UK Osteopaths Research Articles

STANDARD AND BIOPSYCHOSOCIAL OSTEOPATHIC MANAGEMENT FOR PATIENTS WITH NON-SPECIFIC LOW BACK PAIN (THE OSCAR STUDY): A SINGLE-CASE EXPERIMENTAL DESIGN

Purpose and BackgroundGuidelines recommend biopsychosocial care for chronic, complex musculoskeletal conditions, including non-specific low back pain. The aims were: 1/ to assess how patients with low back pain respond to osteopathic treatment, both before and after an osteopath has completed a Biopsychosocial Pain Management (BPM) course; and 2/ to assess if it is feasible and acceptable for osteopath participants to receive weekly SCED data and use it to guide patient management.Methods and ResultsA multiple baseline single case experimental design trial (clinicaltrials.gov, on 18/10/2021, ID number NCT05120921) with 11 UK osteopaths was conducted. Patients were randomised to early, middle or late treatment start dates. Statistical analysis assessed the change between baseline, intervention and follow-up periods. Primary outcomes were the Numeric Pain Rating (NPR) and Patient Specific Function Scales (PSFS), measured during the baseline, the 6-week intervention, and during a 12-week follow-up period.At baseline, the osteopaths reported stronger biopsychosocial attitudes to pain, compared to biomedical beliefs (PABS: 34 behavioural scale; 29 biomedical scale). Overall, patient participants showed daily increases in symptoms during the pre-treatment phase (+0.24/day, p<0.001), and daily decreases during treatment (−2.94 over the treatment phase, p<0.001), which continued post-treatment (−3.36 over 12 weeks, p=0.04). Similar improvements were observed for function.ConclusionOsteopathic care was shown to help patients with persistent low back pain. Patient recruitment was challenging because of the randomisation. With further development, the method shows feasibility as a means of enhancing research activity among practising clinicians.Previous presentations or publications of the workThe protocol was published (https://doi.org/10.1016/j.ijosm.2023.100660) and presented at SBPR in 2022. The results were presented to an osteopathic conference in October 2023.Ethics approval was received from the University College of Osteopathy Research Ethics Committee.Conflicts of interestsJerry Draper-Rodi receives fees from the sales of the e-learning course on the biopsychosocial management on the UCO CPD platform.Sources of fundingThe research was funded by the Osteopathic Foundation.

OSCAR (Osteopathic Single CAse Research) – Assessing the effect of standard and biopsychosocial osteopathic management for patients with non-specific low back pain: Protocol for a Single Case Experimental Design (SCED)

BackgroundOsteopathy has been shown to be effective in the management of chronic low back pain (LBP). Guidelines recommend biopsychosocial care for chronic, complex musculoskeletal conditions, including non-specific LBP. ObjectivesThis study has four aims: 1/to assess how patients with LBP improve after osteopathic treatment, both before and after an osteopath has completed a Biopsychosocial Pain Management course; 2/to assess if it is feasible and acceptable for osteopaths to receive weekly SCED data and use it to guide patient management; 3/to assess if it is acceptable for patients to submit daily data and discuss weekly summary with their osteopaths; and 4/to test feasibility for researchers in collecting, managing and storing large quantities of individual patient data. MethodsA multiple baseline single case experimental design trial with up to 10 UK osteopaths with more than 15 years in practice and 60 patients will assess how change occurs as a result of osteopathic treatment for patients with non-specific LBP of more than 12 weeks’ duration. Statistical analysis will assess the degree and rate of change between baseline, intervention and follow-up periods, and whether differences in effect are observed after the osteopaths have completed the biopsychosocial patient management training course. Primary outcomes will be the Numeric Pain Rating and Patient Specific Function Scales, measured daily at baseline and for 6 weeks during the intervention stage, and weekly or fortnightly during a 12-week follow-up period. EthicsThis research was approved by the University College of Osteopathy Research Ethics Committee.

