Osteopathic Research Articles

Model-base estimation of non-invasive ventilation weaning of preterm infants exposed to osteopathic manipulative treatment: a propensity score-matched cohort study.

Model-base estimation of non-invasive ventilation weaning of preterm infants exposed to osteopathic manipulative treatment: a propensity score-matched cohort study.

Correlation between diminished vagal tone and somatic dysfunction severity in very and extremely low birth weight preterm infants assessed with frequency spectrum heart rate variability and salivary cortisol.

Osteopathic manipulative treatment (OMT) is evolving in the neonatal intensive care unit (NICU) setting. Studies showed its efficacy in length of stay and hospitalization costs reduction. Moreover, it was suggested that OMT has a modulatory effect on the preterm infants’ autonomic nervous system (ANS), influencing saturation and heart rate. Even if OMT is based on the palpatory examination of the somatic dysfunctions (SD), there are controversies about its identification and clinical relevance. The objective of this study was to evaluate the inter-rater reliability, clinical characteristics, and functional correlation of the SD Grade score with the heart rate variability (HRV) and the salivary cortisol (sCor) using a multivariate linear model approach. To evaluate those features, we implemented an ad hoc SD examination for preterm infants that was performed by 2 trained osteopaths. It was based on the new variability model of SD that includes an SD Grade assessment procedure. The ANS features were assessed by frequency parameters of HRV studying high frequency (HF), low frequency (LF), and HF/LF, whereas sCor was tested with a radioimmunoassay. The ANS assessment was standardized and performed before SD testing. Sixty-nine premature infants were eligible. SD Grade showed excellent concordance between the blinded raters. Using SD Grade as a grouping variable, the infants presented differences in GA, Apgar, pathological findings, length of stay, and ventilatory assistance. In our multivariate model, HF, LF, and LF/HF resulted linearly correlated with SD Grade. Instead, sCor presented a linear correlation with 5’ Apgar and respiratory distress syndrome but not with SD Grade. SD Grade was in line with the natural history of the underdevelopment due to prematurity. Our models indicate that the cardiac vagal tone is linearly related with SD Grade. This finding may improve the multidisciplinary decision making inside NICU and the management of modifiable factors, like SD, for cardiac vagal tone regulation.

Osteopathic Manipulative Treatment Decreases Hospital Stay and Healthcare Cost in the Neonatal Intensive Care Unit.

Osteopathic manipulative treatment (OMT) is used in both inpatient and outpatient settings. Evidence suggests that OMT can reduce both patients’ recovery time and the financial cost of their acute medical treatment and rehabilitation. Multiple studies from neonatal intensive care units (NICUs) are presented in this article that demonstrate infants treated with OMT recover faster, are discharged earlier, and have lower healthcare costs than their non-OMT-treated counterparts. Data clearly show that adjunctive OMT facilitates feeding coordination in newborns, such as latching, suckling, swallowing, and breathing, and increases long-term weight gain and maintenance, which reduces hospital length of stay (LOS). Osteopathic techniques, such as soft tissue manipulation, balanced ligamentous tension, myofascial release, and osteopathic cranial manipulation (OCM), can reduce regurgitation, vomiting, milky bilious, or bloody discharge and decrease the need for constipation treatment. OMT can also be effective in reducing the complications of pneumonia in premature babies. Studies show the use of OCM and lymphatic pump technique (LPT) reduces the occurrence of both aspiration and environmentally acquired pneumonia, resulting in significantly lower morbidity and mortality in infants. Based on published findings, it is determined that OMT is clinically effective, cost efficient, a less invasive alternative to surgery, and a less toxic choice to pharmacologic drugs. Therefore, routine incorporation of OMT in the NICU can be of great benefit in infants with multiple disorders. Future OMT research should aim to initiate clinical trial designs that include randomized controlled trials with larger cohorts of infants admitted to the NICU. Furthermore, a streamlined and concerted effort to elucidate the underlying molecular mechanisms associated with the beneficial effects of OMT will aid in understanding the significant value of incorporating OMT into optimal patient care.

