Use Of Osteopathic Manipulative Treatment Research Articles

The Use of Osteopathic Manipulative Treatment for a Case of Cervical Radiculopathy

Abstract Cervical radiculopathy is a clinical condition related to dysfunction of the cervical spinal nerve roots. Signs and symptoms include unilateral neck, shoulder, or arm pain; paresthesias of the arm, forearm or hand; diminished muscle tendon reflexes, sensory disturbances; and/or muscle weakness. Cervical radiculopathy is primarily a clinical diagnosis with patients reporting a varying degree of pain and/or neurologic dysfunction along a nerve root distribution. In addition to a thorough history, a detailed physical exam including muscle strength testing, deep tendon reflex testing and sensory testing should be performed to determine the nerve root involved and to further help determine a course of action for the patient. The current case report demonstrates the impact of a somatic dysfunction component on underlying pathology of cervical spondylosis, likely driving the symptomatic component of cervical radiculopathy. By eliminating the somatic dysfunction components with the use of osteopathic manipulative treatment, the patient's system was able to function maximally within existing structural limitations and the symptoms resolved.

Osteopathic Manipulative Treatment for the Management of Irritable Bowel Syndrome: A Case Report

Abstract Irritable bowel syndrome (IBS) is one of the most common disorders of the gastrointestinal system, occurring in 10-20% of the general population.1,2,3 IBS is associated with heavy social and economic costs in the United States, as it results in the second highest cause of work absenteeism and accounts for 25-50% percent of all gastroenterology referrals.1,4 IBS is characterized by recurrent abdominal pain or discomfort and bowel dysfunction as diarrhea, constipation or both, in the absence of any organic cause.3,5,6,7 The pathophysiology of IBS appears multifactorial, although current focus for an understanding of the disease process is on alteration of gastrointestinal motility, visceral hypersensitivity and dysregulation of the brain-gut axis between the autonomic nervous system (ANS) and the enteric nervous system (ENS).6,8 The lack of full understanding of the pathophysiologic processes of IBS means current management options are often ineffective and unreliable, leaving patients with frustrating and sometimes disabling symptoms.2,7 An osteopathic approach using osteopathic manipulative treatment (OMT) to address symptoms related to IBS is an under-explored treatment option. The use of OMT within a treatment plan offers the ability to address manifestations of visceral and somatic dysfunctions unique to each patient. This case report outlines a successful osteopathic manipulative treatment course for a patient suffering from IBS symptoms. Randomized controlled trials (RCTs) for the use of OMT on patients with IBS in the current literature are also reviewed below and provide further preliminary evidence that OMT may be effective in managing IBS symptoms.2,5,7,9,11

The Use of Osteopathic Manipulative Treatment for Treatment of Sore Throat, Headache, and Facial Pain: A Case Report

Abstract This case report describes the unusual occurrence of acute sinusitis without cervical lymphadenopathy and the application of Osteopathic Manipulative Medicine to treatment of the ensuing somatic dysfunctions. Osteopathic Manipulative Treatment techniques normalize the somatic dysfunctions and result in resolution of the patient’s presenting symptoms. Of note, normalization of the SBS torsion appeared to spontaneously resolve the sacral dysfunction in this patient.

Osteopathic manipulative treatment in improving symptoms and quality of life in patients with Graves’ ophthalmopathy: A case report

BackgroundGraves' Disease (GD) is an autoimmune disorder, with ∼50% of GD patients developing Graves’ Ophthalmopathy (GO). Common presentations include lid retraction, exophthalmos, disfigurement, ocular pain, and pressure. Treatment of GD depends on disease severity, ranging from artificial tears to ocular surgeries. Patients with GO symptoms experience a decreased quality of life (QoL) and could benefit from additional treatment options. ObjectiveThis case report describes the use of osteopathic manipulative treatment (OMT) as an adjunct to standard care for a patient with symptomatic GO, and measurement of treatment response with a standardized QoL assessment tool. Clinical featuresClinical evaluation of a patient with GO showed clinical activity score to be 4 with oppressive feeling behind globes, hyperemia, and eyelid edema. Corneal displacement measured by Hertel exophthalmometer indicated increased proptosis. CT scan showed enlarged extraocular muscles bilaterally, with signs of edema in retrobulbar fat. Visual acuity and optic nerves were within normal limits. Intervention and outcomesThis case report demonstrates the use of OMT in long-term reduction of ocular pain and pressure by relieving orbital myofascial tension along with improving ocular circulation, in a patient with GO. Using the European Group On Graves’ Orbitopathy QoL questionnaire, the patient noted better quality of life (93, 81.3 for pretreatment visual and appearance scores, respectively, and 100, 87.5 for post-treatment visual and appearance scores, respectively) and perceived reduced exophthalmos. ConclusionsProviding OMT as a cost effective, non-invasive treatment option for GO symptoms could meet a significant need for GO patients and warrants further study.