Study to assess existing knowledge of headache disorders among registered osteopaths practising in the UK: A cross-sectional survey

BackgroundHeadache disorders are highly prevalent worldwide. Many headache sufferers search for answers outside medical and pharmaceutical models. Complementary and alternative medicine (CAM) including osteopathy are widely used by headache patients. Indeed 9% of patients consulting osteopaths do so for headaches. There is no existing assessment of headache knowledge among practising Osteopaths in the UK. MethodsThis study was a cross-sectional survey employing an anonymous online questionnaire. An original questionnaire was developed. The scope was based on established guidelines in the primary care setting. Multiple choice and closed-ended questions assessed knowledge of the diagnostic criteria, potential red flags and appropriate investigations. The answers were informed by the International Classification Headache Disorder (ICHD-3) and the British Association for the Study of Headaches (BASH) guidelines. Three case vignettes relevant to osteopathic practice were included. Participants were invited to give optional free text feedback. The questionnaire was open to be self-completed by participants for 30 days. ResultsThere were 398 responders of which 383 were included and all of whom completed the questionnaire. The study found areas where knowledge was good, areas where it was limited and areas of uncertainty. The mean knowledge score was 6.93 out of 10 (range 2.18–9.42). There was a significantly lower mean knowledge score in those who had no prior headache education of −0.716 with a difference in means (−1.075 to −0.353, 95% C.I.) compared to those with prior education. Gender and years qualified had no significant effect on mean knowledge score. Optional free text feedback was given by 81 (21.2%) of the respondents and analyzed. The main themes were acknowledgment of knowledge gaps and a desire for more headache education. ConclusionThe findings suggest there are gaps in the existing knowledge on headache among UK osteopaths and the extent of this is dependent on prior headache education. We propose that ongoing headache education among osteopaths is needed in the field.

The development and exploratory analysis of the Osteopaths’ Therapeutic Approaches Questionnaire (Osteo-TAQ)

BackgroundClinical practice encompasses the complex interaction of different skills, knowledge and values in the context of a therapeutic relationship. Research has demonstrated a positive association between well-developed therapeutic relationships, patient satisfaction and clinical outcomes in musculoskeletal conditions. There has been little research into osteopaths’ decision making regarding choice of therapeutic approaches. AimThe aim of this study was to develop a new questionnaire to assess differences in osteopaths' therapeutic approaches, and to subsequently investigate the internal consistency of the factors identifying different underlying practice concepts and the validity and generalisability of a qualitative grounded theory on osteopaths’ therapeutic approaches and clinical decision-making. MethodA 30-Item Osteopaths’ Therapeutic Approaches Questionnaire (Osteo-TAQ) was developed using modified verbatim phrases from a published qualitative grounded theory. UK osteopaths were invited to complete the Osteo-TAQ questionnaire. An exploratory factor analysis, using both the principal axis factoring method and principal components method, was performed on the responses. Results132 responses were received. Osteo-TAQ displayed acceptable level of modelling adequacy (χ2(435) = 1466.1, p < 0.001; KMO = 0.754) and internal consistency (α = 0.778). Exploratory analysis identified eight factors with eigenvalues >1, accounting for 63.5% of the variance. ConclusionThe Osteo-TAQ identified factors that are congruent with a qualitative grounded theory on osteopaths’ therapeutic approaches. The Osteo-TAQ appeared to have good construct validity with four robust components identified and easily characterised. Further testing for construct validity should be carried out amongst a larger population of osteopaths and outside the UK to test and develop the questionnaire further.

What do UK osteopaths view as the safest lifting posture, and how are these views influenced by their back pain beliefs?

