CORPP's Vision about Osteopathic Research

“No research is osteopathic by itself. The investigator must make it osteopathic by interpreting it in light of osteopathic philosophy and practice.” Patterson, 2005

 

The two most important questions within the framework of osteopathic scientific research are: “Does osteopathy work?” and “How does it work?”

The first question is a question about effectiveness and efficiency of osteopathy as a form of medicine and is answered best by means of clinical research. It is also an important question with regard to the recognition of osteopathy by the community.

The proper scientific method when answering this question, because it relates best to that for which we stand, is the pragmatic (randomized) clinical trial1,2 (PCT). Here, a comparison is made of osteopathy with a no treatment control group and/or a reference control group (“gold standard”).

Without wanting to go deeply into the pros and cons of such research, we are convinced that the PCT answers best to the osteopathic principles. First of all, it is important to verify the effectiveness of osteopathy with different complaints/illnesses/syndromes, without immediately wanting to know the exact components of the osteopathic intervention, which could be responsible for the observed difference between the examined groups4.

When carrying out a clinical study, in theory, one should choose both objective and subjective “outcome data” when assessing the effect of an osteopathic treatment. It is important to evaluate not only the parameters with regard to the illness, but also with regard to the person (“quality of life”).

Furthermore, it also seems important to carry out the clinical research multicentrically, so that not so much the effect of an osteopath, but that of osteopathy is examined.

When we consider at most the underlying osteopathic principles while carrying out the clinical osteopathic research, some specific questions will indeed remain open. In the list below, only a few questions, points of particular interest but also possible solutions are enumerated.

  • The osteopath focuses on the patient and not so much on the pathology; in the treatment, the osteopath focuses on an improvement of “function” and is salutogenetically5 oriented. As opposed to what was stipulated before, this does not entirely justify the intention of mainly pathogenetically oriented research questions such as: “What is the effect of an osteopathic treatment with...” (all possible pathologies and/or syndromes are listed here).
  • When carrying out our PCT’s it might be advisable to switch from the before mentioned “black box approach” to an “open box approach” as much as possible. In this open box approach, the osteopath gives a, possibly detailed, indication or justification of his diagnosis and therapeutical actions with the patients from the test group6. This, however, without wanting to aim at “ICD7 like” criteria for osteopathy, because this is contradictory to the osteopathic principles and does not correspond to the clinical practice (see first point).
  • Treatments are only useful if they bring the patient to a new, better functional level, not if they only relieve a symptom. Do we really bring our patient to a healthier level? How should our clinical aim be and which parameters are useful to verify this?
  • The outcome data should be chosen purposefully (“surrogate, intermediate, long term outcomes”) and should indicate to which extent the distinguishing approach of osteopathic medicine contributes to healthcare.
  • ...


Today, the European research is mainly carried out within the framework of a Master’s project of osteopathy students (DO and/or MSc-thesis). Although the demand for clinical studies is very large and politically of great importance for our professional group, it is for different reasons not always obvious to leave this kind of research to students. As beginning osteopath, one does usually not have the practical skills to conduct this kind of research (unless one has the treatments done by a more experienced osteopath); recruiting patients is not easy and can make the research last a long time which causes it to fall beyond the period of the assignment; one must usually have a larger patient population; ... This kind of research appeals to many students, because it relates very closely to the everyday practice. Nevertheless, we want to act very reserved and suggest a more appropriate research, such as methodological and basic scientific.

A field within osteopathy, which certainly has to be developed further with regard to the question: “Does osteopathy work?” is the field of diagnostics. More specifically: the palpation and all possible diagnostic tests. This requires quite a lot of methodological research (“inter- and intrarater-reliability studies”). The validity of diagnostic and therapeutic techniques as well has to be examined this way.

In order to meet with the political sighs which go hand in hand with a relatively young but especially unconventional (read also too little organized) profession such as osteopathy, there is a need for sociological research. Research as conducted in the UK with the “Standardised data collection within osteopathic practice in the UK” (SDC-Project)8  and en The Osteopathic Survey of Health Care in America (OSTEOSURV)9 in the USA are important means to map the profession in a better way and to give us an idea concerning data about inequity of access to osteopathic care, the quality of osteopathic care, the outcomes of care, the active role of osteopaths in the wider healthcare arena, the possible potential for osteopathy to offer savings of resources, and to aid employers with long term sickness absence. But also with regard to safety and the possible side effects of osteopathy, a lot of work has to be done. Furthermore, such research can definitely be a lead to new research questions as was the case with the SDC-Project.

It is very important that this socio-scientific research is carried out with standardised and validated questionnaires. Therefore, an international cooperation is indispensable.

The second question: “How does it work?” can be answered best by means of basic scientific research in osteopathy. Within the framework of the search for clinical evidence, our involvement with regard to the fundamental research threatens to be forgotten. One should aim at a healthy balance between clinical and fundamental research. This, only because of the fact that going from the fundamental research a whole lot of new insights can be offered, which can influence the way we conduct clinical research and/or the kind of parameters, measuring instruments and such.

Answers to this question also give a better insight on the working mechanisms and making osteopathic care possibly more effective and efficient. Furthermore, with regard to the clinical research new hypothesises can be formulated or a decisive answer can be given about which part and/or approach has been deciding in our “total (wholistic) package of osteopathic care” as offered in our everyday practice.

For the clinical as well as for the basic scientific research we aim at an enclosing framework in projects, in which the same methodology can be elaborated multicentrically. This will allow the professional group to offer publications with more scientific value.

Let us work together to realise this in the interest of our profession.


Patrick van Dun, MSc, DO

President Committee for Osteopathic Research

 

MacPherson H., Pragmatic clinical trials, Complementary Therapies in Medicine 2004; 12: 136-140

Kane M., 2004; Research made easy in Complementary & Alternative Medicine, Churchill Livingstone

http://www.gezondheidsraad.nl/nl/adviezen/alternatieve-behandelwijzen-en-wetenschappelijk-onderzoek#a-downloads

Cardini F. And Weixin H., 1998; Moxibustion for correction of breech presentation: a randomised controlled trial, J.Americ.Med.Assoc., 280(18): 1580-1584

Salutogenesis, as formulated by the Israeli sociologist Aaron Antonovsky, can be seen as the counterpart of “pathogenesis” which already counts for three hundred years as the paradigm within the allopathic medicine. In his research, Antonovsky introduced this new concept as the origin of health. His most important conclusion was that there is a strong connection between body and mind, and the point is that someone has the feeling that there is a connection (Sense of Coherence) within himself and in life.

Wiegant F., Kramers W. And van Wijk R. (2002), The importance of patient selection. In Lewith G., Wayne B.J. and Walach H. (Eds.), Clinical Research in Complementary Therapies: Principles, Problems and Solutions, (p. 159-160), Edinburgh, Churchill Livingstone

International Classification of Diseases (ICD)

8 http://www.osteopathy.org.uk/uploads/standardised_data_collection_finalreport_24062010.pdf

 9 Licciardone J.C., Kearns C.M., Ruggiere P., Background and Methodology of the Osteopathic Survey of Health Care in America 2010 (OSTEOSURV 2010), JAOA, 2011; 111 (12): 670-684 

 

 

 

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