Utilization and reimbursement trends of osteopathic manipulative treatment for Medicare patients: 2000-2019.

Osteopathic manipulative treatment (OMT) has been established as a beneficial and noninvasive treatment option for multiple conditions. With the total number of osteopathic providers tripling and the subsequent increase in osteopathic physician representation, we would expect the clinical use of OMT to increase accordingly. To that end, we evaluated the utilization andreimbursement of OMT services among Medicare beneficiaries. Current procedural terminology (CPT) codes 98925 to 98929 were accessed from the Center for Medicare and Medicaid Services (CMS) from 2000 to 2019. These codes indicate OMT treatment, 98925 (1-2 body regions treated), 98926 (3-4 body regions treated), 98927 (5-6 body regions treated), 98928 (7-8 body regions treated), and 98929 (9-10 body regions treated). Monetary reimbursement from Medicare was adjusted for inflation, and total code volume was scaled to codes per 10,000 beneficiaries to account for the increase in Medicare enrollment. Overall OMT utilization declined between 2000 and 2019 by 24.5%. A significant downward trend in the utilization of CPT codes for OMT involving fewer body regions (98925-98927) was observed, and was contrasted by a slight upward trend in the use of codes for more body regions (98928, 98929). The adjusted sum reimbursement of all codes decreased by 23.2%. Lower value codes showed a higher rate of decline, whereas higher value codes changed less dramatically. We conjecture that lower remuneration for OMT has disincentivized physicians financially and may have contributed to the overall decline in OMT utilization among Medicare patients, along with a decreased number of residencies offering specific training in OMT, and increased billing complexity. In considering the upward trend of higher-value code usage, it is possible that some physicians are increasing the comprehensiveness of their physical assessment and associated OMT to reduce the overall financial impact of reimbursement cuts.

The Use of Osteopathic Manipulative Treatment as a Therapy for Mental Health Disorders: A Review

There is historical and modern evidence for the use of osteopathic manipulative treatment (OMT) to treat patients with mental health disorders. The first section of this article examines the historical perspective, focusing intently on the Still-Hildreth Sanatorium. This hospital specialized in the osteopathic treatment of mental illnesses. While it was open, it saw patients with diverse mental disorders and reported exceptional recovery rates. However, some data from this institution were destroyed, so this perspective is incomplete. The second part of this article examines modern osteopathic research into this topic. Although there is some literature supporting the use of OMT for mental disorders, overall, it is underwhelming. Few mental illnesses have been researched, and for those that have been, there are too few studies to reliably assess the outcomes. Moreover, these studies have limited sample sizes, further affecting their credibility. To accurately gauge the benefits of OMT, future work should overcome these limitations.

Osteopathic manipulative treatment of patients with chronic low back pain in the United States: a retrospective cohort study.

The practice of osteopathic manipulative treatment (OMT) varies substantially across nations. Much of this variability may be attributed to disparate international educational, licensing, and regulatory environments that govern the practice of osteopathy by nonphysicians. This is in contrast with the United States, where osteopathic physicians are trained to integrate OMT as part of comprehensive patient management. This study will analyze the factors associated with OMT use and its outcomes when integrated within the overall medical care for chronic low back pain (CLBP) provided by osteopathic physicians in the United States. A retrospective cohort study was conducted within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION) from April 2016 through April 2022 to study the effectiveness of OMT integrated within medical care provided by osteopathic physicians. The outcome measures, which included pain intensity, pain impact, physical function, and health-related quality of life, were assessed with the National Institutes of Health Minimum Dataset, Patient-Reported Outcomes Measurement Information System, and Roland-Morris Disability Questionnaire. A total of 1,358 adults with CLBP entered the cohort (mean age, 53.2 years; 74.4% female), 913 completed the finalquarterly encounter, 348 were in various stages of follow-up, and 97 had withdrawn. Blacks (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.21-0.63; p<0.001), cigarette smokers (OR, 0.56; 95% CI, 0.33-0.93; p=0.02), and nonsteroidal anti-inflammatory drug users (OR, 0.59; 95% CI, 0.43-0.81; p=0.001) were less likely to have utilized OMT in the multivariable analysis. Mean between-group differences among 753 participants with no OMT crossover and complete follow-up favored OMT: 1.02 (95% CI, 0.63-1.42; p<0.001) for pain intensity; 5.12 (95% CI, 3.09-7.16; p<0.001) for pain impact; 3.59 (95% CI, 2.23-4.95; p<0.001) for physical function, and 2.73 (95% CI, 1.19-4.27; p<0.001) for health-related quality of life. Analyses involving propensity-score adjustment and inclusion of participants with missing data yielded similar conclusions. None of 12 prespecified participant characteristics demonstrated an OMT interaction effect. OMT integrated within medical care provided by osteopathic physicians for CLBP was associated with improved pain and related outcomes. Its use may be facilitated by the growing osteopathic physician workforce in the United States and adherence to relevant clinical practice guidelines.