BackgroundLower back pain is a leading cause of disability and a common condition seen by osteopaths. Evidence and advice for the safest lifting posture vary, as do healthcare practitioners' attitudes and beliefs towards back pain. ObjectivesThe aim of this study was to understand osteopaths' beliefs about safe lifting postures in relation to their attitudes towards back pain, and to compare these findings with published data from physiotherapists and manual handling advisors. DesignCross-sectional study. MethodBetween October and November 2018 a cross-sectional electronic survey was used to invite a sample of UK osteopaths to select images that best represent their perception of safe lifting posture (straight or rounded back), and to complete the Back Pain Attitudes Questionnaire (Back-PAQ). Data was analysed to assess lifting posture selection and relationship to back pain attitudes. Results46 (85.2%) out of 54 osteopaths selected straight back posture as the safest, these participants had significantly more negative attitudes to back pain injury (i.e. higher Back-PAQ scores), than the 8 osteopaths who selected a rounded back posture (p = 0.007). Data from 266 physiotherapists and 132 manual handling advisors revealed an overall agreement about straight back lifting posture, and differences in Back-PAQ attitude between the professions. ConclusionDespite a lack of evidence and inconsistent recommendations, osteopaths in this study believed that straight back lifting posture is the safest and were associated with more negative back pain beliefs. Practitioners' attitudes and beliefs are known to influence their patients' attitudes and recovery behaviour. Further research is recommended to identify reasons for different beliefs, and their impact on advice-giving and patient outcomes.

Attitudes, skills and use of evidence-based practice among UK Osteopaths: a national cross-sectional survey

Evidence-based practice (EBP) is a clinical decision-making framework that supports quality improvement in healthcare. While osteopaths are key providers of musculoskeletal healthcare, the extent to which osteopaths engage in EBP is unclear. Thus, the aim of this cross-sectional study was to investigate UK osteopaths’ attitudes, skills and use of EBP, and perceived barriers and facilitators of EBP uptake. UK-registered osteopaths were invited to complete the Evidence-Based Practice Attitude and Utilisation Survey (EBASE) online. Of the 5200 registered osteopaths in the UK, 9.9% (517/5200) responded to the invitation, and 7.2% (375/5200) completed the EBASE (< 20% incomplete answers). The demographic characteristics of the survey sample were largely similar to those of the UK osteopathy workforce. The osteopaths reported overall positive attitudes towards EBP, with most agreeing that EBP improves the quality of patient care (69.3%) and is necessary for osteopathy practice (76.5%). The majority reported moderate-level skills in EBP, and most (80.8%) were interested in improving these skills. Participating osteopaths typically engaged in EBP activities 1–5 times over the last month. Barriers to EBP uptake included a lack of time and clinical evidence in osteopathy. Main facilitators of EBP included having access to online databases, internet at work, full-text articles, and EBP education materials. UK osteopaths were generally supportive of evidence-based practice, had moderate-level skills in EBP and engaged in EBP activities infrequently. The development of effective interventions that improve osteopaths’ skills and the incorporation of EBP into clinical practice should be the focus of future research.

Attitudes, skills and use of evidence-based practice among UK osteopaths: a national cross-sectional survey

BackgroundEvidence-based practice (EBP) is a clinical decision-making framework that supports quality improvement in healthcare. While osteopaths are key providers of musculoskeletal healthcare, the extent to which osteopaths engage in EBP is unclear. Thus, the aim of this cross-sectional study was to investigate UK osteopaths’ attitudes, skills and use of EBP, and perceived barriers and facilitators of EBP uptake.MethodsUK-registered osteopaths were invited to complete the Evidence-Based Practice Attitude and Utilisation Survey (EBASE) online.ResultsOf the 5200 registered osteopaths in the UK, 9.9% (517/5200) responded to the invitation, and 7.2% (375/5200) completed the EBASE (< 20% incomplete answers). The demographic characteristics of the survey sample were largely similar to those of the UK osteopathy workforce. The osteopaths reported overall positive attitudes towards EBP, with most agreeing that EBP improves the quality of patient care (69.3%) and is necessary for osteopathy practice (76.5%). The majority reported moderate-level skills in EBP, and most (80.8%) were interested in improving these skills. Participating osteopaths typically engaged in EBP activities 1–5 times over the last month. Barriers to EBP uptake included a lack of time and clinical evidence in osteopathy. Main facilitators of EBP included having access to online databases, internet at work, full-text articles, and EBP education materials.ConclusionsUK osteopaths were generally supportive of evidence-based practice, had moderate-level skills in EBP and engaged in EBP activities infrequently. The development of effective interventions that improve osteopaths’ skills and the incorporation of EBP into clinical practice should be the focus of future research.

