Osteopathy Clinic Research Articles

Pressure force on tissues in various osteopathic techniques (pilot study)

Introduction. The main tool of the osteopathic physician, which carries out most of the diagnostic and therapeutic actions, is the hands. To conduct scientifi c research in osteopathy, it is necessary to understand the nature of the impact and its quantitative characteristics, in particular, the pressure force of the physician′s hands on the patient′s body. In the available literature, it was possible to fi nd single instrumental studies of the pressure force of the osteopath′s hands during performing cranial techniques. Similar studies about the performance of other techniques could not be found in the available literature.Aims: to measure by an instrumental method the pressure force of the osteopath hands during various osteopathic techniques (cranial, visceral, structural).Materials and methods. The study was conducted on the basis of the Mokhov Institute of Osteopathy Clinic in January 2023. The study involved 6 lecturers of the Institute of Osteopathy (St. Petersburg), their experience as an osteopath is at least 5 years; the age is from 33 to 53 years. As patients, the residents of the Osteopathy Department of Mechnikov North-West Medical State University were involved. There were 2 men and 4 women, aged from 24 to 26 years, with a normosthenic constitution and a body mass index from 19,5 to 24. The following devices were used to measure the pressure strength of the osteopathic physician′s hands: Fsr402 resistive pressure sensors (Arduino Italy) and A402 (Tekscan USA), FlexiForce Prototyping Kit with FlexiForce MicroView software (Tekscan USA), and a device for determining skin elasticity and human skin scars (strain gauge attached to a caliper, Patent RU 2763 843 C1). Each physician demonstrated several osteopathic techniques on one patient. During the execution of each technique, three measurements were made, and the arithmetic mean was calculated. Structural, visceral and cranial techniques of osteopathic correction were performed.Results. The Friedman test showed a statistically signifi cant difference in pressure strength for different techniques (p<0,01). The greatest pressure force was measured during the mobilization of the descending colon (3,6±0,3 Newton); the minimum force was measured during the mobilization of the thoracic spine in the extension (1,5±0,3 Newton). When performing each technique, there was a range (the difference between the minimum and maximum values) between physicians from 0,95 Newton for performing a frontal bone lift to 1,8 Newton for mobilizing the sigmoid colon. Conclusion. The pilot study showed that during performing different techniques, the pressure strength of the osteopathic physician′s hands differed signifi cantly. It is advisable to continue the study on a more representative sample.> <0,01). The greatest pressure force was measured during the mobilization of the descending colon (3,6±0,3 Newton); the minimum force was measured during the mobilization of the thoracic spine in the extension (1,5±0,3 Newton). When performing each technique, there was a range (the difference between the minimum and maximum values) between physicians from 0,95 Newton for performing a frontal bone lift to 1,8 Newton for mobilizing the sigmoid colon.Conclusion. The pilot study showed that during performing different techniques, the pressure strength of the osteopathic physician′s hands differed signifi cantly. It is advisable to continue the study on a more representative sample.

Does the student-led osteopathy clinical learning environment prepare students for practice?

BackgroundFor many allied health disciplines, pre-professional clinical education takes place in student-led, on-campus clinic environments. In these environments, pre-professional students undertake patient care under the supervision of qualified health professionals. Literature exploring the benefits of the student-led clinical learning environment is limited and little is known about the role student-led clinics play in preparing pre-professional osteopathy students for professional practice.AimTo explore the perceptions of osteopathy clinical educators about the role of the student-led clinic at Victoria University (VU) in preparing pre-professional students for professional practice.MethodsA qualitative collective case study methodology was utilised to explore clinical educator perceptions. Individual interviews were conducted with clinical educators employed in the university osteopathy clinic. Interview questions were framed around the Capabilities for Osteopathic Practice which set the Australian osteopathy practice standards. Data were assessed by two of the authors using thematic analysis.ResultsNine clinical educators out of 31 employed at the university clinic (29%) agreed to participate. Qualitative analysis generated three themes: perceptions of the student-led clinic (SLC) as a learning environment; clinical educator perception of their role in the SLC; and, challenges to and of the SLC environment.ConclusionsClinical educators perceived that the student-led osteopathy clinical learning environment develops pre-professional learners to meet some, but not all, of the capabilities for professional practice as an osteopath in Australia. The environment may be improved through faculty development, fostering a proactive learning approach, addressing system-based issues, and providing opportunities to interact with other health professions.

