Considerations for an Osteopathic Approach to Rheumatoid Arthritis

The mission of the American Academy of Osteopathy (AAO) emphasizes "the integration of osteopathic principles, practices and manipulative treatment in patient care." Osteopathic manipulative treatment (OMT) can be used to address serious conditions affecting older persons (≥65 years). However, the percentage of osteopathic physicians who use OMT in older patients, the differences in conditions for which OMT is used, and the OMT techniques used in older patients compared with younger patients are unknown. To determine the use of OMT by osteopathic physicians in older patients compared with younger patients. Members of the AAO were invited, via 3 e-mail messages sent over the course of a 4-month period, to participate in an anonymous online survey. The survey asked physicians to report the percentage of patients by age group (<65 years, 65-79 years, and ≥80 years) to whom they provided OMT, the types of musculoskeletal and system-based conditions for which OMT was used, and the specific OMT techniques used. A total of 197 of 629 AAO members (31.3%) responded to the survey. Respondents indicated that OMT was used at approximately the same rate in all patients in the 3 age groups. Osteopathic manipulative treatment was frequently used to manage a variety of musculoskeletal conditions, with the exception of osteoporosis, in all patients in the 3 age groups. The system-based conditions most often managed with OMT were respiratory and neurologic conditions. Various OMT techniques were used to treat patients in the 3 age groups; however, high-velocity, low-amplitude (HVLA) was usually avoided in patients aged 65 years or older. Osteopathic physicians who used OMT in their practice administered OMT for a variety of musculoskeletal and system-based conditions in patients of all ages. Various OMT techniques were used by these physicians for patients of all ages, with the exception of HVLA, which was mainly used in patients younger than 65 years.

BackgroundPlacebo treatments should be believable to ensure expectation of benefit, yet not provide a true treatment effect. One obstacle to conducting clinical trials with osteopathic manipulative treatment (OMT) is choosing an appropriate placebo. Various placebo treatments have been used in OMT clinical trials. The purpose of this study was to determine expectations of 3 treatments (HVLA, placebo light touch, placebo sub-therapeutic ultrasound) commonly used in OMT clinical research trials.MethodsA randomized, cross-over design was utilized. Subjects were recruited from the Family Medicine Clinic, Texas College of Osteopathic Medicine. Participants watched a video with 2 minute demonstrations of a High Velocity Low Amplitude (HVLA), placebo light touch (LT), and placebo sub-therapeutic ultrasound (ULTRA) treatment for low back pain. The order of presentations was randomized to control for order effect bias. Subjects indicated the extent of their agreement (using a 4 point Likert scale) with 4 statements that were presented after each treatment was viewed: 1)I believe this treatment would allow me to get better quicker; 2)I believe this treatment would decrease my low back pain; 3)I believe this treatment would make me more able to do the things I want to do; 4)This seems like a logical way to treat low back pain. Repeated measures analysis of variance was performed, and a partial Eta squared was calculated for each statement. Effect sizes (Cohen's d) were calculated where appropriate.ResultsThirty of 40 eligible subjects participated. Twenty-two (73%) were female, 16 (53%) were Caucasian, and 11 (37%) had completed college. The mean age was 43 (SD = 15.). Repeated measures ANOVA revealed no significant differences for statements 2 and 4. For both statements 1 (p = 0.025) and 3 (p = 0.039), post hoc analysis revealed a difference between HVLA and LT. The partial Eta squared (ηp2) was 0.105, 0.072, 0.107, and 0.024 for each statement, respectively.ConclusionThere is a difference in treatment expectation between HVLA and LT for statements 1 and 3. Participants responded more positively after viewing the HVLA treatment than the LT treatment. This suggests that sub-therapeutic ultrasound is the better placebo because the expectations were similar to those for HVLA.

