Australian Osteopaths Research Articles

Therapeutic approaches and conceptions of practice of osteopaths in Australia - a national cross-sectional study and exploratory factor analysis of the Osteo-TAQ

BackgroundHealth professionals develop their own approach to patient care based on education, experience and philosophical stance. Literature suggests that this practice approach informs patient care, and clinical outcomes. The Osteopaths’ Therapeutic Approaches Questionnaire (Osteo-TAQ) is a novel 36-item instrument developed from qualitative grounded theory research with osteopaths in the United Kingdom. The aim of the study was to develop evidence for the structural and construct validity of the Osteo-TAQ in the Australian osteopathic profession and provide initial descriptive data about the therapeutic approaches of osteopaths in Australia.MethodsA cross-sectional study design was used to collect data from registered osteopaths in Australia using the Osteo-TAQ and analysed with Exploratory Factor Analysis (EFA). The EFA utilised parallel analysis to determine the number of factors to extract and McDonald’s omega calculated as the reliability estimation statistic.Results691 Australian osteopaths provided data for the study, representing 25% of the Australian osteopathic profession. Empirically the number of factors to extract based on the parallel analysis was seven. Two- and three-factor solutions were evaluated given the underpinning theory identifying two conceptions of practice and three interrelated therapeutic approaches. Both the two- and three-factor solutions were consistent with the underpinning theory with acceptable reliability estimations for each factor. Descriptive data suggested the most common element of the therapeutic approach of Australian osteopaths was establishing rapport, while the least common was ‘only talking’ with their patients.ConclusionsThis study provides evidence for the structural, content and construct validity of the Osteo-TAQ in an Australian osteopathic practitioner population. The results support both a two- and three-factor structure for the Osteo-TAQ in an Australian osteopathic population, with each factor demonstrating acceptable reliability estimations supporting the items comprising each factor as measuring a single construct. From a theoretical and empirical perspective, it can be inferred that the Osteo-TAQ tool encapsulates an osteopaths’ conception of practice (professional artistry and technical rational) and three main therapeutic approaches to patient care: Educator, Communicator and Treater. Further research is required to explore each of these therapeutic approaches to better understand how they relate to an individual osteopath’s conception of practice, and their associations with other measures of practice including clinical outcomes.

The use of respiratory patient reported outcome measures (PROMs) in the management of COPD: Perceptions of Australian osteopaths

BackgroundPatient reported outcome measures (PROMs) are widely used to capture patients' perspectives of their health status and treatment outcomes and to enable practitioners to evaluate the effectiveness of interventions. The aim of this study was to explore Australian osteopaths’ perceptions of the use of respiratory PROMS in the management of chronic lung conditions. MethodsThis study drew on the social ecological model (SEM), which highlights the interdependence of contextual structures and processes. Osteopaths who were initially part of a larger mixed-methods study were invited to participate in semi-structured interviews. Transcripts were thematically analysed using the SEM. ResultsSeven of the original study osteopaths were interviewed. When presented with a patient who had a co-morbid respiratory condition, they focused on the musculoskeletal aspects of that condition (intrapersonal factors). Participants described sporadic use of musculoskeletal and quality of life PROMs in practice, and scarce use of respiratory PROMs (intrapersonal and organizational factors). Participants’ perceptions of their scope of practice strongly influenced their use of respiratory PROMs (environmental factors). ConclusionIntrapersonal and environmental factors were dominant drivers for participants’ scant use of respiratory PROMs. Further education on the scope and contribution of osteopaths to the management of chronic lung conditions and the use of respiratory PROMS is called for to promote multidisciplinary patient care.

