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OS > Evidence Base of Osteopathic Medicine Lecture > Flashcards

Evidence Base of Osteopathic Medicine Lecture Flashcards

1
Q

Definitions of OMM Research

A

AOA Bureau of Research:

  • “Investigator has to state relevance of proposed project to Osteopathic philosophy and principles, theories, mechanisms or practice”
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2
Q

Contributions

A
  • Louisa Burns, DO
  • J. Stedman Denslow DO
  • Irvin M. Kor PhD
  • William L. Johnston DO
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3
Q

Louisa Burns DO

  • 50 years devoted to Osteopathic Research
A

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
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4
Q

Wilbur Cole, DO

A
  • Studied with Dr. Burns 1948-1950
  • Reproduced her Experiments and Data
  • INTERNAL VALIDATION
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5
Q

J.S. Denslow, DO (1960 - ?)

A
  • 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
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6
Q

I.M. Korr, PhD (1909- 2004)

A
  • 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!
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7
Q

Willing L. Johnston, DO, FFAO (1921 - 2003)

A
  • Reliability Studies
  • Validity Studies
  • VISCEROSOMATIC REFLEXES
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8
Q

DO vs MD Care

A

1) 1918: Spanish Influenze Epidemic
2) 1932: Unit II L.A. County Osteopathic Hospital
3) 1999: NEJM- LBP RCT

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9
Q

Influenza Epidemic 1918

A

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%

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10
Q

LA County Osteopathic Hospital (Unit II)

A
  • 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
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11
Q

LA County General Hospital 1933

A
  • 46,464 inpatient annually
  • 518,377 outpatients
  • Third largest hospital in the Country
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12
Q

LA County General Hospital (OSTEOPATHIC) 1933

A
  • 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
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13
Q

LA County Hospital DO vs MD Care 1930-32

A

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
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14
Q

Comparison of Osteopathic Spinal Manipulation with Standard Care for Patients with Low Back Pain, 1999 ANDERSSON G!!!!

A
  • “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
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15
Q

Osteopathic Spinal Manipulation + Standard Care for Subacute LBP- ANDERSSON NEJM 11/4/1999

A

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%

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16
Q

OMT + Standard Care vs Standard Care of Subacute LBP

A

Results:
- Outcomes for patients were no different, except that the Osteopathic group required LESS medication and LESS PT

  • About 90% of the patients were satisfied with the care they received in BOTH GROUPS
17
Q

5 Clinical Trials- Metabolic Perspective

A

INFLAMMATION:

1) Pancreatitis
2) Ankle Sprain

Infection:

1) Pneumonia
2) Otitis Media
3) Spleen Pump

18
Q

OMT and Pancreatitis

RADJIESKI, JAOA 5/ 1998

A
  • Pilot study: 30 patients
  • Hospitilizated patients
  • Random Assignment: 1/2 OMT
  • General Joint Mobilization
    a) Hip, Shoulders
    b) Sacrum, Spine Ribs
  • Decreased Length of stay
  • Decreased Analgesic Use
  • Increased Patient Satisfaction
19
Q

OMT for Ankle Sprain

A

N = 55 adults with first or second degree Acute Ankle Sprain presenting to the Emergency Department

  • Randomized to OMT or Standard Care
  • Results: OMT Group had DECREASED Edema, Pain, and Increased Range of Motion
20
Q

Hospitalized Elderly with Pneumonia Standard Care +/- OMM

A

Experimental Group:
- 28 patients OMT + OMM specialist OMT Protocol

Control Group:
- 30 patients light non-specific touch for equal length of time as OMT (Sham)

***The Experimental Group had DECREASED IV Abx, All Abx, and LOS!!!!!!

21
Q

Otitis Media in Children

A

Subjects:
- 6 months - 6 y/o

  • Recurrent Otitis Media
  • 25 Standard Care plus OMT
  • 32 Control Standard Care ONLY

OMT GROUP HAD:

  • Fewer Episodes of AOM
  • Fewer Surgical Procedures
  • More mean Surgery-Free Months
  • Increased Frequency of Normal Tympanograms
22
Q

Spleen PUmp

A
  • 1934 Study re-analyzed
  • N = 100 Infected Patents
  • OMT Splenic Pump INCREASED Immune Cells Counts
  • Current Investigations are looking at cell labeling to Identify Immune Activation from Abdominal Pump OMT
23
Q

Special Consideratios in Osteopathic Manipulation REsearch

A
  • Blinding
  • Control
  • Placebo
  • Size, Power, Drop out Control
  • Inclusion Criteria
  • Dependent Variables- Measures
24
Q

OMM vs OMT

A
  • Series of OMT, Duration, Frequency, Order vs

- Just one Maneuver (L-Spine HVLA)

25
Q

Summary

A
  • These are but a few of the many individuals that have paved the way for future OMM Research
  • ORC
    - CONCORD: PBRN
  • Research Institutes:
    a) AT Still Research Institute (Kirksville)
    b) KCUMB developing Research Institutes
    • Human Performance and Biomechanics
    • Neurodegeneration and Aging
  • This profession needs Researchers to demonstrate quality Research on the Osteopathic to Health Care
  • Lots of opportunities to get Involved

OS (9 decks)

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