As one of the key measures of clinical skills assessment, the Comprehensive Osteopathic Medical Licensing Examination-USA Level 2-Performance Evaluation (COMLEX-USA Level 2-PE) is used to rate candidates' performance of osteopathic manipulative treatment (OMT). To evaluate the frequency of specific OMT modalities used by COMLEX-USA Level 2-PE candidates and to report frequent use on the basis of clinical presentation. With enhanced scoring procedures in place, OMT physician-examiners identified and documented specific OMT techniques that were performed by candidates at the 28 colleges of osteopathic medicine and branch campuses that had eligible students at that time. A frequency analysis for OMT techniques, according to clinical content axis, was applied to all candidates (N=4757) for the 2010-2011 testing cycle. Students used a wide range of specific OMT techniques. Candidates performed 24,202 instances of specific OMT techniques, including 10,471 myofascial/soft tissue (43.3%), 3942 muscle energy (16.3%), 1676 sinus drainage (6.9%), 1476 inhibition (6.1%), 1221 fascial release (5.0%), 1171 rib raising (4.8%), 918 lymphatic (3.8%), and 866 counterstrain (3.6%). A few students (<0.01%) used high-velocity, low-amplitude (HVLA), a technique that is prohibited from use on the COMLEX-USA Level 2-PE because of the potential hazard of repeatedly treating a standardized patient with thrust technique to the same segment in a given day. Additional techniques included functional, facilitated positional release, balanced ligamentous tension, and visceral. Use of techniques also varied according to the clinical presentation of the standardized patient (ie, cardiovascular, respiratory, neuromusculoskeletal, gastrointestinal, or other) and chronicity (ie, acute or chronic). Findings contributed to a better understanding of the types of OMT techniques being used by candidates taking COMLEX-USA Level 2-PE. Frequency of use of specific OMT modalities varied according to clinical case presentation.

Use of osteopathic manipulative treatment in management of intractable singultus and associated symptoms

Osteopathic manipulative medicine (OMM) is an adjunctive treatment approach available to geriatric patients, but few studies provide details about presenting conditions, treatments, and response to osteopathic manipulative treatment (OMT) in that patient population. To provide descriptive data on the presentation and management of geriatric patients receiving OMT at anoutpatient osteopathic neuromusculoskeletal medicine (ONMM) clinic. Data were retrospectively collected from electronic health records (EHR) at a single outpatient clinic for clinical encounters with patients over 60years of age who were treated with OMT between July 1, 2016, and June 30, 2019. Records were reviewed for demographic information, insurance type, presenting concerns, assessments, regions treated, OMT techniques used, and treatment response. There were 9,155 total clinical encounters with 1,238 unique patients found during the study period. More women than men were represented for overall encounters (6,910 [75.4%] vs. 2,254 [24.6%]) and unique patients (850 [68.7%] vs. 388 [31.3%]; both p<0.001). The mean (standard deviation, SD) number of encounters per patient per yearwas 4.5 (4.0) and increased with increasing age by decade (p<0.001). Medicare was the most common primaryinsurance (7,246 [79.2%]), with private insurance the most common secondary insurance (8,440 [92.2%]). The total number of presenting concerns was 12,020, and back concerns were most common (6,406 [53.3%]). The total number of assessments was 18,290; most were neuromusculoskeletal (17,271 [94.5%]) and in the thoracolumbar region (7,109 [38.9%]). The mean (SD) number of somatic dysfunction assessments per encounter was 5 (1.7); the thoracic region was the most documented and treated (7,263 [15.8%]). With up to 19 technique types per encounter, the total number ofOMT techniques documented across all encounters was 43,862, and muscle energy (7,203 [16.4%]) was the most documented. The use of high-velocity, low-amplitude (HVLA) declined as age increased (p<0.001). The overall treatment response was documented in 7,316 (79.9%) encounters, and most indicated improvement (7,290 [99.6%]). Our results showed that geriatric patients receiving OMT at our clinic were predominately presenting for neuromusculoskeletal concerns associated with back, neck, and extremity conditions, consistent with national epidemiological data for this population. The most common OMT techniques were also consistent with those used nationally by osteopathic medical students and practicing physicians. Future longitudinal studies are needed to determine the length of time improvement persists and the overall health impact experienced by geriatric patients receiving OMT.

Ehlers-Danlos syndrome (EDS) is a disorder affecting connective tissue throughout the body. Inherited through several different genetic mutations, the EDS symptoms of hyperextensibility, hypermobility, and fragility causesignificant somatic and visceral issues in those affected. Chronic somatic dysfunction, pain, and systemic involvement createlifelong comorbidities and discomfort for these patients. One in every 5,000 individuals is burdened with EDS worldwide; in the US, the range has been reported to be 1/2,500-1/5,000 people. Very few patients with EDS in the literature have been documented and treated with osteopathic manipulative treatment (OMT). The objective of this case report is to describe the response of an EDS patient to outpatient OMT over a series of three office visits. The patient has verbally consented to OMT at each encounter.A combination of soft tissue manipulation, muscle energy, Still's technique, counterstrain, and high-velocity low-amplitude (HVLA) was performed in the head and neck, thoracic, lumbar, ribs, and lower extremity regions. During the three clinic visits of this patient, OMT was performed in the same regions by the student physician under the supervision of the attending physician. At each visit, the patient was asked to report their pain levels pre- and post-treatment and assess symptom improvement using a one to 10 pain scale, as well as any subjective symptoms they are experiencing. Following each treatment, as well as at each follow-up encounter, the patient reported marked pain and symptom improvement. The objective of this case report is to describe the benefits that one patient experienced from three clinic visits. These results showed that subjective improvement in respiratory, gastrointestinal, and musculoskeletal symptoms secondary to the longstanding history of EDS may be possible through the use of OMT.