The effect of osteopathic manipulative medicine and other manual manipulation techniques on dysmenorrhea

Introduction Worldwide, menstrual pain affects up to 90% of reproductive-age women. Dysmenorrhea can cause significant disruption to the daily lives of menstruating persons and absenteeism from work or school. The combination of first line treatment ineffectiveness and significant prevalence calls for further investigation into alternative treatments such as Osteopathic Manipulative Treatment (OMT). Methods This meta-analysis aims to aggregate the evidence supporting the use of OMT as a successful treatment option to reduce pain symptoms due to dysmenorrhea. The criteria for accepted articles in our analysis included the studies that mentioned primary dysmenorrhea, the use of a quantitative pain scale, and the inclusion of only patients with regular cycle lengths. Results A total of four studies were compiled to compare the relative improvement that manual manipulative treatments had on reported pain intensity of primary dysmenorrhea, using the Numeric Rating Scale (NRS). Total number of subjects in the experimental group was 88. The mean numeric pain rating scale amongst the studies was 5.4 before treatment and 2.6 after. The p-value of 0.023 is &amp;lt;0.05 and therefore statistically significant. Conclusion The meta-analysis combining data from four studies showed significant improvement of dysmenorrhea when treated with manual manipulative treatments. Findings warrant further investigation with a larger sample size with utilization of standardized OMM regimen.

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.

Osteopathic manipulative treatment use among family medicine residents in a teaching clinic.

Osteopathic Principles and Practice (OPP), including osteopathic manipulative treatment (OMT) is the core foundation of the education provided by osteopathic medical schools. Multiple studies performed over the past 25years have demonstrated that a dwindling number of osteopathic physicians utilize OMT in their practice, despite 95% of osteopathic family physicians perceiving OMT as an effective treatment modality. The objective of this study is to quantify how often OMT is being performed by residents in an osteopathically recognized family medicine training clinic and to identify the perceived barriers to performing OMT. Fifteen family medicine residents were given access to an anonymous written survey for three 2week periods. The survey allowed them to input the total number of patient encounters for their half clinic day, the encounters in which OMT was perceived to be appropriate, the encounters in which OMT was performed, and the reasoning for encounters in which OMT was not performed. Surveys were collected anonymously, and data were input into a datasheet in which results were calculated. A total of 101 survey responses were collected for a total of 304 patient encounters. OMT was performed in 5/304 (1.6%) encounters, yet it was perceived to be appropriate in 60/304 (19.7%) encounters. The primary documented reason that OMT was deferred was due to time constraints (42/50 responses, or 70.0% of the encounters in which OMT was deemed appropriate). This study highlights time as the main reason OMT is deferred by residents in a teaching clinic. This provides insight into potential interventions in a training clinic to increase the use of OMT by family medicine residents.

Preventing progression from chronic to widespread pain and its impact on health-related quality of life: a historical cohort study of osteopathic medical care.