Release of Cervical Muscle Tension Improves Psychological Stress and Symptoms of Moderate-to-Severe Atopic Dermatitis: a Case Series with 20 Patients.

IntroductionAtopic dermatitis (AD) is a chronic relapsing inflammatory skin disease that is triggered by intense pruritus, impaired skin barrier function, and immune responses to allergenic substances. Break-through therapies for AD include molecular-targeted drugs and the effective management of severe symptoms of AD. However, patients with clinical improvements may continue scratching owing to the influence of psychological stress, which might lead to quick relapses of stressors and subsequent intensive scratching. New drugs may be ineffective because of such scratching behavior caused by stressors. Therefore, it may be useful to consider adjunctive treatment options that focus on external stressors as triggers of deterioration of AD. We hypothesized that improvement of psychological stress by relieving cervical muscle tension would reduce pruritus and atopic symptoms.MethodsOverall, 21 patients with moderate-to-severe AD were treated to relieve cervical muscular tension using Spineliner SA201, which assists in osteopathic manipulative treatment. We assessed the subjective and objective symptoms of AD, cervical muscle tension, which was evaluated using cervical range of motion (ROM), and psychological burden. Only moisturizers were applied topically during the study period, and no topical corticosteroid therapy was used.ResultsTwenty patients who completed the treatment demonstrated improvement in the symptoms of AD: changes on the visual analog scale (VAS) for pruritus were −44.2%, Eczema Area and Severity Index (EASI) was −67.9%, thymus and activation-regulated chemokine (TARC) was −56.2%, Hospital Anxiety and Depression Scale (HADS) was −27.2%, sleep disturbance was −49.7%, and Dermatology Life Quality Index (DLQI) was −46.7%. Additionally, the cervical muscle tension improved significantly: changes in cervical ROM were 14.7%.ConclusionsRelease of cervical muscle tension may improve psychological stress and have an effect on moderate-to-severe AD.

Efficacy of Osteopathic Manipulative Treatment (OMT) Vs Physiotherapy in Chronic Lateral Epicondylitis

Background: Several rehabilitative treatments have been proposed for Lateral Elbow Tendinopathy (LET). Therapeutic exercise showed the greatest beneficial effects together with patient education, and multimodal treatment subject specific. In recent years, osteopathic manipulative treatment (OMT) has been proposed as treatment for LET. The aim of the study was to focus on this emerging approach by comparing it to more traditional physiotherapy. Methods: Thirty-two patients with a diagnosis of LET were enrolled and randomly assigned to two groups: the OMT group and the physiotherapy group. In the former, patients underwent OMT according to the common techniques. In the latter, patients underwent a physiotherapy protocol consisting in stretching and strengthening exercises, and laser therapy. Outcome measures included the Patient-Rated Tennis Elbow Evaluation (PRTEE), the Mayo Elbow Performance, and VAS for pain. Assessment was carried out at baseline (T0), after 1 (T1) and 3 (T2) months. In addition, an ultrasound assessment of the elbow common extensor tendon was performed at T0 and T2. Results: Both the OMT and the Physiotherapy group showed a statistically significant improvement along the follow-up for VAS for pain and PRTEE score. No significant difference was found for the Mayo Score in the Physiotherapy group. Ultrasound assessment confirmed the presence of abnormalities of vascularization, echogenicity, and thickness of the tendon at T0, partially reduced at T2. Conclusion: OMT and physiotherapy resulted both effective in the treatment of LET, offering a significant clinical improvement which helped patients recovering their functional activities in the short-term follow-up.

Chest physiotherapy for pneumonia in adults.

Chest physiotherapy for pneumonia in adults.

Exploring New Patient Understanding of Osteopathic Manipulative Medicine using a Cross-Sectional Survey and Mixed Methods Approach.