‘Thrown at twins’ - A qualitative study exploring the lived experience of Australian osteopaths who regularly treat paediatric patients

Backgroundand purpose: Little is known about the training and experience of osteopaths who treat paediatric patients, and graduates report feeling unprepared for this aspect of practice. The purpose of this study was to investigate the lived experience of Australian osteopaths who regularly treat these patients, in order to better understand their individual educational pathways and their management of this population. Materials and methodsOsteopaths who reported regularly treating paediatric patients were recruited through the Osteopathy Research and Innovation Network (ORION) national practice-based network. Semi-structured interviews were completed, transcribed and thematically analysed using the principles of Descriptive Phenomenology to compile qualitative data. ResultsTen osteopaths were interviewed, whose age ranged from 33 to 71 years and with 15–46 years of clinical experience. Proportion of paediatric patients ranged from 20 to 90 % of participants’ caseload according to self-report. Seven themes were identified that reflected the lived experience of treating paediatric patients: 1) Variable pathways to practice, 2) Challenges and rewards, 3) Scope of practice, 4) Team-based care, 5) Importance of entry-level skills, 6) Family-centred care, and 7) Success. ConclusionThe study found a diversity of educational pathways, that paediatric practice was highly rewarding, the scope of practice was based on diagnostic skills and experience, the practitioners had extensive team-based professional networks, practice reflected a family-centred care model, and personal measures of success were multifactorial. These results give insight into this area of practice to guide further research.

Development and adaptation of the Osteopaths' Therapeutic Approaches Questionnaire (Osteo-TAQ) for the Australian osteopathic profession - A cognitive interview study

BackgroundThe Osteopaths' Therapeutic Approaches Questionnaire (Osteo-TAQ) is a novel 36-item instrument developed from qualitative grounded theory research with osteopaths in the United Kingdom. The Osteo-TAQ has the potential to measure multiple domains of osteopaths' practice including their therapeutic approach, clinical decision-making and therapeutic relationship with patients. It is unknown how well the items in the Osteo-TAQ relate to the practice of Australian osteopaths. ObjectivesTo assess and improve the quality of the Osteo-TAQ survey items prior to utilising the Osteo-TAQ amongst the Australian osteopathic profession. MethodsCognitive interviews with six Australian registered osteopaths (n = 6) were used to generate data on how participants interpreted and understood the Osteo-TAQ items. Interviews were transcribed verbatim and content analysis was used to identify issues of comprehension and problem areas relating to the Osteo-TAQ. ResultsThree areas for improvement were identified in relation to the core aspects of clinical practice (the patient, examination, treatment and management), use of possessive pronouns and Likert scale frequency response options. ConclusionThese problems may reflect the similarities in osteopathic practice in the UK and Australia, but also indicate subtle differences in the terminology utilised by osteopaths to describe and communicate areas of their clinical practice.

How do Australian osteopaths manage migraines? Outcomes from a national practice-based research network

BackgroundIndividuals who experience migraines often seek out a variety of treatment options including manual or physical therapy. Evidence suggests that manual therapy, including osteopathy, can play a role in the management of migraines. Whilst there is some literature on the role osteopathy therapy plays in migraine management, none describes the treatment approaches used by practitioners. ObjectivesTo explore the demographic, practice and clinical management characteristics of Australian osteopaths who report treating migraine ‘often’ in clinical practice. MethodsSecondary analysis of a cross-sectional survey of 988 osteopaths from the Osteopathy Research and Innovation Network (ORION), an Australian practice-based research network. Regression analysis was used to identify demographic, practice and clinical management characteristics of Australian osteopaths who reported ‘often’ treating migraine patients. ResultsOver 40% of respondents (n = 400) indicated treating patients with migraines ‘often’. These osteopaths were less likely to be involved in research and be co-located with a dietician compared to osteopaths who do ‘not often’ treat migraine. Osteopaths who reported ‘often’ treating migraine were: five times as likely to treat non-English speaking ethnic groups; 2.5 times as likely to treat chronic pain, temporomandibular joint disorders and hand musculoskeletal complaints; compared to those that do not treat migraines ‘often’. ConclusionAustralian osteopaths who treat migraine are five times more likely to treat non-English speaking ethnic groups; twice as likely to treat chronic pain; temporomandibular joint disorders, and hand musculoskeletal complaints. More research is needed to identify the practices and patient outcomes associated with osteopathy care for those experiencing migraines.

The Use of Exercise Prescription in Australian Osteopathy Practice: Secondary Analysis of a Nationally Representative Sample of the Profession.