Background: Controlling a headache (HA) secondary to a subarachnoid hemorrhage (SAH) can be challenging for most physicians. At Maine Medical Center in Portland, Maine, the neurointensivist and staff noticed a trend in decreasing HA pain caused by a SAH in patients treated with osteopathic cranial manipulative medicine and osteopathic manipulative medicine (OMM), more so than those treated solely with the traditional opioid approach. It was requested that a chart review of these patients be evaluated for an objective analysis of this observation. Hypothesis: A decrease in HA caused by SAH will be observed in the group treated with OMM in comparison to those treated with opioids alone. Methods and Materials: A retrospective, IRB approved, and exempted study reviewed 21 subjects with a SAH that were treated with OMM. This population was analyzed for a decrease in pain score following osteopathic treatment as well as for adverse events 6-month post treatment. Results: Pain scores were consistently reduced when comparing pre-and-post OMM treatment. After the first treatment, pain scores decreased by an average of 4 points, after the second treatment scores decreased by an average of 3 points and after the third treatment pain scores decreased by an average of 2.5 points. The number of adverse events recorded were found to be less than the national averages. Conclusion: The use of OMM as an adjunct with traditional treatments for a SAH can lead to a decrease in HA pain caused by a SAH. Minimal adverse events were observed.

When choosing to incorporate osteopathic manipulative treatment (OMT) into a patient's care, the risk-to-benefit ratio, the choice of treatment technique, as well as the frequency of treatments are always taken into consideration. This has been even more important during the COVID-19 pandemic, in which social distancing has been the best preventative measure to decrease exposure. By increasing treatment intervals, one could not only limit possible exposure/spread of viruses but also decrease the overall cost to the system as well as to the individual. This is an expansion of a previous study in which quantifiable changes in cervical hysteresis characteristics post-OMT were documented utilizing a durometer (Ultralign SA201®; Sigma Instruments; Cranberry, PA USA). This study compared two treatment modalities, muscle energy (ME) and high-velocity low-amplitude (HVLA) postcervical treatment. Subjects in this study were allowed to re-enroll, provided that they could be treated utilizing the alternate treatment modality. By allowing repeat subjects, analysis of the data for lasting effects of OMT could be observed. To determine whether a significant change in cervical hysteresis would be observed after each treatment regardless of a short treatment interval. A total of 34 subjects were retrospectively noted to be repeat subjects from a larger, 213-subject study. These 34 subjects were repeat participants who were treated with two different direct-treatment modalities 7-10days apart. Each subject was randomly assigned to receive a single-segmental ME or HVLA treatment technique directed toward a cervical (C)segment (C3-C5 only). Subjects were objectively measured pretreatment in all cervical segments utilizing the Ultralign SA201®, then treated with cervical OMT to a single segment, and finally reassessed at all cervical levels with the Ultralign SA201® posttreatment to assess for change in cervical hysteresis. Statistically significant or suggestive changes (p-values 0.01-0.08) with good clinical effect size (0.30 or greater) were noted in all four components of the Ultralign SA201® at multiple cervical levels after the first treatment, but only one component (frequency) had a statistically significant change after the second treatment (AA cervical level, p-value 0.01) with good clinical effect size (0.45). However, when comparing the post-first-treatment values to the pre-second-treatment values, no statistically significant differences (p-value 0.10 or higher) were observed between them. Statistically significant changes were noted after the first treatment; however, when comparing cervical hysteresis changes after the first treatment to the cervical hysteresis values prior to the second treatment delivered 7-10days later, there were no statistically significant or suggestive changes. This data suggest that several post-OMT changes noted after the first treatment were still in effect and may indicate that follow-up visits for direct manipulation may be deferred for a least two weeks.