INTRODUCTIONOsteopathic manipulative medicine (OMM), a patient-focused approach to medical treatment utilized by doctors of osteopathic medicine (DO), continues to be an under-utilized resource in treating musculoskeletal disorders. Lack of familiarity by both referring physicians and patients of OMM can impact patient-physician communication and impede patient-centered care approaches. This 2020-2021 study was conducted to investigate new patient understanding of OMM within the Michigan State University OMM Clinic.METHODSA set of 18 survey questions developed by the authors within their MSU OMM clinic were utilized for the study. The main purpose of the questions was to generally ascertain new patient’s understanding of OMM, its role in patient care, who can place clinic referrals and the services an OMM clinic provides. Respondents were new adult patients at the MSU OMM clinic.RESULTSThe convenience study sample of 83 respondents was primarily female, 60 (72.3%). Few respondents were familiar with OMM, as only eight (9.64%) reported prior experience with OMM. Of the 83 patients in this study, 69 (80.7%) reported back pain. When examining referral patterns, there were low numbers of referrals from non-PCP providers, especially from advanced practice providers (APP), including physician assistants (n = three, 3.66%) and nurse practitioners (n = eight, 7.96%). Most surveyed patients 61 (73.5%) had been referred by their primary care providers.CONCLUSIONSResults indicate that communication directed to non-DO physicians, advanced practice providers and patients about OMM services may be helpful to provide noninvasive symptomatic treatment options for musculoskeletal conditions. Further larger-scale studies examining both non-DO provider and new patient perceptions concerning OMM are clearly warranted.

Osteopathic Manipulative Treatment for Optic Pathway Glioma

Abstract Optic gliomas are a known complication of neurofibromatosis type 1 (NF1) and can result in significant impairment. This case report centers around a 3-year-old girl with NF1 and optic glioma diagnosed by MRI, whose optic glioma has not increased in size since commencing treatment with osteopathic manipulative treatment (OMT) at regular intervals. We cover the rationale behind treating these patients with OMT with a thorough review of the relevant anatomy. We suggest a basis of treatment that could benefit patients with a number of intracranial and extracranial pathologies.

Effectiveness of Osteopathic Manipulation Treatment in the Rehabilitation of Post-External Immobilization for a Supracondylar Fracture of the Distal Humerus: A Case Report

Abstract Pediatric bone fractures are a common occurrence, particularly among youth sports participants. Supracondylar humeral fractures are the most common pediatric elbow fracture, accounting for approximately 60% of all pediatric elbow fractures for children less than 10 years of age. For nondisplaced supracondylar humeral fractures, the standard of care is to immobilize the affected arm with an above the elbow-long cast for 3 weeks. Following cast removal, the recommendations for rehabilitation are conflicting, between doing some physical therapy as part of recovery or no therapy and letting the arm heal on its own for upwards of 12 weeks. The purpose of this case report was to observe if the addition of osteopathic manipulation treatment (OMT) could improve the somatic dysfunctions associated with post-immobilization elbow stiffness and reduce the amount of recovery time. Various OMT techniques were utilized over a span of 8 sessions across 4 weeks. The use of OMT provided relief of stiffness and return to full range of motion of the affected upper extremity joints. The incorporation of OMT as a part of a recovery regimen could be considered for future utilization, research, and evaluation.

A Thematic Analysis of Osteopathic Physicians' Identities and Experiences in North American Professional Sports.

ObjectiveThis interview-based thematic analysis examines the evolving professional identities and practices of osteopathic physicians (DOs) in North American professional sports (baseball, basketball, football, hockey, and soccer) to understand the extent to which DOs employ osteopathic-specific skill sets in their work with player-patients. In addition, the study sought to understand the prevalence of professional bias, interprofessional dynamics between DOs and other health professionals, and other factors such as management.MethodsThis qualitative, interview-based study is grounded in twelve semi-structured interviews with 41% of DOs (all nonsurgical, primary care sports medicine trained) working with North American professional sports teams. Interviews were transcribed and coded to identify key themes and representative quotes.ResultsFindings suggest that DOs believe their training and philosophical orientation positions them well to make important contributions to serving the medical needs of professional sports teams. At the same time, DOs are careful about championing an osteopathically-specific approach to patient care, such as evoking osteopathic principles of care or techniques such as Osteopathic Manipulative Medicine. This is the case for several reasons, the most important of which is a strong drive toward collaboration and collegiality within professional sports medicine teams.ConclusionThis study finds that in navigating the complexities of osteopathic identity, DOs working in professional sports are proud of their osteopathic orientation and report experiencing little discrimination, but also downplay what has historically distinguished their practice from that of other healthcare professionals. These findings have consequences for how scholars think about emerging professional identities in sports medicine, generally, as well as the fast-growing profession of osteopathic medicine specifically.

