Evidence Base of Osteopathic Medicine Lecture Flashcards
Definitions of OMM Research
AOA Bureau of Research:
- “Investigator has to state relevance of proposed project to Osteopathic philosophy and principles, theories, mechanisms or practice”
Contributions
- Louisa Burns, DO
- J. Stedman Denslow DO
- Irvin M. Kor PhD
- William L. Johnston DO
Louisa Burns DO
- 50 years devoted to Osteopathic Research
Louisa Burns DO, 1870 - 1958:
- Pioneer career Osteopathic Researcher
- Director, AT Still Research Institute 1917 - 1935
- Paid as AOA researcher until 1950
- Experimentally induced SPINAL FIXATIONS in animals and then noted the effects of these lesions on BRAIN, HEART, GI, REPRODUCTIVE ORGANS, LUNGS, KIDNEYS (S-V Reflexes)
- V-S Reflexes
Wilbur Cole, DO
- Studied with Dr. Burns 1948-1950
- Reproduced her Experiments and Data
- INTERNAL VALIDATION
J.S. Denslow, DO (1960 - ?)
- Did numerous studies documenting and quantifying muscle, muscle reflex, and autonomic changes in areas of Somatic Dysfunction (“Ostoepathic Lesion”)
- “Reflex Activity in the Spinal Extensors”, utilized EMG. palpation correlation: documented spinal muscle reflex changes in areas of Osteopathic Lesions
- Standard Terminology Proponent
- Facilitation of Spinal Cord
I.M. Korr, PhD (1909- 2004)
- Performed studies documenting changes in GALVANIC SKIN RESISTANCE as a result of disturbances in Autonomic Function, in areas of skin of subjects associated with palpatory findings of Somatic Dysfunction
- AXOPLASMIC FLOW and the Trophic function of Nerves
- Facilitation of Spinal Cord (With Denslow)
- SYMPATHETICOTONIA!!!!!!!
- Promoted entire DO- Patient Interaction as RESEARCH PARADIGM, not just OMT
- “The SECOND GREAT PHILOSOPHER os Osteopathic Medicine”
- Took Still’s Anatomical foundation and added PHYSIOLOGICAL FUNCTION to it!
Willing L. Johnston, DO, FFAO (1921 - 2003)
- Reliability Studies
- Validity Studies
- VISCEROSOMATIC REFLEXES
DO vs MD Care
1) 1918: Spanish Influenze Epidemic
2) 1932: Unit II L.A. County Osteopathic Hospital
3) 1999: NEJM- LBP RCT
Influenza Epidemic 1918
n = 110, 120
2445 DOs
MEDICAL CARE:
a) Overal Mortality:
- 5%
b) Mortality with Pneumonia Complication:
- 30-60%
OSTEOPATHIC MANIPULATION:
a) Overal Mortality:
- 0.25%
b) Mortality with Pneumonia Complication:
- 10%
LA County Osteopathic Hospital (Unit II)
- MD Unit (“Unit I”) had 3574 beds
- DO “Unit II” had only 196 beds (1928)
- Every 10th patient was assigned to Unit II
- But DOs saw one-seventh of total # of patients (Many patient transferred over
- DOs delivered 1/3 of the OB patients
- “Unit II” in 1928 has 6,000 inpatients per year
- 200 outpatients per day
LA County General Hospital 1933
- 46,464 inpatient annually
- 518,377 outpatients
- Third largest hospital in the Country
LA County General Hospital (OSTEOPATHIC) 1933
- 210 average inpatient per day
- 365 ambulatory patients/ day
- 715 admissions per month
- 126 Births per month
- 37 Deaths per month
- 682 discharges per month
LA County Hospital DO vs MD Care 1930-32
MD + DO:
- 9.7% Mortality
- 16 days average LOS
- 14% Coroner’s cases
DO ONLY:
- 5.53%
- 9.7 days average LOS
- 14% Coroner’s cases
Comparison of Osteopathic Spinal Manipulation with Standard Care for Patients with Low Back Pain, 1999 ANDERSSON G!!!!
- “At least 3 weeks but less than 6 months”
- 20 to 59 years old, 155 patients
- Variety of techniques, including Thrust, Muscle Energy, Counterstain, Articulation, and Myofascial Release
- Standard care vs Osteopathic manipulation plus Standard Care
Osteopathic Spinal Manipulation + Standard Care for Subacute LBP- ANDERSSON NEJM 11/4/1999
OMT + PT + Meds:
a) n:
- 83
b) NSAIDS:
- 24%
c) M. Relax:
- 6%
d) PT:
- 0.2%
MD + PT + Meds:
a) n:
- 72
b) NSAIDS:
- 54%
c) M. Relax:
- 25%
d) PT:
- 2.6%