Cranial osteopathic manipulative medicine (OMM) involves the manipulation of the primary respiratory mechanism to improve structure and function in children and adults. To identify and critically evaluate the literature regarding the clinical efficacy of cranial OMM. The clinical keywords "cranial manipulation" OR "osteopathy in the cranial field" OR "cranial osteopathy" OR "craniosacral technique" were searched in the following electronic databases: EMBASE, MEDLINE In-Process & Other Non-Indexed Citations, The Cochrane Central Register of Controlled Trials, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and AMED (Alternative Medicine). Searches were conducted in April 2011 with no date restriction for when the studies were completed. Randomized controlled trials and observational studies that measured the effectiveness of cranial OMM on humans were included in the study. Exclusion criteria included non-English language articles, studies not relevant to cranial OMM, animal studies, and studies in which there was no clear indication of the use of cranial OMM. Studies that described the use of cranial OMM with other treatment modalities and that did not perform subgroup analysis were also excluded. The present study did not have criteria regarding type of disease. Outcome measures on pain, sleep, quality of life, motor function, and autonomic nervous system function were extracted. The methodological quality of the trials was assessed using the Downs and Black checklist. Of the 8 studies that met the inclusion criteria, 7 were randomized controlled trials and 1 was an observational study. A range of cranial OMM techniques used for the management of a variety of conditions were identified in the included studies. Positive clinical outcomes were reported for pain reduction, change in autonomic nervous system function, and improvement of sleeping patterns. Methodological Downs and Black quality scores ranged from 14 to 23 points out of a maximum of 27 points (overall median score, 16). The currently available evidence on the clinical efficacy of cranial OMM is heterogeneous and insufficient to draw definitive conclusions. Because of the moderate methodological quality of the studies and scarcity of available data, further research into this area is needed.

Dystonia is a movement disorder that causes involuntary muscle contractions leading to abnormal movements and postures, such as twisting. Dystonia is the third most common movement disorder in the United States, with as many as 250,000 people affected. Because of its complexity, dystonia presents a significant challenge in terms of management and treatment. Despite limited research, osteopathic manipulative treatment (OMT) has been considered as an adjunctive treatment due to its inexpensive and noninvasive nature, as opposed to other modalities such as botulinum toxin injections, deep brain stimulation (DBS), and transcranial magnetic stimulation, which are often expensive and inaccessible. OMT treatments performed in case studies and series such as balanced ligamentous tension/articular ligamentous strain (BLT/ALS), muscle energy (ME), high-velocity low-amplitude (HVLA), and myofascial release (MFR) have shown reduction of pain and muscle hypertonicity, including in patients with dystonia. The studies reviewed in this paper provide a snapshot of the literature regarding the current evidence of OMT's role for dystonia. A medical reference librarian conducted a thorough literature search across multiple databases including PubMed and Google Scholar to find articles relevant to the use of OMT for dystonia. The search employed a combination of Medical Subject Headings (MeSH) terms and keywords related to osteopathic medicine and dystonia to ensure precise retrieval of relevant articles within the last 20 years. Despite limited research on the topic, all four relevant reports found in the literature were selected for review. Of the four relevant reports, case series and studies highlighted the potential benefits of OMT in managing dystonia, particularly cervical dystonia and foot dystonia. OMT has shown promising results addressing pain, stiffness, and impaired motor function. In cases of foot dystonia in Parkinson's disease, OMT has helped improve gait and reduce pain by targeting somatic dysfunctions (SDs) associated with dystonia, such as abnormalities in foot progression angle (FPA) and musculoskeletal imbalances. Also, OMT has been found to alleviate symptoms of cervical dystonia, including tremors, muscle spasms, and neck stiffness. These interventions performed in case studies and series led to improvements in gait biomechanics in foot dystonia and overall symptom severity in patients with cervical dystonia. Currently, botulinum toxin, oral medications, physical therapy, and rehabilitation are commonly utilized in managing dystonia. The studies reviewed in this paper suggest that these treatments may lead to improvements in pain and muscle hypertonicity in patients with dystonia. It is important to investigate whether factors such as the type of dystonia (eg, focal vs. segmental) and its underlying cause (eg, idiopathic, trauma, infection, autoimmune, medication side effects) influence treatment outcomes. Further research is recommended to explore the role of OMT in managing dystonia.

