a potential concern for the profession given the importance of maintaining accurate records of treatment, particularly in the event of adverse reactions or litigation. The common use of the Fryette spinal model explains the documentation of somatic dysfunction using this model's positional notation. Most respondents bill for OMT and use a modifier. By using the modifier, both the patient visit and OMT can be billed at the same visit, providing an economic incentive for OMT use.
These findings suggest a healthy amount of business savvy amongst this group and an awareness of efficient billing practices for OMT. Respondents reported a low use of diagnostic imaging prior to OMT, which is consistent with current guidelines that state plain imaging is of little use for non-specific spinal pain [ 32 ]. This study has a number of limitations.
The response rate to the survey was relatively low and generalizing these results to the entire AAO membership may be inappropriate. However, according to data provided by the AAO, the demographics of the sampled respondents closely reflect the membership as a whole. No information was available on years of practice experience for members of the AAO, but the comparisons above support the study sample as being representative of the entire membership.
Because the use of OMT is diminishing within the osteopathic profession, study respondents do not necessarily represent the broader profession.
Additionally, due to the relatively low response rate for the survey, a sample bias may favor more computer savvy respondents. Those practitioners who did not respond to the email invitation or did not have an email address listed with the AAO may potentially have been less proficient in newer methods and, thus, have different treatment preferences.
Therefore, caution is necessary when generalizing the results to the membership of the AAO even though similar demographics support this group as representative. Researchers have recommended email and web-based surveys as holding great promise as a fast, inexpensive medium for health research, but comparisons between survey delivery methods have so far demonstrated a greater response rate to postal surveys [ 33 , 34 ]. A combined postal and email survey would likely have improved the response rate, and this method should be considered for future surveys until the time the growing internet culture favors a better response rate for electronic distribution.
It should be understood that this study surveyed what respondents said they did in practice and was not a snapshot survey or a record of what approaches respondents actually used in practice. The responses are therefore subject to recall bias of the practitioners. Although requiring more resources, a snapshot survey is a worthwhile addition for future studies to provide a more accurate indication of technique preferences in the practice setting.
Although the intention of this study was to determine what treatment approaches osteopathic physicians use, a review of the validity and reliability of these approaches may provide additional context for interpreting study results. For instance, few procedures for segmental dysfunction — with the exception of palpation for tenderness and pain provocation — have acceptable interobserver reliability [ 33 ].
For assessment of pelvic and sacroiliac dysfunction, landmark asymmetry and tests that assess sacroiliac motion have been criticized for poor reliability and lack of validity [ 31 , 34 - 36 ]. While cranial approaches for the diagnosis and treatment of the spine and pelvis were favored by study respondents, their use is debated within the profession, with criticisms ranging from the biological plausibility of the concept to the lack of examiner reliability and outcome studies [ 37 , 38 ].
Using the results from this study, which provides information about tests that are in common use, future studies could be designed to improve the reliability of these procedures. Alternatively, the osteopathic profession may want to reconsider the use of these tests. Osteopathic physician members of the AAO who responded to our web-based survey reported using a broad range of osteopathic diagnostic and treatment methods. Their responses were consistent with the Fryette spinal model and Mitchell pelvic model, both commonly advocated by American osteopathic textbooks and educational institutions.
Respondents preferred soft tissue treatment approaches for both spinal and pelvic dysfunction, as well as cranial approaches. The strong inclination for cranial techniques was higher than reported in previous American and international studies and may reflect the preferences of osteopathic physicians who specialize in OMT. GF is an associate member of the American Academy of Osteopathy.
GF devised the research concept and design, developed the survey instrument, implemented the survey, assisted in analysis of data, and wrote the manuscript. CM assisted with survey development and writing of the manuscript. JJ assisted with research concept and design, analyzed the data, and assisted with writing the manuscript. The authors would like to thank the American Academy of Osteopathy for their assistance with distribution of this survey and the AAO members who participated in this study.
National Center for Biotechnology Information , U. Osteopath Med Prim Care. Published online Apr Author information Article notes Copyright and License information Disclaimer.
Corresponding author. Gary Fryer: ude. Received Dec 24; Accepted Apr This article has been cited by other articles in PMC. Abstract Background Osteopathic manipulative medicine texts and educators advocate a range of approaches for physical assessment and treatment, but little is known about their use by osteopathic physicians in the United States.
Handbook of Osteopathic Technique
Methods A web-based survey using a 5-point Likert scale was developed and e-mailed to practicing osteopathic physician members of the American Academy of Osteopathy. Conclusion Respondents reported the use of a broad range of assessment and treatment approaches. Background Osteopathic practice typically involves a holistic, multidimensional approach to patient care and may include consideration of emotional, psychobehavioral, environmental, ergonomic, and biomechanical issues.
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Methods The subjects of this study were practicing AAO physician members. Open in a separate window.
Osteopathic Manipulation for Low Back Pain
Figure 1. Procedures used to identify spinal somatic dysfunction. Figure 2. Figure 3. Figure 4.