Rethinking causation and mechanisms in osteopathy and physical intervention trial design: the positivist-realist continuum

There has been renewed interest in mechanistic theory within osteopathy and the associated musculoskeletal professions, particularly regarding the role mechanisms play in osteopathic, manual and other physical interventions. Evidence-Based Medicine which commits to evidential pluralism (explicit incorporation of mechanistic evidence to inform trial design, through the selection of more meaningful controls and measuring more relevant outcomes) is known as Evidence-Based Medicine Plus (EBM+).

This position paper introduces the concept of EBM+ to the osteopathy and MSK research community, and proposes the evolution of a theory of mechanisms that borrows from both positivist and realist traditions to better account for the mechanistic effects of physical interventions that are described in trials as specific, non-specific and contextual effects, and which have a relevance for clinical practice and education … ABSTRACT