It is generally acknowledged that osteopathic physicians take a holistic approach to patient care. This style may help prevent the progression of painful musculoskeletal conditions, particularly if combined with osteopathic manipulative treatment (OMT). The study aimed to determine if osteopathic medical care lowers the risk of progression from localized chronic low back pain to widespread pain and lessens the impact of pain on health-related quality of life. A historical cohort study was conducted within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION Pain Research Registry) using data acquired from April 2016 through March 2021. Registry participants aged 21-79 years with chronic low back pain at the baseline encounter were potentially eligible for inclusion if they had a treating physician, completed all four quarterly follow-up encounters, and did not report physician crossover at the final 12-month encounter. Eligible participants were classified according to the type of physician provider at baseline and thereby into osteopathic or allopathic medical care groups. Participants were also classified according to prior use of OMT at the final encounter. Widespread pain was measured at baseline and each quarterly encounter to determine the period prevalence rate of widespread pain and its severity over 12months using the Minimum Dataset for Chronic Low Back Pain recommended by the National Institutes of Health. Participants who reported "not being bothered at all" by widespread pain during each encounter were classified as not having widespread pain, whereas those who were bothered "a little" or "a lot" at any quarterly encounter were classified as having widespread pain. The severity of widespread pain was measured by summing participant responses at each encounter. The Patient-Reported Outcomes Measurement Information System was used at each encounter to measure health-related quality-of-life (HRQOL) scores for physical function, anxiety, depression, fatigue, sleep disturbance, participation in social roles and activities, and pain interference with activities. A total of 462 participants were studied, including 101 (21.9%) in the osteopathic medical care group and 73 (15.8%) who used OMT. The mean age of participants at baseline was 52.7±13.2 years (range, 22-79 years) and 336 (72.7%) were female. A lower period prevalence rate of widespread pain was observed in the osteopathic medical care group (OR, 0.47; 95% CI, 0.27-0.81; p=0.006) and in the OMT group (OR, 0.40; 95% CI, 0.21-0.75; p=0.004), although the latter finding did not persist after adjustment for potential confounders. The osteopathic medical care and OMT groups both reported lower widespread pain severity. The osteopathic medical care group also reported better age- and sex-adjusted outcomes for each of the seven HRQOL dimensions throughout the study. The OMT group reported better outcomes in five of the HRQOL dimensions. This study supports the view that osteopathic physicians practice a holistic approach to medical care that manifests itself through a lower risk of progression from chronic low back pain to widespread pain, lower widespread pain severity, and lesser deficits in HRQOL. Similar findings were generally associated with OMT use.

Efficacy of osteopathic manipulative treatment in patients with Parkinson’s disease: a narrative review

Parkinson's disease (PD) is a neurodegenerative disease that leads to impaired motor and non-motor function in patients. PD is non-curative and gradually reduces quality of life, leading patients to seek treatment for symptom management. Osteopathic manipulative treatment (OMT) applies the biomechanical, neurologic, circulatory, metabolic, and psychosocial models in approaching and treating the major symptomatology of PD patients. This article evaluates the literature published in the past 10 years analyzing evidence on OMT and its functional application on gait, balance, motor function, bradykinesia, and autonomic dysfunctions, and to identify promising avenues for further investigation. The authors obtained studies from the research databases MEDLINE/PubMed, ScienceDaily, and EBSCO, as well as the Journal of American Osteopathic Association's published archives. Searches were conducted in December 2020 utilizing the search phrases "OMM" (osteopathic manipulative medicine), "OMT," "osteopathic," "Parkinson Disease," "manual therapy," "physical therapy," "training," "autonomics," "gait," and "balance." Articles published between 2010 and 2021 including subjects with Parkinson's disease and the use of OMT or any other form of manual therapy were included. Five authors independently performed literature searches and methodically resolved any disagreements over article selection together. There were a total of 10,064 hits, from which 53 articles were considered, and five articles were selected based on the criteria. The progressive nature of PD places symptom management on the forefront of maintaining patients' quality of life. OMT has demonstrated the greatest efficacy on managing motor-related and neurologic symptoms and assists in treating the greater prevalence of somatic dysfunctions that arise from the disease. Research in this field remains limited and should be the target of future research.

Conductive Hearing Loss: A Case Report

Abstract In this case report, osteopathic manipulative treatment restored hearing to an 8-year-old female suffering from conductive hearing loss. Numerous factors can result in hearing loss. In children and adolescents, mild or greater hearing loss occurs with a prevalence of 3.1%.1 Current osteopathic literature focuses on conductive hearing loss due to middle ear effusion (MEE).This case report examines an 8-year-old female presumed to have permanent conductive hearing loss without MEE after a traumatic ATV accident. The use of osteopathic manipulative treatment (OMT) resulted in complete resolution of the patient’s conductive hearing loss. To the authors’ knowledge, this is the first case report documenting the successful use of OMT to treat conductive hearing loss without MEE. Being able to recognize and understand the connection between the primary respiratory mechanism (PRM), which includes the cranial bones and nerves, allows an osteopathic physician to provide a unique approach to patient care and the use of OMT as a treatment modality for conductive hearing loss should be considered.