Osteopathic Medical Students’ Preferred Method of Participation in Online Lectures and Learning Activities

Abstract Introduction The demand for online education is on the rise as technology and a global community expand. In the context of COVID-19 pandemic, the Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine (NMM/OMM) Department at Western University of Health Sciences College of Osteopathic Medicine Pacific (COMP) and Pacific-Northwest (COMP-NW) was required to transition from a hands-on, in-person model to entirely virtual teaching. With the rapid transition, student feedback was paramount in determining the effectiveness of the virtual curriculum model and establishing evidence-based guidelines to inform future online delivery methods for the teaching of osteopathic manipulative medicine. Methods A 7-question Qualtrics survey was developed to assess the first and second-year osteopathic medical students’ perception of their online curriculum participation, the preferred method of participation, barriers to participation, and how the NMM/OMM department can improve the curriculum to increase student participation. The survey was distributed electronically to the students at Western University of Health Sciences COMP and COMP-NW. Results 85 students participated in the survey. The most preferred method of participation was an anonymous online polling platform such as “Kahoot!” The most frequently reported barrier to participation was lack of confidence. The most popular suggestion about increasing student participation was to increase more anonymous polls or gamification, such as “Jeopardy,” for review sessions. The logistic regression analysis showed that the following 3 student characteristics were the most decisive factors for a student to report that more participation would increase their OMM knowledge: fear of public speaking (p = 0.024), difficulty staying focused during online curriculum (p=0.041), and being a first-year osteopathic medical student (p<0.01). Conclusion Online curriculum design and delivery pose new and unique challenges to teachers and institutions worldwide. Understanding the creativity it allows, its limitations, and how to increase student engagement and participation needs to be continuously investigated as the technology and demand of online learning grow.

Review Examines Efficacy and Safety of Osteopathic Manipulative Treatment

Lippincott's Bone and Joint Newsletter: September 2022 - Volume 28 - Issue 8 - p 90-91 doi: 10.1097/01.BONEJ.0000872696.99008.f2

Thoracic outlet syndrome: a review for the primary care provider.

Thoracic outlet syndrome (TOS) symptoms are prevalent and often confused with other diagnoses. A PubMed search was undertaken to present a comprehensive article addressing the presentation and treatment for TOS. This article summarizes what is currently published about TOS, its etiologies, common objective findings, and nonsurgical treatment options. The PubMed database was conducted for the range of May 2020 to September 2021 utilizing TOS-related Medical Subject Headings (MeSH) terms. A Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) systematic literature review was conducted to identify the most common etiologies, the most objective findings, and the most effective nonsurgical treatment options for TOS. The search identified 1,188 articles. The automated merge feature removed duplicate articles. The remaining 1,078 citations were manually reviewed, with articles published prior to 2010 removed (n=771). Of the remaining 307 articles, duplicate citations not removed by automated means were removed manually (n=3). The other exclusion criteria included: non-English language (n=21); no abstracts available (n=56); and case reports of TOS occurring from complications of fractures, medical or surgical procedures, novel surgical approaches, or abnormal anatomy (n=42). Articles over 5 years old pertaining to therapeutic intervention (mostly surgical) were removed (n=18). Articles pertaining specifically to osteopathic manipulative treatment (OMT) were sparse and all were utilized (n=6). A total of 167 articles remained. The authors added a total of 20 articles that fell outside of the search criteria, as they considered them to be historic in nature with regards to TOS (n=8), were related specifically to OMT (n=4), or were considered sentinel articles relating to specific therapeutic interventions (n=8). A total of 187 articles were utilized in the final preparation of this manuscript. A final search was conducted prior to submission for publication to check for updated articles. Symptoms of hemicranial and/or upper-extremity pain and paresthesias should lead a physician to evaluate for musculoskeletal etiologies that may be contributing to the compression of the brachial plexus. The best initial provocative test to screen for TOS is the upper limb tension test (ULTT) because a negative test suggests against brachial plexus compression. A positive ULTT should be followed up with an elevated arm stress test (EAST) to further support the diagnosis. If TOS is suspected, additional diagnostic testing such as ultrasound, electromyography (EMG), or magnetic resonance imaging/magnetic resonance angiography (MRI/MRA) might be utilized to further distinguish the vascular or neurological etiologies of the symptoms. Initial treatment for neurogenic TOS (nTOS) is often conservative. Data are limited, therefore there is no conclusive evidence that any one treatment method or combination is more effective. Surgery in nTOS is considered for refractory cases only. Anticoagulation and surgical decompression remain the treatment of choice for vascular versions of TOS. The most common form of TOS is neurogenic. The most common symptoms are pain and paresthesias of the head, neck, and upper extremities. Diagnosis of nTOS is clinical, and the best screening test is the ULTT. There is no conclusive evidence that any one treatment method is more effective for nTOS, given limitations in the published data. Surgical decompression remains the treatment of choice for vascular forms of TOS.

