Research is vital to assess the efficacy of osteopathic treatment and further a knowledge base on which to enhance patient care and rational osteopathic practice.
Osteopathic research has grown in recent years, spurred on in part by the annual International Conference of Osteopathic Research that started ten years ago, and whose proceedings are printed in the International Journal of Osteopathic Medicine. A research ethos is encouraged in the undergraduates at the osteopathic colleges.
To help establish an evidence base the GOsC has helped to establish and part fund the National Council for Osteopathic Research (NCOR). This is an independent body, whose remit is to encourage and develop a research culture within the field of osteopathy.
The NCOR consists of representatives from GOsC, the osteopathic educational institutions, the British Osteopathic Association,(www.osteopathy.org) the NHS and private practitioners. It is chaired by Professor Ann Moore who is Director of the Clinical Research Centre forHealthProfessions (www.brighton.ac.uk/sohp/research/) at the University of Brighton. It has established research hubs throughout the UK where practicing osteopaths assemble to discuss and help implement research projects. For further information contact the Research Development Officer for NCOR or visit their website at www.ncor.org.uk.
EUROPEAN GUIDELINES FOR THE MANAGEMENT OF CHRONICNON-SPECIFIC LOW BACK PAIN
Summary of the concepts of treatment of chronic low back pain (CLBP)
• Conservative treatments:Cognitive behavioural therapy, exercise therapy, brief educational interventions,and multidisciplinary (bio-psycho-social) treatment can each be recommendedfor non-specific CLBP. Back schools, and short courses of manipulation canalso be considered. The use of physical therapy (TENS, heat/cold, traction,laser, ultrasound, short wave, interferential, massage, corsets) cannot be
EUROPEAN GUIDELINES FOR THE MANAGEMENT OF ACUTE NONSPECIFIC LOW BACK PAIN IN PRIMARY CARESummary of recommendations for treatment of acute non-specific low back pain:
Consider (referral for) spinal manipulation for patients who are failing to return to normal activities
The musclulo-skeletal services framework. Published by the DOH in 2006 which suggests developing capacity in primary care including osteopathy.Welsh Back CampaignTaken from www.welshbacks.com Advice for health professionalsManagement of acute mechanical low back painIf failing to return to normal activities: Reassess to exclude serious pathology • Consider a short course of manipulation • Address beliefs/behaviours that may be delaying recovery Designed for People with Chronic Conditions Service Development and Commissioning Directives Chronic Non-Malignant Pain 4.4 Effective acute pain managementPossible solution:An example of how primary care could provide for early identification and management of red and yellow flags would be an acute back pain clinic. People with acute back pain could present for assessment, simple advice and treatment according to the evidence based guidelines. These centres could be run by appropriately trained nurses, physiotherapists, osteopaths and chiropractors. They could operate on a 6 treatment basis in liaison with the GP who could then seek other treatment avenues should ongoing treatment be required. 1. Systematic reviews and meta-analysis In 2005 a meta-analysis of osteopathic manipulative treatment for LBP was carried out.Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials BMC Musculoskeletal Disorders 2005, 6:43 doi:10.1186/1471-2474-6-43 Results: Overall, OMT significantly reduced low back pain (effect size, -0.30; 95% confidence interval, -0.47 – -0.13; P = .001). Stratified analyses demonstrated significant pain reductions in trials of OMT vs active treatment or placebo control and OMT vs no treatment control. There were significant pain reductions with OMT regardless of whether trials were performed in the United Kingdom or the United States. Significant pain reductions were also observed during short-, intermediate-, and long-term follow up.
Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. Spine J. 2004 May-Jun;4(3):335-56.
cONCLUSIONS: Our data synthesis suggests that recommendations can be made with some confidence regarding the use of SMT and/or MOB as a viable option for the treatment of both low back pain and NP.Non pharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007 Oct 2;147(7):492-504.CONCLUSIONS: Therapies with good evidence of moderate efficacy for chronic or subacute low back pain are cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation.