Patient-centered care or osteopathic manipulative treatment as mediators of clinical outcomes in patients with chronic low back pain.

Patient-centered care is often considered a characteristic of osteopathic medicine, in addition to the use of osteopathic manipulative treatment (OMT) in such musculoskeletal conditions as low back pain. This study aimed to determine if patient-centered care or OMT are mediators of the clinical outcomes of osteopathic medicine in patients with chronic low back pain. A comparative effectiveness study was conducted within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION Pain Research Registry). Eligible patients met the diagnostic criteria recommended by the National Institutes of Health Task Force on Research Standards for Chronic Low Back Pain and completed four consecutive quarterly encounters between April 2016 and November 2020. The Consultation and Relational Empathy instrument for patient-centered care was used at the baseline encounter and OMT use was measured at the final encounter. The clinical outcome measures included low back pain intensity on a numerical rating scale (NRS) from 0 to 10, back-related functioning on the Roland-Morris Disability Questionnaire (RMDQ), and pain impact on the National Institutes of Health Minimum Dataset for Chronic Low Back Pain (NIH-MDS). A parallel multiple mediator model was used to compute the direct and indirect effects of osteopathic medicine in achieving each of the three clinical outcomes. The 404 study patients had a mean age of 52.2 years (standard deviation, 13.1 years) and 288 (71.3%) were female. The 88 (21.8%) patients treated by osteopathic physicians reported more favorable scores for patient-centered care (mean, 41.3; 95% CI 39.0-43.5) than patients treated by allopathic physicians (mean, 38.0; 95% CI 36.8-39.3) (p=0.02). Fifty-six (63.6%) patients treated by osteopathic physicians used OMT. The age- and sex-adjusted outcomes for patients of osteopathic vs. allopathic physicians across all four encounters were: mean, 5.4; 95% CI 5.0-5.7 vs. mean, 5.9; 95% CI 5.7-6.1 on the NRS for pain intensity (p=0.01); mean, 11.3; 95% CI 10.1-12.6 vs. mean, 14.0; 95% CI 13.3-14.7 on the RMDQ for back-related disability (p<0.001); and mean, 26.8; 95% CI 24.9-28.7 vs. mean, 30.1; 95% CI 29.1-31.1 on the NIH-MDS for pain impact (p=0.002). Patient-centered care did not mediate any outcome of osteopathic medicine, whereas OMT mediated better outcomes in low back pain intensity. This appears to be the first study to simultaneously address both patient-centered care and OMT as potential mediators of the effect of osteopathic medicine in treating chronic pain. Patient-centered care did not mediate the effects of osteopathic medicine and OMT only mediated outcomes relating to low back pain intensity. More research is needed to identify other aspects of osteopathic medicine that mediate its beneficial effects in patients with chronic low back pain.

The Lymphatic System: An Osteopathic Review.

Osteopathic principles and philosophy suggest the use of osteopathic manipulative treatment (OMT) to restore, augment, or facilitate lymphatic fluid flow to maintain body fluid balance, and/or to stimulate immune system responses to aid in the recovery from illness and maintain normal body defense mechanisms. This review provides an osteopathic view of the role of the lymphatic system in health and disease, with an emphasis on the use of OMT to alleviate somatic dysfunctions (SD) that inhibit the optimum function of the lymphatic system. The current evidence base is reviewed for the use of OMT to assist in restoring or augmenting lymphatic system function to help patients recover from illness and maintain health and wellness. An overview is provided on how osteopathic principles and philosophy relative to the immune system are applied in practice. A literature search was conducted using databases such as Medline, PubMed, Ostmed-DR, and Scopus, focusing on osteopathic approaches to the lymphatic system. Keywords used included osteopathic manipulative medicine, OMT, and lymphatic manual treatment or therapy. Current osteopathic textbook information was also surveyed. There is support for the application of osteopathic principles and OMT for certain conditions that involve the lymphatic system. More prospective research is needed.