Exercise is beneficial for improving general health, wellbeing, and specific medical conditions. In musculoskeletal conditions such as chronic low back and neck pain, prescribed exercise has been found to be moderately effective in decreasing pain and improving function. Osteopaths are primary contact health professionals who manage predominantly musculoskeletal complaints. This work presents a secondary data analysis of the Australian osteopathy practice-based research network and profiles the characteristics of osteopaths who often use exercise prescription in patient care. Methodology. Secondary analysis of a cross-sectional survey of 992 osteopaths was registered with the Osteopathy Research and Innovation Network, an Australian practice-based research network. Demographics, practice, and treatment characteristics of Australian osteopaths who "often" use exercise prescription in patient care were examined. Seven-hundred and thirty-three Australian osteopaths (74%) indicated that they use exercise prescription "often" in patient care. Australian osteopaths who often use exercise prescription are more likely to be colocated with another osteopath (ORa 1.54) and send referrals to an exercise physiologist (ORa 1.94) and a specialist medical practitioner (ORa 1.72). Those osteopaths who often used exercise prescription were also more likely to discuss physical activity (ORa 5.61) and nutrition (ORa 1.90). Australian osteopaths who use exercise prescription often were more likely to treat patients with sports injuries (ORa 2.43) and use soft tissue techniques (ORa 1.92), trigger point techniques (ORa 2.72), and sports taping (ORa 1.78). Osteopaths who utilise exercise prescription were more likely to discuss physical activity, diet, and nutrition and utilise referral networks with specialist medical practitioners and exercise physiologists. Australian osteopaths who often use exercise prescriptions were also more likely to treat patients with sport injury. The results suggest that most Australian osteopaths use exercise prescription and have referral networks with other health professionals for patient management. Further work is required to explore the type of exercise prescription used and for what conditions.

Osteopathy Referrals to and from General Practitioners: Secondary Analysis of Practitioner Characteristics from an Australian Practice-Based Research Network.

Australian osteopaths engage in multidisciplinary care and referrals with other health professionals, including general practitioners (GPs), for musculoskeletal care. This secondary analysis compared characteristics of Australian osteopaths who refer to, and receive referrals from, GPs with osteopaths who do not refer. The analysis was undertaken to identify pertinent characteristics that could contribute to greater engagement between Australian osteopaths and GPs. Data were from the Australian osteopathy practice-based research network comprising responses from 992 osteopaths (48.1% response rate). Osteopaths completed a practice-based survey exploring their demographic, practice, and clinical management characteristics. Backward logistic regression identified significant characteristics associated with referrals. Osteopaths who reported sending referrals (n = 878, 88.5%) to GPs were more likely than their non-referring colleagues to receive referrals from GPs (aOR = 4.80, 95% CI [2.62-8.82]), send referrals to a podiatrist (aOR = 3.09, 95% CI [1.80-5.28]) and/or treat patients experiencing degenerative spinal complaints (aOR = 1.71, 95% CI [1.01-2.91]). Osteopaths reporting receiving referrals (n = 886, 89.3%) from GPs were more likely than their non-referring colleagues to send referrals to GPs (aOR = 4.62, 95% CI [2.48-8.63]) and use the Medicare EasyClaim system (aOR = 4.66, 95% CI [2.34-9.27]). Most Australian osteopaths who report engaging in referrals with GPs for patient care also refer to other health professionals. Referrals from GPs are likely through the Chronic Disease Management scheme. The clinical conditions resulting in referrals are unknown. Further research could explore the GP-osteopath referral network to strengthen collaborative musculoskeletal care. The outcomes of this study have the potential to inform Australian osteopaths participating in advocacy, public policy and engagement with Australian GPs.