PROMIS Neuropathic and Nociceptive Pain Quality in Musculoskeletal Pain Presentations.

Musculoskeletal pain is a significant contributor to the global disease burden. Management of musculoskeletal pain where a neuropathic component is present can be challenging. This study evaluated the internal structure of the Patient-Reported Outcome Measures Information System (PROMIS) pain quality scales, explored the prevalence of neuropathic and nociceptive pain, and identified health demographics and behaviors related to musculoskeletal pain presentations. Patients presenting to the Victoria University Osteopathy Clinic (Melbourne, Vic., Australia) were invited to complete a health demographics and behaviors questionnaire, and the PROMIS Neuropathic (NeuroPQ) and Nociceptive (NociPQ) pain quality scales, before their initial consultation. Descriptive, inferential, and correlation statistics were used to evaluate the PROMIS scales, health demographics, and behaviors. Mokken scale analysis was used to evaluate the internal structure and dimensionality of the NeuroPQ and NociPQ scales. Three hundred eighty-three (N=383) patients completed the measures. Mokken scaling suggested the PROMIS scales demonstrated acceptable internal structure and were unidimensional. Over 22% of patients demonstrated cutoff scores above 50, suggesting a substantive neuropathic pain component to their musculoskeletal presentation. Patients who reported cigarette smoking, not being born in Australia or not speaking English at home, demonstrated higher NeuroPQ scores. Females demonstrated significantly higher NociPQ scores than males. Pain intensity demonstrated small to medium correlations with NeuroPQ and NociPQ scores. This study provides support for the use of the NeuroPQ and NociPQ scales in musculoskeletal pain patients. Associations with health demographics and behaviors were identified, and patients typically experienced a combination of neuropathic and nociceptive pain.

“Who am I to disagree?” A qualitative study of how patients interpret the consent process prior to manual therapy of the cervical spine

BackgroundClinical practice standards dictate a requirement for osteopaths to gain informed consent prior to any examination or treatment. Despite previous research on adverse events, communication and patient preferences, no published studies were identified that looked qualitatively at patients experiences of informed consent. This study aimed to explore patient perceptions of the consent process in a student-led osteopathy clinic. MethodsSemi-structured interviews were carried out with a purposive sample of seven patients attending a student osteopathy clinic. Interviews were transcribed verbatim, and constructivist grounded theory was used as a framework for data collection, conceptualisation and analysis. ResultsOne core theme was identified to highlight participants' perception of a hierarchical power-divide. Three further themes were constructed to illustrate perceived key influencers of the consent experience: commitment to symptom resolution; lack of knowledge and; unwilling to cause friction. ConclusionsPatients’ experiences of consent were unified through the core theme of situational disempowerment, questioning the efficacy of current informed consent processes. This study has implications for further research into patient and practitioner perceptions and highlights a need for additional training and reflection on existing communication strategies and consent practices.

The short-form Orebro Musculoskeletal Pain Questionnaire (OMPQ-10): Associations with determinants of health and demographics in a musculoskeletal pain cohort

BackgroundPsychosocial influences in musculoskeletal complaints are widely recognized to contribute to chronicity of the complaint. A number of patient-report outcome measures have been published to screen for the presence of these influences. ObjectiveExplore the relationship between health demographics and behaviours and the short-form Orebro Musculoskeletal Pain Questionnaire (OMPQ-10). DesignCohort study. SettingUniversity teaching clinic. MethodsPatients were invited to complete a demographic and health questionnaire in addition to the OMPQ-10 prior to their consultation. Descriptive and inferential statistics were used to explore the relationships between health behaviours, determinants of health and the OMPQ-10. ParticipantsPatients attending the Victoria University Osteopathy Clinic for their initial osteopathy consultation. ResultsData from 353 patients were analysed. Mean age was 33.4 (±11.5) years and 93.8% were employed. OMPQ-10 mean total score was 38 (±12). Reliability estimations did not support the calculation of a total score - analysis was undertaken using the OMPQ-10 Domain areas. No significant difference was identified between Domain area score and gender, presenting complaint region, speaking English at home, having had blood pressure assessed in the last 6 months or employment status. Patients with a chronic condition demonstrated significantly higher Pain Experience (p < 0.01, d = 0.79) and Return to Work (p = 0.033, d = 0.26) domain area scores. ConclusionAssociations with health behaviors and determinants were identified. The utility of the OMPQ-10 may be limited given the high number of patients who were employed. Further work is required to evaluate other psychosocial screening tools that may be useful for an osteopathy patient population.