UK trained osteopaths' relationship to evidence based practice - An analysis of influencing factors

BackgroundUse of evidence based practice (EBP) remains controversial amongst UK osteopaths and developing an understanding of factors that influence EBP implementation is important for the profession. This study aimed to explore factors that influence the use of EBP amongst UK osteopaths and to compare these with other healthcare professionals. DesignWe used the JQ37 questionnaire to survey UK registered osteopaths (n = 2010). Logistic regression analyses measured associations between attitudes/beliefs, education, knowledge, EBP skills, and clinical guideline access with osteopaths' age, years since graduation, undergraduate and postgraduate degree level, attention to literature, and use of clinical guidelines. Results370 respondents (18.4%) completed the questionnaire: UK osteopaths generally had positive attitudes about EBP. They agreed that EBP was necessary, improved quality of care and assisted clinical decision-making. They also agreed that literature/research findings were useful in their practice and were interested in learning/improving EBP skills necessary to incorporate EBP into practice. Critical appraisal, professional database use, training and familiarity with search strategies were positively associated with younger osteopaths and those with higher levels of degree, or held a research or educational position in addition to clinical practice. Perceived barriers to utilising EBP were lack of time, inapplicability and uniqueness of their osteopathic patient population. Discussion and conclusionGenerally UK osteopaths had positive attitudes about EBP and interested in improving skills needed to implement EBP into practice. However, respondents did not search or use available online practice guidelines, believing guidelines were inapplicable to osteopathic patients, who were unique.

The attitudes and beliefs of UK osteopaths towards the management of low back pain: A cross-sectional study

ObjectivesTo assess the biomedical (BM) and biopsychosocial (BM) attitudes and beliefs of osteopaths towards the management of low back pain (LBP) and whether this is associated with certain demographic variables. MethodsA cross-sectional survey of UK osteopaths was undertaken utilising the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS.PT), which assesses practitioners' treatment orientation (BPS or BM) in LBP management. A demographic questionnaire was used to assess the relationship with certain demographic variables. ResultsResponses were analysed from 107 osteopaths. The mean PABS.PT score for the BM scale was 32.41 (SD 6.32) and 31.99 (SD 4.09) for the BPS scale. There was a statistically significant, negative correlation between the scales. Most osteopaths recognised stress as a contributing factor to LBP and believed in the benefits of exercise for LBP but had diverse views regarding the relationships between pain and tissue damage. None of the demographic variables were associated with the PABS.PT scales. ConclusionOsteopaths' beliefs may indicate an acceptance of the BPS approach, but some still hold strong BM beliefs about pain, which may influence their clinical decision making. Future studies should investigate the impact of osteopaths’ beliefs on their clinical management of LBP.

Quiet dissent: The attitudes, beliefs and behaviours of UK osteopaths who reject low back pain guidance – A qualitative study

IntroductionClinical guidelines are derived from best research evidence and aim to: improve quality of non-specific low back pain (nsLBP) management and identify patients at risk of suffering chronic pain. However, guideline discordant attitudes and beliefs have been identified in healthcare students and practitioners, including osteopaths. DesignA qualitative approach with elements of grounded theory was used to explore underlying attitudes and beliefs of practitioners/students working in a British osteopathic education institution. All participants rejected guideline recommendations for managing nsLBP. A constant comparative method was used to code and analyse emergent themes from transcript data. SubjectsPurposive sampling identified 5 clinic tutors and 7 students; all participated in semi-structured interviews. InterpretationOur central theme was a ‘Precedence of Osteopathy’ over medicine and other manual therapies. Three subthemes were: 1) beliefs about self; 2) perceptions of others; 3) attitudes to guidelines and research. ConclusionParticipants possess a strong professional identity fostered by their education. This bestows autonomy, authority and distinctness upon them. The central theme was modelled as a lens through which participants viewed research: the evidence pyramid appears inverted, explaining why participants value expert opinion above all other evidence. Guidelines and research are perceived to threaten professional identity. In contractual situations that oblige practitioners to follow guidelines management, perhaps reflecting a pragmatic response to health-care market forces, clinical practice is modified. Developing further understanding of osteopaths' attitudes and beliefs and behaviour in respect of evidence-based guidance in education is important to enhance the quality of clinical practice in osteopathy.