Perceptions of Australian osteopaths on the use of telehealth for patient care: Barriers and enablers for implementation

BackgroundTelehealth is increasingly becoming a significant strategy for the delivery of healthcare in Australia in a wide range of professions. Recent physical distancing requirements were a catalyst for professions such as osteopathy (where the dominant care model is manual therapy) to make significant changes to adapt their approach for telehealth platforms. ObjectiveTo explore the perceptions of Australian osteopaths’ use of telehealth for patient care, and the associated barriers and enablers of its implementation. MethodsThe Theoretical Domains Framework informed the development of semi-structured interviews which were conducted with osteopaths. Transcriptions were analysed thematically. ResultsNine osteopaths participated in semi-structured interviews. They described their beliefs about osteopathy and the challenge telehealth has posed to their professional identity as healthcare providers. Osteopaths described uses ranging from simply staying connected with patients, through to innovative ways to assess and teach patients how to self-treat and self-manage their conditions. ConclusionEnablers for the use of telehealth by participating osteopaths were face-to-face practice restrictions imposed during the pandemic lockdown and acknowledgement of the potential for telehealth to offer convenient and beneficial care, particularly for patients with limited access. Participating osteopaths who saw their value and self-worth as healthcare providers of manual therapy, and a lack of training in telehealth platforms, were major barriers to its uptake in osteopathic practice.

Osteopathic management of non-specific neck pain: Preliminary findings from a cross sectional study of Australian osteopaths

ObjectiveNeck pain is a highly prevalent condition that leads to considerable pain and disability. There is an economic cost to neck pain at both a personal and broader health system level. Neck pain may be classified as ‘non-specific’ neck pain (NSNP) when there is an absence of identifiable underlying disease or abnormal anatomical structure. Osteopaths play a role in the management of NSNP, but it is unclear how osteopaths specifically manage this condition. This study explores what osteopaths do for patients with NSNP. MethodsCross sectional design. Via an online survey. ResultsAll participants in this study reported applying soft tissue techniques, using exercise prescription, discussing physical activity levels, physical fitness, stress management, pain education and posture and ergonomics for patients with NSNP. Less than half of the osteopaths in this study reported using PROMs in clinical practice for the management of non-specific neck pain and only a small number completed continuing professional development (CPD) related to the clinical management of NSNP. ConclusionThis study demonstrates Australian osteopaths use a range of manual therapy techniques and education strategies in clinical practice for the management of NSNP in line with clinical practice guidelines. Implications for clinical practice•All osteopaths in this study reported applying soft tissue techniques, using exercise prescription, discussing physical activity levels, physical fitness, stress management, pain education and posture and ergonomics for patients with NSNP.•Less than half of the osteopaths in this study reported using PROMs in clinical practice for the management of non-specific neck pain.•Only a small number of Australian osteopaths completed continuing professional development (CPD) related to the clinical management of NSNP.

Views from Australian osteopaths and industry stakeholders about the profession: A qualitative study

BackgroundThe future health and longevity of the osteopathy profession relies heavily on its practitioners and industry stakeholders to support it. Possessing a deeper understanding of practitioner and stakeholder views of the profession may provide crucial insights into the wellbeing of the workforce and their perceived skills and expertise in the wider healthcare landscape. ObjectiveTo provide a review of current and emerging attitudes, beliefs and behaviours of Australian osteopaths and supportive external stakeholders towards the profession. MethodsA qualitative approach using grounded theory explored the attitudes, beliefs and behaviours of Australian osteopaths and supportive external stakeholders. Purposive sampling identified 18 practitioners (Victoria 10, Western Australia 5, and New South Wales 3) and 6 external stakeholders. All participated in semi-structured focus groups. A constant comparative method followed data collection whereby repeated ideas formed the extraction of the emerging themes presented. ResultsCentral themes for each group included: 1) practitioner wellbeing and 2) osteopathic skills and expertise. Subthemes included: 1) career sustainability and longevity for practitioners, and 2) osteopathy within the broader context of allied healthcare in Australia. ConclusionThreats to practitioner wellbeing included lack of early career support, limited career pathways, and uncertainty surrounding the future of the profession. External stakeholders echoed similar concerns regarding the future of the profession, acknowledging whilst osteopathy may play a sustainable role in managing the health and wellbeing of Australians, their skills and expertise are not unique nor exclusive to the profession, are under-evidenced, and undervalued by other healthcare professionals. Fostering a healthy and fulfilled workforce lies in securing a sustainable role for the profession by addressing these limitations.