PROMIS\xae General Life Satisfaction scale: construct validity in musculoskeletal pain patients

BackgroundLife satisfaction is part of subjective well-being. Measurement of life satisfaction is undertaken using self-report measures. This study aimed to evaluate the structural validity, concurrent validity, and internal structure of the PROMIS® General Life Satisfaction Scale (GLSS) in a musculoskeletal pain cohort.MethodConsecutive new patients attending the Victoria University Osteopathy Clinic (Melbourne, Australia) were invited to complete the GLSS prior to their initial consultation. Structural validity and internal structure were explored using confirmatory factor analysis and Mokken scale analysis. Concurrent validity was evaluated against a single-item measure of life satisfaction.ResultsThe PROMIS® GLSS comprised a single factor and formed an acceptable Mokken scale in this population. No differential item functioning was observed. A large positive correlation (r = 0.70) was observed between the General Life Satisfaction scale and a single-item measure of life satisfaction.ConclusionsThe PROMIS® General Life Satisfaction scale demonstrated acceptable internal structure and structural validity in a musculoskeletal pain population. Additional research is required to explore concurrent validity and other measurement properties, however initial data suggests the measure could be a feasible screen of life satisfaction for Australian osteopathic patients.

Self-management behaviour and knowledge of patients with musculoskeletal complaints attending an Australian osteopathy clinic: A consecutive sampling design

BackgroundMusculoskeletal complaints present a substantial disease burden worldwide and account for nearly 8% of the total disease burden in Australia. Like other chronic diseases, self-management plays a significant role in the overall management plan for musculoskeletal complaints. ObjectiveEvaluate the self-management behaviours of patients seeking care for a primary musculoskeletal complaint in an Australian osteopathy clinic. DesignConsecutive sampling design. SettingVictoria University Osteopathy Clinic (Melbourne, Australia). MethodsPatients were invited to complete a health information and demographic questionnaire in addition to the Partners in Health (PiH) scale prior to their initial consultation. The PiH subscales and total score were evaluated to ascertain their relationship with gender, age, and other health demographic variables. ParticipantsConsecutive patients attending the Victoria University Osteopathy Clinic. ResultsData from 331 patients was available for analysis. The PiH total score mean was 70.9 (±14.3). Reliability estimations for the PiH subscales were acceptable (McDonald's omega > 0.75). PiH total and subscale scores were not associated with age, and not significantly different for gender and chronicity of complaint. Significant differences for other health behaviours (smoking, blood pressure assessment) were identified. ConclusionsThe current study provides support for the use of the PiH in a patient population seeking osteopathy care for primary acute or chronic musculoskeletal complaint, and also in younger populations seeking care. The results of the study suggest that osteopathy patients seeking care for a primary musculoskeletal complaint demonstrated a relatively high disposition towards the self-management of their health complaints.

Life satisfaction and musculoskeletal complaints in a population seeking osteopathy care: consecutive sample of 611 patients

BackgroundLife satisfaction is a component of the subjective well-being construct. Research consistently suggests that life satisfaction is associated with enhanced social benefits and improved health outcomes. However, its relationship to musculoskeletal health outcomes is underexplored. This study evaluates the life satisfaction of a patient population presenting with musculoskeletal complaints, and the relationship of life satisfaction with other health demographics and behaviours.MethodThe study used a consecutive sampling design. Patients attending the Victoria University Osteopathy Clinic (Melbourne, Australia) were invited to complete the PROMIS® General Life Satisfaction scale (GLSS) along with questions related to health demographics and behaviours.ResultsThe GLSS T-score was not significantly different for gender, being born outside of Australia, speaking English at home, or complaint chronicity.ConclusionsLife satisfaction did not appear to be related to a range of health and demographic variables in the current musculoskeletal pain cohort. The PROMIS® General Life Satisfaction scale could prove useful to explore the relationship between life satisfaction and treatment outcomes for musculoskeletal complaints.