Integrating Osteopathic Evaluation and Treatment in a Case of Opioid-Induced Hyperalgesia

Abstract This paper reviews a multimodal approach to the treatment of acute pain. Early recognition of systemic changes in pain indicators may be efficacious for the patient and practitioner to understand the subjective pain response. The application of osteopathic manipulative medicine may be beneficial during de-escalation therapy of opioid pain medication when the patient is experiencing symptoms consistent with opioid-induced hyperalgesia syndrome. Improved education and recognition of opioid-induced hyperalgesia can potentially improve medical management with the use of osteopathic manipulative treatment.

The use of osteopathic manipulative treatment in the newborn nursery and its effect on health in the first six months of life: A retrospective observational case-control study

BackgroundLimitations of traditional medicine and rising interest in complementary medicine call for a closer look at the potential relevance of manual medicine, specifically osteopathic manipulative treatment (OMT) in children. ObjectiveTo conduct a retrospective observational pilot study of babies who received OMT in the newborn nursery compared to those who did not, by quantifying their outpatient health issues in the first 6 months of life, and to determine the feasibility of further definitive randomized controlled trials of a similar nature. DesignRetrospective chart review of the first 6 months of life from pediatric clinic records of 58 case-matched pairs of children, half of whom received OMT as part of their routine newborn care by virtue of their physician “call” assignment to the author. The sample from which the case-matched control group was chosen were babies who had received routine allopathic newborn care without OMT. Both groups received their pediatric care in the same academic ambulatory clinic and received no further OMT. MethodsOutpatient paper chart review consisted of tabulation by points of the following variables: mention of spitting/vomiting, gassiness, food intolerance, irritability/sleeplessness, colic suggested or diagnosed, episodes of otitis media, frequency of antibiotics given, frequency of upper respiratory infections, frequency of lower respiratory problems, diarrhea, and rashes, separated by month of visit in which the variable was reported. ResultsExploratory analysis by Pearson Chi-square yielded a few statistically significant differences between the 2 groups, in favor of the OMT-treated group, including Month 2 food intolerance (Χ21 = 4.14, P = .04), Month 3 colic suggested (Χ21 = 4.14, P = .04), Month 5 spitting/vomiting (Χ21 = 8.59, P = .003), and Month 5 antibiotic usage (Χ21 = 6.33, P = .012). ConclusionsFindings point to the need for further research in this area based on the suggestion that OMT given to a newborn can positively affect that baby's short-term and quite possibly long-term health, specifically related to GI complaints and irritability. Other studies would benefit from a variety of methodologic changes, including correlation of timing of administration of OMT with possible symptoms and changes in those symptoms over longer periods of observation, as well as correlation of anatomic osteopathic findings with specific symptoms.

Use of Lean Management to Increase Efficiency and Osteopathic Manipulative Treatment in a Family Medicine Residency

Objectives: To determine Lean management's ability to improve the efficiency of residents and increase osteopathic manipulative treatment (OMT) in a family medicine residency clinic. &#x0D; Methods: A Key Performance Indicator Board (KPI), a process of Lean management, was created in a residency clinic by various staff. Patient wait times were chosen for the quality measure and daily huddles took place to track progress. A “5-why” was conducted to determine the reasons for failure to meet goals. Faculty used this information to create the 5 “S” of Efficiency method to help residents improve timeliness in caring for complicated patients. Comparisons of the number of patient visits failing wait time goals and total OMT performed before and after the intervention was analyzed. Chi-square was used for statistical analysis and the p-value was set at 0.05. &#x0D; Results: Implementation of the 5 “S” of Efficiency method resulted in a significantly lower percentage of days failing the wait time goal in comparison to months before the intervention (p = 0.00001): the average percentage of failed days decreased from 43.1% to 10.4% with the intervention. Enacting Lean management also resulted in a significantly greater percentage of billed OMT billing codes (6.8% vs. 5.3%) (p = 0.03). &#x0D; Conclusion: This study indicates that the use of Lean may reduce patient wait times and lead to increased OMT use among family medicine residents. Use of Lean or the 5 “S” of Efficiency method may help other osteopathic programs attempting to improve care; however, further research is indicated.

Support for osteopathic manipulative treatment inclusion in chronic pain management guidelines: a narrative review.