Osteopathy in rural and remote Australia: analysis of demographic, practice and clinical management characteristics from a nationally representative sample of 992 osteopaths.

There is significant interest in allied health and the role it plays in health care for rural and remote populations. In Australia, osteopaths are allied health professionals who manage predominantly musculoskeletal complaints using manual therapy, exercise and patient education. Workforce distribution is a significant issue for osteopathy in Australia with most practitioners centred in the metropolitan regions of Victoria and New South Wales. There is limited evidence about the role osteopathy plays in the musculoskeletal health of Australian rural and remote populations. This research sought to profile the characteristics of Australian osteopaths who practise in rural and remote settings. A secondary analysis of the Osteopathy Research and Innovation Network (ORION) data was undertaken to identify the demographic, practice and clinical management characteristics of Australian osteopaths in rural and remote settings. ORION is a practice-based research network for the Australian osteopathy profession. The ORION questionnaire comprised 27 items regarding osteopaths' characteristics. Inferential statistics were used to identify characteristics that were significantly different between Australian osteopaths practising in rural and remote settings compared to those practising in urban settings. Logistic regression was used to calculate adjusted odds ratios (AOR) relating to characteristics significantly associated with practising in a rural and remote setting. Of 992 osteopaths who responded to the ORION questionnaire, 18.3% (n=172) indicated practising in a rural and remote setting. Australian osteopaths in rural and remote settings were more likely to report receiving referrals from massage therapists (AOR 2.17), send referrals to other osteopaths (AOR 1.64), and often treat patients over the age of 65 years (AOR 2.25) compared to their urban counterparts. Osteopaths in rural and remote setting were less likely to report using private health insurance claim systems (AOR 0.36) and to treat non-English-speaking patients (AOR 0.09). This secondary analysis identified several practitioner and practice characteristics that differ between osteopaths practising in rural and remote settings and those practising in urban settings. These findings contribute to the emerging picture of the practice of rural and remote Australian osteopaths. Further research is required to understand the role osteopaths play in rural and remote health care, and how the current data can inform workforce and health policy development.

Demographic, practice and clinical management characteristics of osteopaths referring to podiatrists: secondary analysis of a nationally representative sample of Australian osteopaths

BackgroundInterprofessional care is paramount in contemporary healthcare practice. How different professions interact, and the characteristics of those practitioners who practice in an interprofessional way are rarely described in the literature. The aim of the current work was to identify the demographic, practice and clinical management characteristics of Australian osteopaths who report referring to podiatrists.MethodsThe study was a secondary analysis of data from the Osteopathy Research and Innovation Network (ORION). Inferential statistics were generated to identify statistically significant demographic, practice and clinical management characteristics associated with referrals to podiatrists by Australian osteopaths.ResultsNine-hundred and ninety-two Australian osteopaths responded to the questionnaire. Sending referrals to a podiatrist was reported by 651 participants (65.6%). Female Australian osteopaths were less likely to report referring to podiatrists compared to male osteopaths (OR 0.76, 95%CI 0.59–0.99). Australian osteopaths who reported referring to podiatrists were more likely to report receiving referrals from podiatrists (OR 9.75, 95%CI 6.98–13.61), use orthopaedic testing in patient assessment (OR 7.62, 95%CI 2.82–20.60), and often treat patients with postural disorders (OR 1.71, 95%CI 1.03–2.26), compared to osteopaths who do not refer to podiatrists.ConclusionThis study provides initial evidence for the referral relationship between Australian osteopaths and podiatrists. Further work could explore the nature of these referrals, including the complaints resulting in referral and outcomes of care. This information will be useful to those involved in health policy development and the professions advocating for their role in the wider healthcare system.