Osteopaths in the United Kingdom and Australia: Attitudes, practice, confidence and knowledge with regard to melanoma recognition – An observational questionnaire study

BackgroundMelanoma causes the majority of skin cancer deaths. Australia (AUS) has the world's highest incidence rate, whereas the United Kingdom's (UK) incidence rate is one third of that, but rising rapidly. Osteopaths, many of whom routinely look at least at a part of the patient's skin as part of their osteopathic examination, are potentially in an ideal position for melanoma recognition. ObjectiveTo investigate the current attitudes, practice, confidence and knowledge of osteopaths practising in the UK and Australia with regard to melanoma recognition. Materials and methodsA link to an electronic questionnaire was sent out by e-mail to 2368 osteopaths registered with the General Osteopathic Council (UK) and to 942 osteopaths registered with the Osteopathy Board of Australia. Descriptive and inferential statistics were applied to the quantitative data. The qualitative data were evaluated with a thematic analysis approach. ResultsFollowing exclusions, 378 responses from UK osteopaths and 137 responses from AUS osteopaths were analysed.Melanoma recognition was seen as a valuable part of osteopathic practice by 85% of all osteopaths, but the topic of melanoma constituted only a minor aspect in everyday interactions with patients and colleagues, and confidence-levels with regard to early recognition were in the medium-to-low range only. Participants did not perform better than by chance when discriminating melanoma from benign lesions in picture tests, but scored high in melanoma background knowledge.The vast majority of osteopaths relied on rule-based approaches, for example the ABC(D)(E) acronym, rather than the more promising “ugly duckling sign” (a lesion that appears different from a patient's other moles). ConclusionsUK and AUS osteopaths have a positive attitude towards melanoma recognition, however they demonstrate limited levels of confidence and knowledge. Future research should evaluate the reliability of melanoma recognition rates by osteopaths using the “ugly duckling sign” versus osteopaths using rule-based approaches.

Day-to-day practice of osteopaths using osteopathy in the cranial field, who are affiliated with the Sutherland Cranial College of Osteopathy (SCCO): A national survey by means of a standardised data collection tool

BackgroundThere is very little published information on the practice of osteopaths using osteopathy in the cranial field (OCF) in the UK today. ObjectivesTo describe the practice of UK osteopaths using OCF who are affiliated with the SCCO; create a profile of their patients; their reasons for seeking treatment; the treatment approaches used; and reported responses to treatment. MethodsProspective cohort study of practitioners and their patients. 278 practitioners were invited to take part by completing an enhanced standardised questionnaire for 10 consecutive patients attending for a new episode of care. A patient-reported symptom severity item was included. ResultsOne in five eligible practitioners (n = 58/270) participated in the study. Questionnaires were returned for 530 patients aged between one week and 89 years. Most patients (68%) were specifically seeking cranial osteopathy, a third reported prior NHS treatment/investigation. Presenting problems included musculoskeletal pain/stiffness (69%) and unsettled baby/infantile colic (13%). Half the patients received cranial-only techniques. Only 6% received osteopathic high velocity thrust techniques. Transient treatment reactions within the first 48 hrs were reported by 32% of patients. Mean patient-reported scores of symptom severity fell from 5.9 (maximum score 10) to 1.6 for those patients with a completed episode of care (p < 0.001). ConclusionsThe majority of patients were seeking a particular approach to osteopathic treatment. Babies or infants and those aged over 70 comprise a substantial group of patients. The majority of patients presented with musculoskeletal complaints. Adverse treatment reactions appeared to be transitory in nature. Many patients reported a significant reduction in symptom severity scores following an average of three treatments. Without a control group, we cannot attribute direct causality to this finding. Further testing of the patient-reported symptom severity Visual Analogue Scale (VAS) as a promising outcome tool in this context is warranted.