Determinants of health, health behaviours and demographic profile of patients attending an Australian university student-led osteopathy clinic

BackgroundProfiles of health professions practice can inform pre-professional education, provide evidence to assist with interprofessional practice, and inform policy development. An understanding of the profile of patients seeking osteopathy care is emerging. Current research suggests that musculoskeletal presentations predominate with approximately one-third of patients presenting with co-morbid diseases. There is little data on these presentations in Australian osteopathy practice. This study aimed to describe the patient demographics, clinical presentations, health behaviours and determinants of health, including health literacy, of those attending for care at an Australian student-led osteopathy clinic.MethodsA convenience sample design was utilised where consecutive patients presenting for their initial consultation were invited to complete a health information questionnaire during 2016–2017. The questionnaire explored a range of health behaviours and the patient’s health status. Data from the clinical records were also extracted to establish the presenting complaint, duration of the complaint and pertinent demographics. Descriptive statistics were generated for each variable.ResultsData were available for 1617 patients presenting for their initial consultation. The mean age of patients was 33.7 (±13.1) years with 55% (n = 887) identifying as female. Acute presentations predominated (n = 840, 52%), with presentations affecting the spine being the most common (57.8%). Most patients rated their health status as good to very good (75%). Approximately 7.5% of patients were identified as having low health literacy and 55.9% were currently suffering from one or more co-morbid presentations.ConclusionsThe demographic profile and presenting complaints of patients presenting to a student-led osteopathy clinic are largely consistent with other Australian private practice profiles. The current work also identified co-morbid presentations, and positive and negative health behaviours. Osteopaths may play a role in the management of, or referral for, these presentations where health behaviours require change, or management of co-morbid conditions is beyond the scope of practice. The increasing volume of patient profile literature globally suggests that osteopaths can play a substantial role in the management of musculoskeletal complaints. Further, osteopathy may play a role in screening determinants of health, and engage in multidisciplinary care to ensure those patients with co-morbid conditions or adverse health behaviours are managed appropriately.

Conservative treatment of cephalohematoma in children of the first two months of life

Cephalohematoma remains a serious and important problem of healthcare, its incidence tendency to decrease. Current treatment tactics remains controversial and is determined the presence of concomitant pathology and the tendency to resorption or progression. the effectiveness of osteopathic correction of cephalohematomas in children of the first two months of life. Materials and methods: on the basis of «Family Osteopathy Clinic» correction for children of the first two months of life who came to the clinic because of the first time.Osteopathic correction of cephalohematoma in children in the first two efficient.

Blood pressure screening in an Australian osteopathy student-led clinic

ObjectivesApproximately 25% of the Australian population are hypertensive, contributing 5% to the total burden of disease in Australia. The measurement of blood pressure (BP) and management of hypertension is relatively straightforward, and is a modifiable risk factor for cardiovascular disease. Given the prevalence of hypertension in the community, osteopaths are in a position to be able to measure BP and do so in routine practice. The present study sought to identify the frequency of blood pressure measurement of patients attending a student-led osteopathy clinic. MethodNew patients attending the Victoria University (VU) Osteopathy Clinic between March and June 2016 completed a demographic and health information questionnaire prior to their initial consultation. During the initial consultation students are asked to measure the patients BP and record this in the clinical history, this is a routine part of their standard osteopathy consultation. ResultsBP measurements were available for 31.2% (n = 129) of new patients attending the VU Osteopathy Clinic, 68.8% of new patients did not have BP measurements recorded. Of those patients whose blood pressure was recorded, approximately 25% were classified as hypertensive. Age, gender and cardiovascular history did not appear to influence whether BP was recorded. ConclusionsNearly 70% of patients did not have their BP recorded. Future research should evaluate the reasons for student osteopaths not measuring and/or recording new patients BP, and whether these reasons are modifiable. Changes in the curricula and training of clinical educators may be required to increase the clinical practice of measuring BP in student-led clinics.