British School of Osteopathy
journal PublicationsAbbey, H. (2008). ‘Assessing Clinical Competence in Osteopathic Education; analysis of outcomes of different assessment strategies at the British School of Osteopathy.’ International Journal of Osteopathic Medicine, 11 (4): 125-131.Brownhill, K. (2007). ‘Back pain and the homoeostatic requirements of the spinal system.’ International Journal of Osteopathic Medicine, 10 (1): 18-23.London, S. (2008). ‘The assessment of clinical practice in osteopathic education: Is there a need to define a gold standard?’ International Journal of Osteopathic Medicine 11 (4): 132-136.Parsons, S, Breen, A, Foster, N, Letley, L, Pincus, T, Vogel, S & Underwood, M. (2007). ‘Prevalence and comparative troublesomeness by age of musculoskeletal pain in different body locations.’ Family Practice 24 (4):308-16.Pincus, T, Santos, R et al. (2007). ‘Depressed cognitions in chronic pain patients are focused on health: evidence from a sentence completion task.’ Pain 130 (1-2): 84-92.Pincus, T, Ruso, A & Santos, R. (2008). “Responsiveness and construct validity of the Depression, Anxiety and Positive Outlook Scale (DAPOS)” Clinical Journal of Pain. 24 (5):431-7.Pincus, T, Santos, R, Breen, A, Burton, K & Underwood, M. (2007). “A review and proposal for a core set of factors for prospective cohorts in low back pain; the MMICS Statement.” Arthritis Care & Research, Arthritis and Rheumatism 28; 59 (1):14-24.Tyreman, S. (2007). ‘It's Illness, But Is It Mental Disorder?’
Philosophy, Psychiatry & Psychology – 14 (2): 103-106.Tyreman, S. (2008). ‘Valuing osteopathy: What are (our) professional values and how do we teach them?’ International Journal of Osteopathic Medicine 11 (3): 90-95.Tyreman, S. (2008). ‘Commentary on Is there a place for science in the definition of osteopathy?’ International Journal of Osteopathic Medicine 11 (3): 102-105.Zamani, J, Vogel, S, Moore, A & Lucas, K. (2007). ‘Analysis of exercise content in undergraduate osteopathic education - A content analysis of UK curricula.’ International Journal of Osteopathic Medicine 10 (4): 97-103.
Published journal paper reviews
Abbey, H. (2008). ‘Psychosocial predictors of chronicity in low back pain’ International Journal of Osteopathic Medicine, 11 (1): 34-38.Abbey, H. (2008). ‘Who uses CAM in Canada for back pain?’ International Journal of Osteopathic Medicine, 11 (3): 114-119.Abbey, H. (2008). ‘Psychosocial differences between acute and chronic low back pain patients’ International Journal of Osteopathic Medicine, 11 (3): 114-119.Abbey, H. (2008). ‘Do beliefs about back pain relate to pain experiences and contact with health professionals in Norway?’ International Journal of Osteopathic Medicine 12 (1): 1-5. (In press)Abbey, H. (2008). ‘Who gets what? A new screening tool to identify patient subgroups for back pain treatment allocation in primary care’ International Journal of Osteopathic Medicine 12 (1): 1-5. (In press)Blanchard, P. (2008). ‘Orthopaedic tests of the shoulder – are they accurate?’ International Journal of Osteopathic Medicine, 11 (2): 71-75. Blanchard, P. (2008). ‘Referred and nerve root pain arising from the low back – are they two distinct entities?’ International Journal of Osteopathic Medicine, 11 (2): 71-75. Blanchard, P. (2008). ‘Are there predictive rules for the development of adverse events following chiropractic care for patients with neck pain?’ International Journal of Osteopathic Medicine 12 (1): 1-5. (In press)Evans, D. (2008). ‘Persistent sciatica creates widespread sensitivity to further noxious stimuli’ International Journal of Osteopathic Medicine, 11 (1): 34-38.Evans, D. (2008). ‘Persistent neck pain – what hurts and where?’ International Journal of Osteopathic Medicine, 11 (3): 114-119.
Morrison, R. (2008). ‘Physiotherapy education: using simulated patients an evidence-based model’ International Journal of Osteopathic Medicine, 11 (3): 114-119.Parry, C. (2008). ‘The role of red flags in musculoskeletal pain presentations’ International Journal of Osteopathic Medicine, 11 (1): 34-38.
Parry, C. (2008). ‘Night pain in back pain triage: what is its significance?’ International Journal of Osteopathic Medicine, 11 (1): 34-38.Pincus, T. (2008). ‘Pain, ethnicity, race and culture: more research needed’ International Journal of Osteopathic Medicine 12 (1): 1-5. (In press)Tyreman, S. (2008). ‘Influence of a postgraduate clinical master’s qualification in manual therapy on the careers of physiotherapists in the United Kingdom’ International Journal of Osteopathic Medicine, 11 (1): 34-38.Vogel, S. (2008). ‘Adverse events round up’ International Journal of Osteopathic Medicine, 11 (2): 71-75. Zamani, J. (2008). ‘What influences physiotherapists to undertake Masters Level Study?’ International Journal of Osteopathic Medicine 12 (1): 1-5. (In press)
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