Evidence Based OMT Flashcards
Types of research used in osteopathic medicine
1) inter-examiner reliability
2) standardized technique/treatment protocols effectiveness
3) Chart review
Challenges and Limitations
- availability and accessibility to patient records
- sham effect (light touch) vs. placebo
- number of patients, number of sites
- examiner’s skills/experience level
- funding sources
- recruitment of patient population
- what techniques to use
- how many treatments and for how long
Early accomplishments in OMM research
“facilitation”- viscerosomatic and somatovisceral reflex
- reliability of examiners and treatment protocol
- standardization of terminology and measurements
How were metabolic processes studied?
- techniques used to evaluate the effect on the immune systems
- lymphatic pump techniques
- which inflammatory markers or other blood components were used in the study
Diseases processes
- Acute Otitis Media (AOM)
- Pneumonia
AT Still MD DO function as a reasearcher
- observed, studied, questioned, constructed testable hypotheses
- knowledge of current research on OMM come from basis of his questioning
What did the AOA do in 1909?
-formed the AT Still research institute with $16,000
What kind of research was encouraged at the COMs in the first 1/3 of the 1900s?
- neural and physiologic aspects of somatic dysfunctions
- effects of OMT on symptoms and immune function
- effects formed the basis of the lines of study still used currently
Who helped progress the growth in research in the 1940s?
Denslow and Korr as they started working on facilitated segment
Why were DOs much busier after WWII
many MDs were deployed overseas
What happened in 1950s that brought controversy in California?
- merger issues
- made the 1960s a fight for survival of the osteopathic profession and not be absorbed into the AMA
- missed out on early research expansion
What 5 schools remained after the merger?
Kirksville, Chicago, KC, Philadelphia, Des Moines
When did the expansion of new schools begin?
1970-2000
What occurred during the expansion of new schools?
- outside sources began funding osteopathic research
- residency programs began requiring research projects adding the evidence base
Where were funds established for a research center?
Texas School of Osteopathic Med (ORC)
What formed after the ORC?
AT Still University Research Institute
What is seen in research 2008 to present?
- expanding research in US and around the world
- more multidisciplinary cooperation in projects and symposiums
Who are early researchers in Osteopathic Med?
Louisa Burns Wilbur Cole J Stedman Denslow Irvin M. Korr William Johnston
First person to dedicate career to OMM research
Louisa Burns
Experimentally induced spinal fixations in animals and noted effects of these lesions on brain, heart, GI, reproductive organs, lungs, kidneys
Louisa Burns
Founded the AT Still Research University in 1914
Louisa Burns
Director AT Still Research Institute 1917-1935
Louisa Burns
Who studied with Dr. Burns in 1948-1950
Wilbur Cole
Published numerous articles and served as Bureau of Research for the AOA
Wilbur Cole
Graduated from Kirksville, joined staff if KCOC in 1951
Wilbur Cole
Who advocated for use of scientific instruments and measurements for the validation of osteopathic clinical findings and outcomes?
John Stedman Denslow
Studies somatic dysfunction using EMG
John Stedman Denslow
Became director of Kirksville and mentored Irwin Korr
John Stedman Denslow
Physiologist in Kirksville 1945
Irvin Korr
Proposed facilitated treatment of spinal cord and trophic functions of nerves
Irvin Korr
Studied how emotional states can escalate the impact of increased sympathetic tone
Irvin Korr
Remembered as a philosopher and visionary of osteopathic research
Irvin Korr
Who completed the best inter-examiner reliability studies to date?
William Johnston
Why were the inter-examiner reliability studies successful?
- examiners worked together for extended periods of time to ensure they were able to attend to the same palpatory cues
- palpatory procedures were carefully considered for their simplicity
- palpatory cues were simplified to ensure reliability of the recorded findings
What 3 things were Dr. Johnston noted for?
- reliability studies
- validity studies
- viscerosomatic reflexes
Some challenges to researching OMM
- “objective: findings can only be appreciated by a subjective experience
- variability in skills of those applying OMM
- resources required to administer OMM to enough patients to achieve a well powered study
- RTC work well for studying a small number of known variables that are easily measured
Special Considerations in Osteopathic Manipulation Research
- blinding examiners
- control grou
- placebo vs sham vs light touch groups
- number of “arms” in the study
- size (n) and drop out rate
- inclusion criteria
- dependent variables
Current areas of Osteopathic research
- clinical outcome based
- inter-examiner reliability
- safety (tolerance)
- cost effective of OMM
Current areas of Osteopathic research: Clinical Outcomes
AOM in Peds
Chronic Sinusitis
Pneumonia
Current areas of Osteopathic research: Inter-examiner reliability
Inter-examiner
Inter-observer
Inter-rater
Current areas of Osteopathic research: safety (tolerance)
Pregnancy
Rib Raising
Current areas of Osteopathic research: Cost effective
- cost effectiveness of OMM (secondary benefits of healthcare)
- decreased length of hospital stay, duration of antibiotic use, etc.
- cost savings to healthcare systems