A Mokken analysis of the literacy in musculoskeletal problems questionnaire

BackgroundLimited health literacy is known to impact on medication adherence, hospital readmission and potentially poorer health outcomes. The literature on the health literacy of those with musculoskeletal conditions suggests greater functional limitations and increased pain levels. There are a number of measures of health literacy. One that specifically relates to musculoskeletal complaints is the Literacy in Musculoskeletal Problems (LiMP) questionnaire. The LiMP contains 9 multiple choice items that cover anatomy, musculoskeletal conditions and the diagnosis of musculoskeletal complaints. The aim of the study was to evaluate the dimensionality and internal structure of the LiMP in patients attending for osteopathy care at a student-led clinic, as a potential measure of musculoskeletal health literacy.MethodThree hundred and sixty-one (n = 361) new patients attending the Victoria University Osteopathy Clinic completed the LiMP and a demographic and health information questionnaire prior to their initial consultation. Mokken scale analysis, a nonparametric item response theory approach, was used to evaluate the dimensionality and structure of the LiMP in this population, to ascertain whether the questionnaire was measuring a single latent construct – musculoskeletal health literacy. McDonald’s omega and Cronbach’s alpha were calculated as the reliability estimations. The relationship between the LiMP and a single item screen of health literacy was also undertaken.ResultsThe 9 items on the LiMP did not form a Mokken scale and the reliability estimations were below an acceptable level (alpha and omega <0.45). LiMP items 5 and 8 were more likely to be answered correctly by those with higher health literacy (p < 0.05), however the effect sizes were small (<0.20).ConclusionCalculation of a total score for the LiMP, as advocated by the original authors, is not supported based on data in the present study. Further research is required to explore the relationship of the LiMP items to demographic and clinical data, and to other broader measures of health literacy. Further research may also develop a health literacy measure that is specific to patients seeking manual therapy care for musculoskeletal complaints.

Health literacy screening of patients attending a student-led osteopathy clinic: A pilot investigation

Adequate levels of health literacy (HL) are required for patients to access appropriate health services and develop an understanding of the options for managing their healthcare needs. There is limited literature on HL of patients seeking care for a musculoskeletal complaint. The present study sought to screen the HL of patients presenting to an Australian osteopathy student-led clinic using a single screening question ‘Are you confident completing medical forms?’. Less than 10% of patients attending the clinic were considered to have below adequate levels of HL using this question, consistent with other work in Australian populations. Logistic regression analysis identified that the most significant demographic variables associated with lower HL were patients who did not speak English at home, those with lower education levels, and those who were less satisfied with their life. Evaluation of a patients' HL may assist practitioners to improve patient education and management strategies.

Exploration of clinical changes following a novel mobilisation technique for treatment of chronic low back pain: A single cohort design

To explore clinical changes following a novel manual mobilisation technique, 24 participants who experienced 'moderate' to 'severe' chronic low back pain were recruited from new patients attending a suburban osteopathy clinic. The intervention was a previously undescribed side-lying mobilisation technique targeting the lumbosacral spine (median of 6 treatment sessions). After 8 weeks reductions were shown in Oswestry Disability Index of 15 points (95% CI: 9.3, 22.7; p<0.0001 for overall ANOVA); Quadruple Visual Analogue Scale of 2.0 points (95% CI: 1.0, 3.0; p<0.0001); and Patient Specific Functional Scale of 3.1 points (95% CI: 1.9, 4.3; p<0.0001). The results indicate that pain intensity, disability and function improved in most participants following treatment. Further investigation is indicated using more robust research designs to compare this approach with other treatment approaches and usual care for the treatment of chronic low back pain.