Comparison of Occupational Therapy and Osteopathic Manipulative Treatment in Neonatal Intensive Care Units

Comparison of Occupational Therapy and Osteopathic Manipulative Treatment in Neonatal Intensive Care Units

The effect of the COVID-19 pandemic on osteopathic education in ACGME-OR residencies from February 2020 to February 2021.

It remains to be determined exactly how the COVID-19 pandemic has and will continue to impact osteopathic resident education, in particular as it pertains to treatment with osteopathic manipulative medicine (OMM). Although the long-term effects of the pandemic cannot be determined yet, changes in current resident education can be analyzed. Here, we describe how the format, frequency, and environment of OMM training have changed in residency programs from prior to February 2020 to the "lockdown" period of February 2020 to June 2020, and then to the "recovery" period of July 2020 to February 2021. A 19-question survey inquiring about the above three categories was emailed via SurveyMonkey to 282 Accreditation Council for Graduate Medical Education (ACGME) residency programs with osteopathic recognition at the end of January 2021. Of the 282 programs surveyed, 24.5% (69) responded. Osteopathic neuromusculoskeletal medicine (ONMM) programs were excluded from the data analysis, resulting in a modified sample size of n=60. Responses indicated that residency programs dramatically decreased the frequency of OMM didactic education sessions (100.0% [60] reported offering OMM didactic education before the lockdown period; compared to 73.3% [44] during the lockdown period) and shifted their educational programs from an in-person-only environment (88.3% [53] before lockdown; 8.3% [5] during lockdown) to either a combined in-person/virtual platform (6.7% [4] before lockdown; 31.7% [19] during lockdown) or to a virtual-only platform (0.0% [0] before lockdown; 46.7% [28] during lockdown). During the recovery period, 91.7% (55) programs reported giving some form of OMM didactic education. The percentage of programs reporting in-person-only, combined in-person/virtual platform, and virtual-only didactic education were 3.3% (2), 53.3% (32), and 41.7% (25), respectively, during the recovery period. The preferred method of instruction changed from a combination of resident and attending lectures with a hands-on component (55.0%; 33) before lockdown, to the same but without a hands-on component (28.3%; 17) during lockdown, and back to the same but with a hands-on component (36.7%; 22) during the recovery period. Furthermore, the number of programs offering OMM didactic education [OMM patient care] at least once a month decreased from 70.0% (42) [78.3% (47)] before the lockdown period to 46.7% (28) [48.3% (29)] during the lockdown period. It then increased to 55.0% (33) [73.3% (44)] during the recovery period. Finally, before the lockdown period, programs offered OMM patient care predominantly in a combination of an inpatient/outpatient environment (63.3%; 38). The preferred patient care setting changed to an outpatient-only environment (43.3%; 26) during the lockdown period and then back to a combination of an inpatient/outpatient environment (45.0%; 27) during the recovery period. This study demonstrates that programs have been dramatically impacted by the COVID-19 pandemic, by the augmentation of the osteopathic learning environment, and by the delivery of OMM to patient care within the training programs. These impacts were still present 1year after the start of the pandemic. It will be imperative for ACGME Osteopathic Recognition (ACGME-OR) programs to continue an assessment of these impacts on resident physicians' learning and preparedness.