Context: Doctors of Osteopathic Medicine (DOs) are physicians who are trained in the practice of osteopathic manipulative treatment (OMT). OMT is a form of manual manipulation that can be applied to the patient’s body to aid the body in its own healing properties. The overprescribing and overuse of medication is currently a problem, as it can result in adverse consequences such as antibiotic resistance. Exploring OMT as either an alternative or as a complementary therapy in the pediatric population is beneficial in potentially curbing antibiotic use and improving symptoms and disease-related processes. Objective: To explore OMT as a therapy for treating common pediatric ailments, specifically otitis media, asthma, and ADHD. Methods: This literature review primarily used PubMed, De Gruyter, and Google Scholar to find literature. The search terms used included the following: osteopathic manipulative medicine, osteopathic manipulative therapy, osteopathic medicine, children, pediatrics, infants, otitis media, asthma, and ADHD. Randomized controlled trials, case studies, and literature reviews were utilized. Results: The existing literature shows that OMT is efficacious in improving symptoms and/or shortening disease courses of otitis media, asthma, and ADHD in the pediatric population. OMT was also found to be associated with symptom improvement and decreased length of hospital stay for neonates. Conclusion: OMT shows promise as a mainstay treatment when it comes to a variety of prevalent pediatric conditions. It is vital to continue exploring the therapeutic effects of it across different disease types in future research.

Osteopathic manipulative treatment (OMT) has been demonstrated to have an effect on the autonomic nervous system, which may have antiarrhythmic effects. The effects of OMT in patients with cardiac implantable electronic devices (CIEDs) have not previously been reported. This study investigated the impact of OMT on quality of life (QOL) in this patient population. The purpose of this study is to investigate the effects of OMT on QOL in CIED patients. Subjects with CIEDs were recruited into a double-blind randomized controlled institutional review board (IRB)-approved clinical trial (ClinicalTrials.gov ID: NCT04004741) and randomized to OMT or light touch (control) groups. Subjects received a one-time intervention, performed by board-certified neuromusculoskeletal medicine (NMM) and osteopathic manipulative medicine (OMM) physicians. The OMT protocol utilized techniques including myofascial release, rib raising, facilitated positional release (FPR), and osteopathic cranial manipulative medicine. Subjects' QOL was assessed immediately preceding intervention and one-month postintervention utilizing the Research ANd Development (RAND) 36-Item Short Form Health Survey (SF-36, eight parameters). Groups were compared utilizing unpaired t tests; α=0.05. Forty-two subjects were enrolled, with four lost to follow-up, which resulted in 19 OMT and 19 control subjects for analysis. Of the eight QOL parameters, two showed significant improvement with OMT: role limitations due to physical health (p=0.001) and pain (p=0.003). This study demonstrates the potential for QOL improvement in CIED patients. Specifically, subjects in the OMT group reported an improvement in activities of daily living as well as a decrease in overall pain, including pain interfering with work. Additional research is necessary to further understand the physiologic effects of OMT, including its effects on arrhythmias, in CIED patients.

Minimum core competencies for allopathic medical students in the specialty area of geriatrics have been developed, comprising 26 competencies divided into 8 topical domains. These competencies are appropriate for osteopathic medical students, but they do not include competencies relating to osteopathic principles and practice (OPP) in geriatrics. There remains a need within the osteopathic profession to develop specialty-specific competencies specific to OPP. To develop more specific and comprehensive minimum competencies in OPP for osteopathic medical students in the field of geriatric medicine. The Delphi technique (a structured communication technique that uses a panel of experts to reach consensus) was adapted to generate new core competencies relating to OPP. Osteopathic geriatricians and members of the Educational Council on Osteopathic Principles (ECOP) of the American Association of Colleges of Osteopathic Medicine participated in a breakout session and 2 rounds of surveys. Proposed competencies with 80% of the participants ranking it as "very important and should be added as a competency" were retained. Participants were also asked if they agreed that competencies in OPP should include specific types of osteopathic manipulative treatment techniques for the elderly. Responses were received from 26 osteopathic physician experts: 17 ECOP members and 9 geriatricians. Fourteen proposed competencies were developed: 7 related to the existing topic domains, and 7 were placed into a new domain of osteopathic manipulative medicine (OMM). Six proposed competencies were retained, all of which were in the new OMM domain. These competencies related to using OMM for gait and balance assessment, knowing adverse events and contraindications of OMM, using OMM for pain relief and end-of-life care, using OMM in the hospital and nursing home setting, adapting OMM to fit an elderly individual, and using OMM to address limited range of motion and ability to perform activities of daily living. Thirteen of 22 participants (59%) agreed that OPP competencies should include specific osteopathic manipulative treatment techniques. The Delphi consensus building process was used to create 6 new minimum competencies in OMM for osteopathic medical students for the specialty area of geriatrics. Using data from this consensus, medical schools, residencies, and fellowships can create standards and expectations for osteopathic physicians regarding the best care of geriatric patients.