Aplicação do questionário QVWOQOL‑Bref antes e após tratamento manipulativo osteopático

Introduction: Pain is an unpleasant sensory or emotional experience associated with an actual or potential damage tis-sue. Among the treatments given to minimize this condition is osteopathy, which evaluates and treats individuals globally. Objective: Evaluate the quality of life through the WHOQOL-Bref questionnaire before and after manipulative osteopathic treatment. Method: 20 patients with chronic pain enrolled for treatment in osteopathy clinic on the outpatient of the Os-teopathy Brazilian Institute from the University Hospital of Santa Catarina were randomized in Study Group (SG) (n = 10) and control group (CG) (n = 10). Patients answered the questionnaire QVWOQOL-Bref before and at the end of osteopathic treatment. SG has received six osteopathic treatments and the CG remained two months without intervention. Results: the mean percentage of QOL showed no significant difference (p>0.05) between the groups in the initial and final evaluation. The comparison of the initial and final means in the same group showed no significant difference, despite the final means of the SG being higher. Conclusion: There was no significant difference between GC and SG; however, SG’s means in all areas were higher in the final evaluation.

Developing a chronic pain self-management clinic at the British School of Osteopathy: Quantitative pilot study results

BackgroundStill's maxim ‘Find it, fix it and leave it alone’ is relevant for acute pain but osteopaths can feel challenged when managing chronic conditions unlikely to resolve with manual therapy alone. Research indicates that Mindfulness and Acceptance-based approaches, part of 3rd wave Cognitive Behavioural Therapy (CBT), are effective in addressing negative beliefs which maintain fear-avoidance behaviour and pain-related disability, improving outcomes by developing flexible responses to pain and enhancing patients' capacity to live more fully in accordance with personal values. Common ground between osteopathic concepts of function and ‘functional contextualism’ in CBT provided a rationale for developing a new osteopathic approach to chronic pain management and this study evaluated outcomes from a six week Acceptance-based course for patients at the British School of Osteopathy (BSO) Clinic. MethodsA mixed-methods pilot study with a purposive sample of patients with pain for more than 6 months. Participants were identified by osteopaths as likely to benefit from pain management support, recruitment interviews explored scope for change and decisions about joining the course were collaborative. 2 patients decided not to join, 2 dropped out through ill-health and 15 completed the course (4 male, 11 female). Participants attended group sessions for 2 h per week for 6 weeks, facilitated by a clinical health psychologist and an osteopath. Data was collected at course start, end, and 3 month follow-up from semi-structured interviews and the Chronic Pain Acceptance (CPAQ), Chronic Pain Values Inventory (CPVI), Bournemouth (BQ) and WHO Quality of Life questionnaires. Results132 questionnaires were returned (73% response rate). CPAQ scores improved significantly by 3 months for Activity (Z = −2.38, p = 0.02) but not Willingness (Z = −1.68, p = 0.09). Differences between ‘importance’ and ‘success’ in CPVI Relationships scores decreased significantly (Z = −2.12, p = 0.03), indicating increased success living in accordance with family, friends and relationship values, but not in Agency scores for work, health and growth values (Z = −1.75, p = 0.08). BQ scores improved at 6 weeks but returned to previous levels by 3 months (Z = −1.40, p = 0.16) and Quality of Life remained stable. Individual participants with high initial BQ scores reported less fear-avoidance behaviour at 3 months; those with low CPAQ scores showed higher levels of acceptance and activity; but participants with poor scores in both areas showed less overall change. ConclusionsParticipants showed improvements in motivation and ability to engage in valued activities and personal relationships, but not in pain willingness, fear-avoidance or work activity. The lack of a control group and small, purposive sample mean these results should be interpreted cautiously and interview data is being analysed to explore individual experiences and outcomes. A new clinic is being developed to integrate psycho-educational material into osteopathic treatment sessions, as these results indicate that Mindfulness and Acceptance-based approaches offer promising new directions for enhancing function and agency in chronic pain patients who cannot be ‘fixed’ by manual therapy alone.