Osteopathic Treatment for Gastrointestinal Disorders in Term and Preterm Infants: A Systematic Review and Meta-Analysis.

The aim of this systematic review and meta-analysis is to evaluate the effectiveness of osteopathic manipulative treatment (OMT) for gastrointestinal disorders in term and preterm infants. Eligible studies were searched on PubMed, Scopus, Embase, Cochrane, Cinahl, and PEDro. Two reviewers independently assessed if the studies were randomized controlled trials (RCTs) and retrospective studies with OMT compared with any kind of control in term or preterm infants to improve gastrointestinal disorders. Nine articles met the eligibility criteria, investigating OMT compared with no intervention, five involving term infants, and the remaining treating preterm infants. Five studies showed low risk of bias. In the meta-analysis, two studies were included to analyze the hours of crying due to infantile colic, showing statistically significant results (ES = −2.46 [−3.05, −1.87]; p < 0.00001). The quality of evidence was “moderate”. The other outcomes, such as time to oral feeding, meconium excretion, weight gain, and sucking, were presented in a qualitative synthesis. OMT was substantially safe, and showed efficacy in some cases, but the conflicting evidence and lack of high-quality replication studies prevent generalization. High-quality RCTs are recommended to produce better-quality evidence.

Osteopathic Manipulative Treatment and the Management of Headaches: A Scoping Review.

Headaches have been studied and treated since nearly 7,000 BC because of their significant global impact. Current headache treatment modalities are various and have a wide variety of targets, but medications are the most common. Since conventional medical treatments have several side effects, alternative remedies such as osteopathic manipulative treatment (OMT) should be considered. OMT can assist in the management of various health conditions, such as low back pain, neck pain, and headaches. The purpose of this scoping review is to evaluate recent findings regarding the efficacy of OMT modalities in the management of headaches such as tension-type headaches (TTH) and migraines.This study was designed as a scoping review to gather evidence on the efficacy of OMT modalities in the management of headaches. Following PRISMA guidelines, four databases were used to search for articles published between 2010 and 2022 that reported the use of OMT and manual therapy for TTH and migraines. Databases used include Embase, PubMed, Medline, and Web of Science. The following keywords were used: treatment, therapy, Headache, migraine, craniosacral, muscle energy, myofascial release, trigger point, osteopathic, and manipulation. The initial search yielded 473 unique articles after removing duplicates. After screening based on the inclusion and exclusion criteria, and after further analysis, 15 articles were selected.Data reports of OMT and manual therapy efficacy and/or effectiveness in treating TTH and migraine were analyzed. Articles included were randomized control studies (13 of 15, 86.6%), one pilot study (one of 15, 6.7%), and one case series (one of 15, 6.7%), which were divided into TTH (nine of 15, 60%) and Migraine Headaches (six of 15, 40%). All articles reported significant headache improvement in at least one measurement. Of all treatments analyzed, single technique interventions (seven of 15, 47%) and multiple technique interventions (eight of 15, 53%) were identified. Among the techniques used, Myofascial Release was the most common (nine of 15, 60%).The articles presented provide evidence of the significant benefits of manual therapy. Because of the limitations of traditional medicine, OMT can be used either as an alternative or adjuvant therapy for headaches. Evidence suggests the positive impact it can provide on headache management, but the number of randomized control trials and population samples should be increased to support its recommendation. This demonstrates how different osteopathic techniques can provide therapeutic effects on TTH, MH, and potentially other types of headaches. A preference for myofascial release was observed, which can be due to the fast relief from the physiologic effect on tissue movement.This review study demonstrates the benefits OMT has on decreasing headache frequency, intensity, and duration in TTH and migraines. OMT has shown to be beneficial, especially for patients seeking alternative non-pharmaceutical and non-invasive treatments. Further studies are needed to evaluate the effects of different OMT techniques, and different combinations of treatments, on other types of headaches.