Osteopathic manipulative medicine (OMM) is a unique skill set consisting of physical manipulations that treatthe neuromusculoskeletal system. Although OMM can improve patient outcomes such as functionality and pain, as well as increase physician reimbursement, its use is declining. Barriers to its use include a lack of proficiency, support, reimbursement, and time. Knowledge gaps remain as to how OMM training during graduate medical education (GME) affects OMM use. This study describes relationships between OMM exposure during GME and the use of OMM in practice. An online survey of physicians in a variety of medical fields during late 2022 assessed the impact of OMM education during postgraduate training on its use in clinical practice. Survey data were analyzed to compare training characteristics and OMM use via chi-square tests and binary logistic regression. A total of 299 surveys were completed. Respondents who received formal OMM education during residency were more likely (59.8 %) to utilize OMM in medical practice than those who practiced OMM informally (37.8 %, p<0.001) and those who had no OMM exposure during residency (10.3 %, p<0.001). Respondents who trained with more osteopathic attendings (p<0.001) and co-residents (p=0.012) were also more likely to utilize OMM. Those who completed residencies that were accredited by the Accreditation Council for Graduate Medical Education (ACGME) with an Osteopathic recognition track, by the American Osteopathic Association (AOA), and were dually-accredited (ACGME/AOA), were all more likely to utilize OMM (60 %, 56 %, and 53 %, respectively) than those who completed residencies with ACGME accreditation alone (22 %, p<0.01). Although OMM can improve patient outcomes, it is underutilized by Doctors of Osteopathic Medicine (DOs) in practice. Lack of training after medical school has been identified as a contributing factor to its disuse. The results of our study illustrate that there is a positive association between OMM education during postgraduate training and OMM use in clinical practice.

Osteopathic medical students receive an abundance of training in osteopathic manipulative treatment (OMT) during their first 2years of medical school and less during the second 2years. Family Medicine residency programs often include significantly more OMT training during residency, but it is less frequently applied in other residencies. This survey was designed utilizing the theory of planned behavior to see whether specific training in osteopathic manipulative medicine (OMM) after osteopathic medical school was an influence in changing behavior, attitudes, and knowledge around OMT in osteopathic residents. A total of 188 osteopathic medicine residents were invited to complete an anonymous cross-sectional online survey. The survey asked residents about their postgraduate OMT training and their knowledge, attitudes, norms, intentions, and behavior regarding OMT. Inferential statistics were utilized to determine whether significant differences existed by specialty and by type of training. Sixty residents (31.9% response rate) completed the survey. This response rate is consistent with previous online survey studies, but it may indicate that residents chose not to participate due to survey fatigue or alack of interest in OMM. Overall, residents who completed postgraduate training reported significantly stronger positive attitudes about the value of OMT in patient care (t=3.956; p<0.001). Primary care residents talk to their patients about OMT and perform OMT more frequently than residents in surgical (p<0.01) and other subspecialties (p<0.01). Residents who completed postgraduate training (n=41) reported significantly more knowledge about the fundamental principles (p=0.04), benefits (p=0.03), and common techniques (p=0.01) of OMT, and rated their ability to perform OMT (p=0.001) higher than those who had not completed postgraduate training. Trained residents also talked to patients about OMT (p<0.001), referred patients for OMT (p=0.01), and performed OMT (p<0.001) more frequently. They also reported significantly stronger subjective norms (p=0.000; p<0.001), perceived behavioral control (p=0.02; p=0.004), positive attitudes (p=0.004; p=0.003), and intentions (p<0.001; p<0.001) regarding talking to patients and performing OMT, respectively. Residents who completed in-person training reported talking to their patients about OMT (p=0.002) and performing OMT (p=0.001) more frequently, and having more confidence in their ability to perform OMT (p=0.02). Residents who completed in-person training reported significantly stronger subjective norms (p<0.001; p<0.001), perceived behavioral control (p=0.001; p=0.002), positive attitudes (p=0.05; p=0.03), and intentions (p<0.001; p=0.001) regarding talking to patients about OMT and performing OMT, respectively. Residents who completed in-person training reported stronger subjective norms (p=0.05) related to referring patients for OMT. Residents who complete postgraduate training perform OMT, talk to their patients about OMT, and refer patients for OMT more frequently. Residents who participate in training, particularly in-person training, have stronger subjective norms, perceived behavioral control, positive attitudes, and behavioral intentions regarding talking with patients about OMT and performing OMT. These variables are validated predictors of behavior, making them important outcomes for training to promote OMT in patient care.