Clinical characteristics of Australian osteopaths who teach: A national sample

Background: Health professionals involved in teaching future practitioners have been studied to some extent, but our knowledge of their clinical characteristics is variable. Our study sought to profile the clinical characteristics of osteopaths who teach in the three Australian universities delivering pre-professional osteopathy education.Materials: This study is a secondary analysis of data collected via the Australian Osteopathy Research and Innovation Network (ORION) project. Descriptive statistics were generated for each of the 27-item questionnaire variables. For binary responses, unadjusted odds ratios were calculated, and for continuous variables, independent t-tests were used. Backward step-wise regression modelling was used to identify significant characteristics associated with university teaching in osteopathy. Results: The survey demonstrated 9.9% of Australian osteopaths reported being involved in university teaching. Compared to non-teaching survey respondents, the osteopaths involved in university teaching were more likely to be female (OR 1.56), older (p 0.01) and in clinical practice for longer (p 0.01) but report fewer patient care hours (p 0.01) and patient visits per week (p 0.01). Osteopaths involved in university teaching were also more likely to be involved in research (OR 18.54) and clinical supervision (OR 12.39). They also reported a broader range of patient presentations and therapeutic modalities than their counterparts.Conclusions: This nationally representative survey demonstrates a small percentage of the Australian osteopathy profession are engaged in university teaching. Our secondary analysis has highlighted several characteristics associated with involvement in university teaching that begin to shed light on the composition of the Australian osteopathy teaching workforce. This data may inform development of a skilled and experienced teaching workforce.

Use of muscle energy technique amongst a nationally representative sample of Australian osteopaths

IntroductionMuscle energy technique (MET) is a therapeutic technique involving active muscle contraction by the patient. The selection of particular techniques by osteopaths is underexplored. The aim of the study was to explore the practice profile of those Australian osteopaths who use MET often in their practice compared to those who do not use the technique often. MethodsA secondary analysis of data collected from 922 participants by a practice-based research network (PBRN) for the Australian osteopathy profession was performed. Frequency of use of MET on a 4 point scale: never, rarely, sometimes, and often were binary coded as less often and often. Inferential statistics were used to explore the associations between individual practice characteristics and the frequency of MET use. Adjusted odds ratios (OR) with 95% confidence intervals (CI) and p-values were calculated from regression modelling. ResultsDichotomising participant responses resulted in less often (203, 20.5%) and often (788, 79.4%). There was a significantly greater proportion of male practitioners using MET compared to those practitioners who did not often use the technique (OR = 0.46; CI = 0.33, 0.63; p < 0.01). Australian osteopaths who often used MET were younger (36.3 vs 44.6 years old) and had fewer years in practice (9.9 vs 17.3 years) compared to osteopaths who used the technique less often. ConclusionOsteopaths who reported that they often used MET were more likely to be male, often use counterstrain and more likely to use orthopaedic testing in patient examination. The study provides an insight into how Australian osteopaths practice, particularly their use of MET. Implications for practice•When the responses of 922 Australian osteopaths who participated in a practice-based research network were dichotomized according to usage of MET, the majority reported they use MET frequently.•MET and counterstrain appear to be used in combination for musculoskeletal patient care by Australian osteopaths.•Australian osteopaths who reported often using MET were more likely to see patients for low back pain, perform orthopaedic testing, use neurological cranial nerve testing, and refer for diagnostic imaging.•The practice characteristics of osteopaths who use MET often compared to those who do not reveal insight into different practice styles within the osteopathic profession.

Practitioner and practice characteristics of Australian osteopaths who discuss lifestyle factors with patients: Findings from a national practice-based research network.

