Posts by: Patrick van Dun

The rationale for including osteopathic manipulative treatment in the management of infections: a hermeneutic review

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As the prevalence of drug-resistant infections continues to outpace the development of new antibiotics, we must explore all reasonable options for enhancing the effectiveness of existing anti-infectives. The emergence of novel pathogens without initial drug treatments or vaccines, typified by the severe acute respiratory syndrome coronavirus-2 pandemic, further underscores the need for non-pharmacologic adjunctive measures for infection management. Osteopathic manipulative treatment (OMT) may represent such an adjunct … ABSTRACT

Osteopaths’ Perspectives on Patient Adherence to Self-Management Strategies: A Qualitative Content Analysis

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Self-management strategies (SMS) have been found to positively affect healthcare outcomes. However, clinicians often encounter patients with differing levels of adherence to SMS, making it an imperative to recognise and manage the factors underpinning patient adherence to such strategies. To this end, this study explored practitioner-perceived barriers and enablers that affect patient adherence to SMS … ABSTRACT

Cost comparison of osteopathic manipulative treatment for patients with chronic low back pain

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Chronic low back pain (cLBP) is the second leading cause of disability in the United States, with significant physical and financial implications. Development of a multifaceted treatment plan that is cost effective and optimizes patients’ ability to function on a daily basis is critical. To date, there have been no published prospective studies comparing the cost of osteopathic manipulative treatment to that of standard care for patients with cLBP. The objectives of this study are to contrast the cost for standard of care treatment (SCT) for cLBP with standard of care plus osteopathic manipulative treatment (SCT + OMT) … MORE

Prognostic factors for pain chronicity in low back pain: a systematic review

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Low back pain is the leading cause for years lived in disability. Most people with acute low back pain improve rapidly, but 4% to 25% of patients become chronic. Since the previous systematic reviews on the subject, a large number of new studies have been conducted. The objective of this article was to review the evidence of the prognostic factors behind nonspecific chronic low back pain. A systematic literature search was performed without date limitation from the MEDLINE, Cochrane library, and Medic databases. Specific inclusion criteria were used, and risk factors before the onset of chronic symptoms were searched. Study quality was assessed by 2 independent reviewers. One hundred eleven full articles were read for potential inclusion, and 25 articles met all the inclusion criteria. One study was rated as good quality, 19 studies were rated as fair quality, and 5 articles were rated as poor quality. Higher pain intensity, higher body weight, carrying heavy loads at work, difficult working positions, and depression were the most frequently observed risk factors for chronic low back pain. Maladaptive behavior strategies, general anxiety, functional limitation during the episode, smoking, and particularly physical work were also explicitly predictive of chronicity. According to this systematic review, several prognostic factors from the biomechanical, psychological and psychosocial point of view are significant for chronicity in low back pain … MORE

The legacy and implications of the body-mind-spirit osteopathic tenet: a discussion paper evaluating its clinical relevance in contemporary osteopathic care

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A current osteopathic tenet inherited from Native American principles involves viewing each person as a dynamic interaction of body-mind-spirit (BMS). Because of its traditional medicine heritage and current evidence-based approach, the osteopathic profession is, arguably, uniquely positioned to promote evidence-informed person-centered approaches that transcend improvements in pain and musculoskeletal function. It may be particularly relevant in the context of integrating the BMS tenet into osteopathic care according to the diversity of patients’ values and sociocultural assumptions towards health, symptoms, and subsequent care, which range from the typical Western to complementary and alternative medicine perspectives. There is currently a lack of robust clinical practice frameworks in this area, confusing patients and practitioners and blurring professional identities. The current commentary provides an opportunity to initiate discussions in the profession with a rationale for creating a roadmap to develop an evidence-informed framework for osteopathic care that integrates the BMS tenet … ABSTRACT

Direct and mediated effects of treatment context on low back pain outcome: a prospective cohort study

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Contextual components of treatment previously associated with patient outcomes include the environment, therapeutic relationship and expectancies. Questions remain about which components are most important, how they influence outcomes and comparative effects across treatment approaches. We aimed to identify significant and strong contextual predictors of patient outcomes, test for psychological mediators and compare effects across three treatment approaches … MORE

Digital health technologies for osteopaths and allied healthcare service providers: A scoping review

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Digital health technologies are poised to revolutionise the healthcare industry by improving accessibility to services and patient outcomes. The novel coronavirus disease-19 (COVID-19) pandemic has presented unprecedented challenges for the delivery of allied healthcare and has catalysed rapid adoption of telehealth. As such, allied healthcare consumers and providers stand to benefit from the capabilities of the digital health movement, ultimately justifying a scoping review of current and emerging technologies. The objective of this scoping review is to provide decision makers with up-to-date information on the allied health applications of new and emerging digital health technologies; their evidence of efficacy, scope of use, and limitations … ABSTRACT

Effect of osteopathic manipulative therapy on pulmonary function testing in children with asthma

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Asthma is a leading cause of pediatric chronic illness, and poor disease control can lead to decreased quality of life and impaired academic performance. Although osteopathic manipulative treatment (OMT) has been shown to have positive effects on pulmonary function in adult patient populations, less is known about its impact in children. The objectives of this study was to evaluate changes in pulmonary function testing (PFT) in pediatric patients on the same day they received OMT compared with PFT in those who received usual care … MORE

Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine

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Chronic pain is a leading cause of disability globally and associated with enormous health-care costs. The discrepancy between the extent of tissue damage and the magnitude of pain, disability, and associated symptoms represents a diagnostic challenge for rheumatology specialists. Central sensitisation, defined as an amplification of neural signalling within the CNS that elicits pain hypersensitivity, has been investigated as a reason for this discrepancy. Features of central sensitisation have been documented in various pain conditions common in rheumatology practice, including fibromyalgia, osteoarthritis, rheumatoid arthritis, Ehlers-Danlos syndrome, upper extremity tendinopathies, headache, and spinal pain. Within individual pain conditions, there is substantial variation among patients in terms of presence and magnitude of central sensitisation, stressing the importance of individual assessment. Central sensitisation predicts poor treatment outcomes in multiple patient populations. The available evidence supports various pharmacological and non-pharmacological strategies to reduce central sensitisation and to improve patient outcomes in several conditions commonly seen in rheumatology practice. These data open up new treatment perspectives, with the possibility for precision pain medicine treatment according to pain phenotyping as a logical next step. With this view, studies suggest the possibility of matching non-pharmacological approaches, or medications, or both to the central sensitisation pain phenotypes … MORE

Sham treatment effects in manual therapy trials on back pain patients: a systematic review and pairwise meta-analysis

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The objective of this systematic review and meta-analysis was to assess the effects and reliability of sham procedures in manual therapy (MT) trials in the treatment of back pain (BP) in order to provide methodological guidance for clinical trial development … MORE

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