Osteopathic manipulative treatment (OMT) is used to treat chronic pain conditions. However, few guidelines focusing on chronic pain management include recommendations for OMT. To evaluate previous literature on the use of OMT for improving chronic pain. A literature search was conducted on MEDLINE/PubMed and ScienceDirect on August 26-27, 2019, using theterms "osteopathic," "chronic," and "pain," yielding a total of 312 MEDLINE/PubMed articles and 515 ScienceDirect articles. Eligibility criteria required that studies investigate pain, functional status, or medication usage through an experimental design, focusing on human subjects with chronic pain who had various forms of OMTadministered by osteopathically trained individuals in which the comparator group received no intervention, asham or placebo, or conventional care. Three authors independently performed literature searches and methodically settled disagreements over article selection. In the 22 articles included in our study that examined OMT use in chronic pain conditions, we evaluated primary outcomes of pain (22; 100%) and functional status (20; 90.9%), and the secondary outcome of medication usage (3; 13.6%). The majority of articles showed that OMTresulted in a significant decrease in pain levels as compared to baseline pain levels or the control group (20;90.9%) and that OMT resulted in an improvement in functional status (17; 77.3%). In articles that did not find a significant difference in pain (2; 9.1%) or functional status (3;13.6%), there were overall outcomes improvements noted. All articles that investigated medication usage (3;13.6%) showed that OMT was effective in decreasing patients' medication usage. Our study was limited by its small sample size and multimodal comparator group exclusion. OMT provides an evidence-based management option to reduce pain levels, improve functional status, and decrease medication usage in chronic pain conditions, especially low back pain (LBP). Pain management guidelines should include OMT as a resource to alleviate chronic pain.

Osteopathic manipulative treatment for allopathic physicians: piloting a longitudinal curriculum.

Under the Accreditation for Graduate Medical Education (ACGME) single accreditation system, there is likely to be increasing interest and opportunity for teaching osteopathic manipulative treatment (OMT) to allopathic residents and residency faculty. When learning OMT, allopathic physicians (MDs) have distinct needs compared with osteopathic medical students. For example, MDs already have a foundation in anatomy and medical vocabulary, but incorporating an osteopathic approach to patient care may require a paradigm shift. Thus, a unique approach to osteopathic education for MDs in residency programs with osteopathic recognition (OR) is needed. To create a longitudinal OMT elective for allopathic residents and residency faculty and assess its impact on attitudes and confidence regarding osteopathic principles and treatment. Drawing from standard texts used during preclinical osteopathic education, a blended online and in-person laboratory modular curriculum for the OMT elective course was developed by osteopathic residents and faculty within the Department of Family Medicine and Community Health at the University of Wisconsin in Madison. The modalities of muscle energy, counterstrain, myofascial release, and soft tissue were included; the curriculum also reviewed autonomic physiology, somatovisceral, and viscerosomatic reflexes. A quality improvement study of the course was conducted via pre- and postcourse surveys to assess its impact on perceptions and confidence regarding the theory and practice, referral, and use of OMT. A precourse survey was distributed before the first module to obtain background information and assess participants' prior OMT exposure, among other things. Nine months after the course ended, a corresponding postcourse survey was distributed. Pre- and postcourse surveys were individually matched to improve statistical analysis, using unique identifiers. Also, following each laboratory, a postlaboratory survey was collected about the participant's experience for that lecture and for laboratory-specific quality improvement purposes. Two years after course completion, graduates were reached via phone or email for informal interviews to assess the perceived long-term impact from the elective. Eleven MDs from a total potential pool of 26 residents and approximately 120 attending physicians enrolled in the course; eight (72.7%) completed all modules and pre- and postcourse evaluations. Participants reported statistically significant gains in attitudes and confidence regarding OMT ("knowledgeable regarding OMT principles": precourse mean, 2.50 [0.76], vs. postcourse mean, 3.37 [0.52]; p=0.021; "know how to treat using OMT": precourse mean, 2.25 [1.39], vs. postcourse mean, 3.12 [1.25]; p=0.041). Several participants (five; 62.5%) had completed prior OMT training. There was an increase, albeit nonsignificant, in the use of OMT, with more providers using OMT (precourse mean, five, vs. postcourse mean, six; p=0.171), and providers using OMT more often (precourse OMT use monthly or more often, three, vs. postcourse OMT use monthly or more often, six; p=0.131). Implementing a longitudinal elective curriculum is a feasible way to improve attitudes and confidence in OMT for MDs involved in a family medicine residency. Whether our elective leads to competency in OMT for allopathic residents and faculty remains to be formally evaluated. Our pilot established the feasibility and led to a revision of our curriculum; the elective continues to occur yearly. Future analyses will focus on competency assessment.