Healthcare professionals' advice on lifestyle behaviours is a key factor in improving a nation's health. Although allied health professionals have been well placed to provide such advice as part of patient care, little is known about the characteristics of allied health practitioners who discuss lifestyle topics with patients. This paper focused upon an overlooked avenue for lifestyle advice regarding an allied health profession - osteopathy. A workforce survey including questions about four lifestyle topics (including diet/nutrition, smoking/drugs/alcohol, physical activity/fitness, and stress management) was distributed to a nationally representative sample of Australian registered osteopaths in 2016. Separate multivariate logistic regression and Poisson regression models were developed to determine the most important predictors of the discussion of lifestyle factors. Amongst the 992 participating osteopaths, 89%, 49%, 38%, and 18% often discussed physical activity/fitness, stress management, diet/nutrition, and smoking/drugs/alcohol with their patients, respectively. Approximately 30% of participating osteopaths discussed at least three lifestyle topics with patients. Varied predictors were identified for discussing each lifestyle topic. Osteopaths who often discuss diet/nutrition in patient management plans were more likely to often discuss smoking/drugs/alcohol (OR=14.13), physical activity/fitness (OR=2.71), and/or stress management (OR=1.69). In conclusion, lifestyle factors are often discussed with patients as part of osteopathy treatments in the Australian healthcare context. Osteopaths are well positioned to initiate discussions regarding patient lifestyles, and such discussions may be an effective contribution to health promotion.

The use of visceral techniques in Australian osteopathic practice: A descriptive cross-sectional study

Background Visceral techniques have taken their place in the established osteopathic treatment approaches, however, very little research exists on their use in clinical settings in Australia. This study reports on the prevalence, enablers of and barriers to visceral technique use by registered osteopaths currently practising in Australia utilising a nationally representative database from the Osteopathy Research and Innovation Network (ORION). Methods The recruitment invitation pack for this study was distributed via email to the ORION database during July 2019. The study utilised a 27-item survey with both Likert scale and free text responses. All data were imported into the statistical software package SPSSTM 25 for descriptive statistical analysis. Results A total of 143 Australian osteopaths participated in the study representing a response rate of 14.4%. The participants reported a mean number of 16.1 years in practice, with 55.3% identifying as female and approximately 70% reporting as working from a metropolitan location. The majority of respondents (71.5%) reported using visceral techniques within the preceding 6 months, with 12.8% indicating that they had previously used visceral techniques in practice but had subsequently elected to stop using them. Key barriers identified by the study in relation to visceral technique usage related to practitioner knowledge, confidence and a perceived lack of support, while enablers were linked to perceived benefit in patient management and private payment. Conclusion This study provides an important step forward in our understanding of the current use of visceral techniques by the Australian osteopathic workforce. Further research is required to better understand practitioners’ rationale for including visceral techniques in practice, patient outcomes where visceral techniques are used, and the cost-effectiveness of their inclusion in patient care.

Characteristics of Australian Osteopaths Managing Tendinopathies: Analysis of a Nationally Representative Survey of 989 Practitioners

Background. Tendinopathies are a common complaint presenting to health professionals, including osteopaths. Evidence supports the use of exercise rehabilitation, with a potential role for manual therapy. This study sought to profile the practice and clinical management characteristics of Australian osteopaths who often treat tendinopathies. Methods. The study was designed as a cross-sectional survey of Australian osteopaths. Participants were Australian osteopaths who were members of the Osteopathy Research and Innovation Network (ORION)-the Australian professions’ practice-based research network. Participants were invited to complete a 27-item practice and clinical management characteristic questionnaire. The questionnaire asked participants to identify demographic, practice and clinical management characteristics associated with their practice. Regression modelling was used to identify significant characteristics associated with often treating tendinopathies. Results. Nine hundred and eighty-nine osteopaths responded and over 41% (n = 410) reported often treating tendinopathies. This group were more likely to be female (ORa 1.5), often treat patients with chronic pain (ORa 3.8) and sports injury (ORa 2.5) and often use exercise prescription (ORa 1.6) in patient care. Conclusions. Australian osteopaths who often treat tendinopathies demonstrate different clinical practice and management characteristics compared to their colleagues who do not often treat this complaint. Research into patient outcomes and cost-effectiveness of osteopathy care for the management of tendinopathies is now required.