An investigation to explore personality profiles and practice characteristics of registered UK osteopaths, using the NEO PI-R UK Inventory

An investigation to explore personality profiles and practice characteristics of registered UK osteopaths, using the NEO PI-R UK Inventory

The immediate effects of sigmoid colon manipulation on pressure pain thresholds in the lumbar spine

Visceral manual therapy is increasingly used by UK osteopaths and manual therapists, but there is a paucity of research investigating its underlying mechanisms, and in particular in relation to hypoalgesia. The aim of this study was to investigate the immediate effects of osteopathic visceral mobilisation on pressure pain thresholds. A single-blinded, randomised, within subjects, repeated measures design was conducted on 15 asymptomatic subjects. Pressure pain thresholds were measured at the L1 paraspinal musculature and 1st dorsal interossei before and after osteopathic visceral mobilisation of the sigmoid colon. The results demonstrated a statistically significant improvement in pressure pain thresholds immediately after the intervention (P<0.001). This effect was not observed to be systemic, affecting only the L1 paraspinal musculature. This novel study provides new experimental evidence that visceral manual therapy can produce immediate hypoalgesia in somatic structures segmentally related to the organ being mobilised, in asymptomatic subjects.

Service delivery characteristics of UK osteopaths – a cross sectional survey

Introduction: There is little empirically derived information available about the characteristics of osteopathic services in the UK, the nature of the care they give and the population of patients that receive that care. Whilst the National Council for Osteopathic research has been established in the UK to promote research, little work to date has characterised UK osteopathy. The current study aimed to describe selected aspects of care delivery and osteopathic practice and was used as a vehicle to promote research and data collection to attendees at a series of conferences.

Testing the effectiveness of an innovative information package on practitioner reported behaviour and beliefs: The UK Chiropractors, Osteopaths and Musculoskeletal Physiotherapists Low back pain ManagemENT (COMPLeMENT) trial [ISRCTN77245761

BackgroundLow back pain (LBP) is a common and costly problem. Initiatives designed to assist practitioner and patient decisions about appropriate healthcare for LBP include printed evidence-based clinical guidelines. The three professional groups of chiropractic, osteopathy and musculoskeletal physiotherapy in the UK share common ground with their approaches to managing LBP and are amongst those targeted by LBP guidelines. Even so, many seem unaware that such guidelines exist. Furthermore, the behaviour of at least some of these practitioners differs from that recommended in these guidelines.Few randomised controlled trials evaluating printed information as an intervention to change practitioner behaviour have utilised a no-intervention control. All these trials have used a cluster design and most have methodological flaws. None specifically focus upon practitioner behaviour towards LBP patients. Studies that have investigated other strategies to change practitioner behaviour with LBP patients have produced conflicting results. Although numerous LBP guidelines have been developed worldwide, there is a paucity of data on whether their dissemination actually changes practitioner behaviour. Primarily because of its low unit cost, sending printed information to large numbers of practitioners is an attractive dissemination and implementation strategy. The effect size of such a strategy, at an individual practitioner level, is likely to be small. However, if large numbers of practitioners are targeted, this strategy might achieve meaningful changes at a population level.MethodsThe primary aim of this prospective, pragmatic randomised controlled trial is to test the short-term effectiveness (six-months following intervention) of a directly-posted information package on the reported clinical behaviour (primary outcome), attitudes and beliefs of UK chiropractors, osteopaths and musculoskeletal physiotherapists. We sought to randomly allocate a combined sample of 1,800 consenting practitioners to receive either the information package (intervention arm) or no information above that gained during normal practice (control arm). We collected questionnaire data at baseline and six-months post-intervention. The analysis of the primary outcome will assess between-arm differences of proportions of responses to questions on recommendations about activity, work and bed-rest, that fall within categories previously defined by an expert consensus exercise as either 'guideline-consistent' and 'guideline-inconsistent'.

