Exploring the use of exercise therapy in UK osteopathic practice

Abstract

Introduction: Exercise based interventions are common in the treatment of musculoskeletal disorders. These interventions have been investigated in other manual therapy disciplines, but little empirical data exists about osteopathic approaches to exercise. Previous work has identified exercise content in undergraduate education in the UK. However it is unclear whether content within educational programmes reflects current clinical practice (Zamani et al, 2007). Therefore this study aimed to explore what practitioners understand and interpret as exercise therapy within osteopathic treatment and management in practice. Design: Semi-structured interviews were used to explore the potential for the use of exercise therapy in osteopathic practice. Methods: Interviews were arranged for UK registered osteopaths who volunteered to take part in the study. The potential for the use of exercise therapy in osteopathic practice was explored. Participants were recruited via an advertisement placed in the UK osteopathic press. Data were analysed using qualitative methods. Content analysis and constant comparison between transcripts were used as the main analytic method. Results: Fifteen UK registered practitioners volunteered to participate. Nine themes emerged from the transcripts. Specific aims of exercise interventions included: strengthening, stabilising, and pain relief. General aims were focussed on improving physical health and general well being. Practitioners were more comfortable offering generic physical activity advice than specific exercise therapy. Reasons for this included: low levels of pre-graduation preparation and conceptualising exercise therapy as being associated with expertise in other manual therapy disciplines such as physiotherapy. In the main, the practitioners adopted a partnership approach with their patients and reported sharing the development of treatment aims and decision making processes. However there remains some confusion over the use and understanding of exercise terminology. Paradoxically with the stated patient centred approaches practitioners expressed exercise delivery using paternalistic language. Favoured modes of exercise show common trends with other manual therapies such as the use of ‘‘core stability’’ programmes, but bear little resemblance to those delivered during undergraduate education. Reasons for this may be collaborative CPD provision delivered by experts from other disciplines, perceived current good practice and reluctance to use research to drive practice. Conclusions: Exercise therapy and its potential for use is a substantial issue for osteopaths and for education providers in the UK. Practitioners are more comfortable giving generic rather than specific exercise advice and interventions. There is some dissonance between clinicians reported patient centred care approaches and actual delivery of exercise advice. Exercise education in osteopathy and clinical practice are not concordant. Further study is indicated to confirm these findings in a larger sample and there is a need for further consensus about the role of exercise therapy in osteopathic practice and this should be a driver for a more coherent approach across education and practice. Reference