The clinical management of neck pain of novice and experienced Australian osteopaths: A secondary analysis of a nationally representative sample

IntroductionNeck pain is one of the most common musculoskeletal disorders worldwide. Osteopaths are primary contact health professionals who predominantly manage musculoskeletal complaints. How Australian osteopaths manage neck pain is beginning to emerge in the literature and there may be differences based on clinical experience. This work presents a secondary data analysis of the Australian osteopathy practice-based research network and aims to examine the clinical management characteristics of experienced and novice osteopaths who often treat neck pain. MethodologySecondary analysis of a cross-sectional survey of osteopaths registered with the Osteopathy Research and Innovation Network (ORION), an Australian practice-based research network. Demographic, practice and treatment characteristics of osteopaths who ‘often’ treat neck pain. Data was split into two groups: novice practitioners (up to nine years in clinical practice), and experienced practitioners (10 years or more in clinical practice), and clinical management was compared. ResultsMost (98%) of the 971 osteopaths reported that they treat neck pain often. Of those that treat neck pain often, 58% reported being male. The mean number of patient care hours per week was 28.1 ± 12.1 and the mean number of patient visits per week was 36.7 ± 18.7. There was a statistically significant difference between novice and experienced groups for discussing occupation (p < 0.01; d = 0.26) and stress (p = 0.045; d = 0.13) during their consultations, with a low to medium and low effect size, respectively. ConclusionThis work demonstrates differences in the management strategies of experienced and novice Australian osteopaths that includes utilisation of a multidisciplinary approach to patient management. The results support the conclusion that there are differences in the clinical management strategies employed by experienced versus novice Australian osteopaths.

Utilisation of pain counselling in osteopathic practice: secondary analysis of a nationally representative sample of Australian osteopaths.

Advice, reassurance and education are recommended as first line treatments for musculoskeletal pain conditions such as low back pain. Osteopaths are registered primary contact allied health professionals in the Australian healthcare system who primarily manage acute and chronic musculoskeletal pain conditions. This study aimed to investigate the proportion of Australian osteopaths who do and do not utilise advice, reassurance and education (pain counselling) in their clinical practice, and determine the characteristics associated with the frequency of using pain counselling in clinical practice. A secondary analysis of practice characteristics from a nationally representative sample of Australian osteopaths was undertaken. Participants completed a 27-item practice characteristics questionnaire between July-December 2016. Bivariate analyses were used to identify significant variables for inclusion in a backward multiple logistic regression model. Adjusted odds ratios (OR) were calculated for significant variables. Responses were received from 991 Australian osteopaths, representing 49% of the profession. Of these 264 (26.64%) indicated often utilising pain counselling, and 727 (73.36%) reported not often utilising pain counselling. Those who utilised pain counselling were more than twice as likely to report research evidence had a high impact on their clinical practice (OR 2.11), and nearly twice as likely to discuss physical activity with their patients (OR 1.84). Pain counselling is under-utilised by nearly three quarters of the Australian osteopathic profession as a management strategy. Future studies are required to explore the reasons why most in the profession comprised in this sample are infrequently utilising this guideline recommendation. Given the frequency of chronic musculoskeletal pain conditions presenting to Australian osteopaths, strategies appear to be needed to advance the profession via professional development in accessing and using evidence-based care for pain conditions.

Clinical characteristics of osteopaths treating work-related injuries in Australia: A cross-sectional study

ObjectiveWork-related injuries constitute a significant proportion of osteopaths' practice. This study was designed to determine the practitioner and practice characteristics of osteopaths who treat people with work-related injuries and to identify the impact of workers’ compensation scheme status on the use of osteopathic medicine. MethodsA cross-sectional survey was distributed to a nationally-representative sample of 992 Australian osteopaths. Multivariate logistic regression modelling was performed to identify the practitioner and practice characteristics of osteopaths that were statistically significantly associated with the treatment of work-related injuries. ResultsA total of 847 osteopaths (86%) at least sometimes treated people with work-related injuries within the previous 12-months. One hundred and three participating osteopaths indicated they often treated people with work-related injuries who were covered by a workers' compensation scheme and 341 participating osteopaths indicated they often treated people with work-related injuries who were not covered by a workers’ compensation scheme. Osteopaths who often treated work-related injuries were also more likely to often treat people with sports-related injuries, often treat people with traffic-related injuries, and/or often discuss medications with patients. ConclusionsA large proportion of Australian osteopaths treat people with work-related injuries. Further examination of osteopathic medicine use for work-related injuries is warranted.