Consent in osteopathy: A cross sectional survey of patients' information and process preferences

BackgroundConsent is an ethical and legal requirement for any therapeutic process. It is the responsibility of healthcare practitioners to respect patients' rights of autonomy and to receive their consent. The United Kingdom law currently states that all relevant risks, which a reasonable patient would want to know, must be told to them. Consequently the General Osteopathic Council's (GOsC) “Code of Practice” includes specific expectations in this area. As a result risk disclosure and informed consent has become of increasing importance within osteopathy, particular in today's increasingly litigious society. Osteopathy is a patient centred approach to healthcare; as such research to determine patients' expectations and preferences is needed. ObjectiveTo explore and describe patients' preferences of consent procedures in a sample of UK osteopathic patients. MethodsA cross sectional survey using a new questionnaire was performed incorporating paper and web-based versions of the instruments. 500 copies were made available, (n = 200) to patients attending the British School of Osteopathy (BSO) clinic, and (n = 300) for patients attending 30 randomly sampled osteopaths in practice. Quantitative data were analysed descriptively to assess patient preferences; non-parametric analyses were performed to test for preference difference between patients using demographic characteristics. Results124 completed questionnaires were returned from the BSO sample representing a 41% response rate. None were received from patients attending practices outside of the BSO clinic.The majority (98%) of patient respondents thought that having information about rare yet potentially severe risks of treatment was important. Patients' preferred to have this information presented during the initial consultation (72%); communication method favoured was verbal (90%). 99% would like the opportunity to ask questions about risks, and all respondents (100%) consider being informed about their current diagnosis as important. ConclusionPatients endorse the importance of information exchange as part of the consent process. Verbal communication is very important and is the favoured method for both receiving information and giving consent. Further research is required to test the validity of these results in practice samples.

Should your GP be an osteopath?: Patients’ views of an osteopathy clinic based in primary care

Spinal pain is a common reason for consulting general practitioners (GPs), and complementary therapists such as osteopaths and chiropractors. Patients express greater satisfaction with the care from chiropractors and osteopaths, because they are perceived as having more empathy, diagnostic skill and effective treatment, but their attitude to a GP providing an osteopathy service is unknown. To explore patients' views of receiving osteopathy in contrast with usual GP care, to provide insight into the psychological benefit of treatment, and to explore their views on how such a service should be provided and funded. Qualitative study using semi-structured interviews preceded by short questionnaires. Primary care osteopathy clinic treating patients from Llanfairfechan Health Centre, which also accepted referrals from neighbouring practices in North West Wales in a randomised controlled trial. Short questionnaires followed by semi-structured interviews with 20 participants. The interview transcripts were analysed by open coding into categories, axial coding to define the categories' properties and selective coding for the final thematic account. Traditional GP skills were valued, but GP care for spinal pain was perceived as limited and ineffective. Osteopathy was attractive because it did not involve drugs, but it had short-term painful side effects, and some found it frightening. Physical benefits included increased mobility and reduced pain; psychological benefits included removal of fear and improved understanding. Provision of osteopathy by a GP was welcomed, so long as the GP was properly qualified, and had sufficient time. A GP run osteopathy clinic provided additional physical and psychological benefit. GP consultation might be improved by adopting some features from the osteopathic consultation.

Cost-utility analysis of osteopathy in primary care: results from a pragmatic randomized controlled trial

Spinal pain is common and costly to health services and society. Management guidelines have encouraged primary care referral for spinal manipulation, but the evidence base is weak. More economic evaluations alongside pragmatic trials have been recommended. Our aim was to assess the cost-utility of a practice-based osteopathy clinic for subacute spinal pain. A cost-utility analysis was performed alongside a pragmatic single-centre randomized controlled trial in a primary care osteopathy clinic accepting referrals from 14 neighbouring practices in North West Wales. Patients with back pain of 2-12 weeks duration were randomly allocated to treatment with osteopathy plus usual GP care or usual GP care alone. Costs were measured from a National Health Service (NHS) perspective. All primary and secondary health care interventions recorded in GP notes were collected for the study period. We calculated quality adjusted life year (QALY) gains based on EQ-5D responses from patients in the trial, and then cost per QALY ratios. Confidence intervals (CIs) were estimated using non-parametric bootstrapping. Osteopathy plus usual GP care was more effective but resulted in more health care costs than usual GP care alone. The point estimate of the incremental cost per QALY ratio was 3560 pounds (80% CI 542 pounds-77,100 pounds). Sensitivity analysis examining spine-related costs alone and total costs excluding outliers resulted in lower cost per QALY ratios. A primary care osteopathy clinic may be a cost-effective addition to usual GP care, but this conclusion was subject to considerable random error. Rigorous multi-centre studies are needed to assess the generalizability of this approach.