The UK BEAM trial – a review and discussion

In the hierarchy of evidence that influences healthcare policy, randomised controlled trials (RCTs) are considered by most to be the top individual unit of research. RCTs of treatments for simple, ‘mechanical’ low back pain have consistently shown comparative treatments to have small effect sizes. There are arguments for using both explanatory and pragmatic RCTs to evaluate this field further. The UK Back pain, Exercise And Manipulation (BEAM) trial is the largest pragmatic RCT to have investigated interventions provided by UK osteopaths. The main aim of this review is to describe the UK BEAM trial and to help practitioners judge the external validity of the trial – the extent to which the results of the trial represent their own practices. Two main questions will be addressed: (1) Are the subjects in the trial similar to patients seen in practice? and (2) Are the interventions used in the trial similar to those used in practice? A further aim is to offer some reflections on the strengths and weaknesses of the study. The trial compared the ‘best care’ from General Practitioners (GPs) alone, against best care from GPs plus an exercise class, against best care from GPs plus a manipulation package, against a combination of all of these interventions (best care from GPs plus a manipulation package, followed by an exercise class). The results of the study showed a small, but statistically significant additional positive effect from the manipulation package, as well as smaller positive effects from the exercise package when each was compared to best care from GPs alone. The combination of all three interventions provided a slightly increased effect, but was found to be costly. Whether the size of these positive effects is clinically meaningful remains a point of discussion. Further studies of a more explanatory nature are called for, along with a need to use usual GP care as a control arm if future evaluations are to show the potential of these interventions to contribute to the care of back pain patients.

Attitudes towards prescribing rights: a qualitative focus group study with UK osteopaths

Background A range of practitioners allied to medicine have recently acquired limited prescribing rights and there are moves to extend these rights to others. The opportunity for osteopaths to lobby for limited prescribing rights is available. Objectives The study aimed to identify some osteopaths' attitudes and beliefs about the role of prescribing in osteopathy in the UK and to develop a conceptual model to map a range of beliefs that influence attitudes towards prescribing. Methods A qualitative exploratory study was undertaken. Two minimally moderated semi-structured focus groups were run, each comprising a sample of five opportunistically selected practising osteopaths who were also members of faculty at the British School of Osteopathy. Transcripts of the focus groups were analysed using a Grounded Theory approach and constant comparison procedures. Emergent themes were conceptually coded as matters of ideology (principles, philosophy) or of pragmatics, (relating to either clinical practice or professional issues). Further analysis involved taking an overview of the data extracted by coding and synthesizing those data to form coherent thematic structures under the two supra-themes. Results Three ideological and four pragmatic themes emerged. We focused on the three ideological themes and extracted models, representing extreme positions, labelled as ‘Scientific Osteopathy’, ‘Osteopathic Purity’ and ‘Osteopathic Prescribing’. Conclusions Models have been derived that may explain attitudes towards prescribing. Further work is needed to test whether the models identified in this small qualitative study are valid and whether the themes identified in the focus groups represent issues of importance to the whole profession. Further survey work is recommended to inform decision making at a professional and regulatory level.

Approach to the education of health care professionals within the European Community

The provision of health care is excluded from the treaty of Rome (1957), but the education of health professionals is a Community concern. Specific European directives have been issued for physicians, dentists, nurses, midwives, pharmacists, veterinary surgeons and general practitioners. A general directive lays down principles for recognition of the education of other professionals, including chartered physiotherapists and psychologists. The Community has consistently refused to issue regulations to cover the education and practice of complementary therapists, saying that these are matters entirely for the individual Member States. The UK osteopaths' bill may go some way to resolving some of the problems of complementary therapists within the Community.