The effect of postgraduate osteopathic manipulative treatment training on practice: a survey of osteopathic residents.

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.

Promoting cultural competency and osteopathic medicine awareness among premedical students through a summer premedical rural enrichment program.

Premedical preparatory programs at osteopathic medical schools that recruit students from medically underserved areas (MUAs) may promote interest in practicing osteopathic medicine in underserved or rural areas. In these programs, emphasis on cultural competency may increase diversity among medical school applicants and decrease healthcare disparities in the future. The goal of this study is to determine whether a summer premedical rural enrichment program (PREP) held at an osteopathic medical school located in a MUA will foster greater prioritization of cultural competency in medicine, enhance interest in practicing in rural or underserved areas, and increase familiarity with osteopathic medicine. An eight-week summer PREP was hosted at the California Health Sciences University College of Osteopathic Medicine (CHSU-COM) in Clovis, California. Seventy-eight diverse participants were recruited from the Central Valley, an underserved region of California. Attendees were required to finish the formal application process and were recommended to have completed medical school prerequisite courses. The curriculum included Medical College Admission Test (MCAT) preparation through team-based learning sessions, introduction to the osteopathic medical school curriculum, osteopathic philosophy, and osteopathic manipulative medicine, as well as integrated anatomy and physiology sessions, medical school application workshops, mock interviews, simulation workshops, and sociology and cultural competency sessions. Data were collected via a voluntary and anonymous survey administered before and after the program with questions about familiarity with osteopathy, interest in practicing in underserved areas, medical school preparedness, and a post-course survey about cultural competency. The surveys had students rate statements on a Likert scale. Seventy-four of the 78 premedical students (95%) completed the pre-and postsurvey. There was a significant increase in agreement to statements evaluating medical school preparedness, osteopathic familiarity, and desire to practice medicine locally in the postprogram survey, compared to the preprogram survey. In the cultural competency postsurvey, 75.0% of the responses to questions that evaluated the positive effect of the course were "Agree" or "Strongly Agree." Of the reported postcourse outcomes, the average MCAT score was 504 ± 6.2 (38 students reported, 50.7%). Of the 27 participants who reported matriculation, 16 (59.2%) were admitted to osteopathic medical schools, 9 (33.3%) to allopathic medical schools, and 2 to other health programs. After completing the PREP program, premedical participants reported that they have better understanding of cultural competency and improvement in preparation for medical school, including familiarity with osteopathic medicine, and interest in serving MUAs. These findings indicate that similar programs may have a positive impact on MUAs. These programs may help create diverse and culturally competent osteopathic physicians.

Osteopathic Manipulative Treatment for Pediatric Conditions: An Update of Systematic Review and Meta-Analysis.

Osteopathic manipulative treatment (OMT) continues to be used for a range of diseases in children. Objectives: The aim of this paper is to update our previous systematic review (SR) initially published in 2013 by critically evaluating the evidence for or against this treatment. Methods: Eleven databases were searched (January 2012 to November 2021). Study selection and data extraction: Only randomized clinical trials (RCTs) of OMT in pediatric patients compared with any type of controls were considered. The Cochrane risk-of-bias tool was used. In addition, the quality of the evidence was rated using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria, as recommended by the Cochrane Collaboration. Results: Thirteen trials met the eligibility criteria, of which four could be subjected to a meta-analysis. The findings show that, in preterm infants, OMT has little or no effect on reducing the length of hospital stay (standardized mean difference (SMD) −0.03; 95% confidence interval (CI) −0.44 to 0.39; very low certainty of evidence) when compared with usual care alone. Only one study (8.3%) was judged to have a low risk of bias and showed no effects of OMT on improving exclusive breastfeeding at 1 month. The methodological quality of RCTs published since 2013 has improved. However, adverse effects remain poorly reported. Conclusions: The quality of the primary trials of OMT has improved during recent years. However, the quality of the totality of the evidence remains low or very low. Therefore, the effectiveness of OMT for selected pediatric populations remains unproven.