years. Over 53.3% had intended to work in a rural area after finishing their osteopathic studies. Overall, 73% of rural osteopaths intend to keep working in a rural area as an osteopath indefinitely, with another 11.7% intending to keep working in a rural area for the next 5-20 years. Over 83% of rural osteopaths believe that there is a greater need for osteopaths in rural areas, with the explanations including that rural areas are underserved by osteopaths, they felt overworked/burnt out, patients travelling long distances due to lack of osteopathic services, and the general shortage of osteopaths in Australia. The five major advantages of rural osteopathic practice were sense of being needed, seeing a variety of issues, cost of living, relying on own skills, and having a personal knowledge of the patient. The availability of locums was seen as a disadvantage by 63% rural osteopaths. There were only two categories, “seeing a variety of conditions” and “using a range of skills”, that had no disadvantages recorded.
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Main treatment approaches were soft tissue (22.3%), muscle energy technique (14.6%), articulation techniques (14.3%) and education/advice (11.9%). Improvement or resolution of the complaint was experienced by 96.2% of patients within a small number of treatments. Complications of treatment were minor and of low frequency. Conclusions: In this study, Australian osteopaths mainly see patients with acute or sub-acute musculoskeletal problems which are predominantly spinal conditions. A significant proportion of these patients have one or more co-existing condition, largely of the cardiovascular and respiratory systems, along with mental health disorders. The majority of patients have a significant improvement within few treatments, with infrequent and minor adverse events reported. These findings should be tested through multi-centred pragmatic trials of osteopathic practice.
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The average number of visits per patient was 3.6 visits, plus in more than half of the cases, treatment did not exceed 2 months. In light of these results, osteo- pathic care appears to be effective over a short period of time and with a relatively low number of sessions. Despite these results, the clinical effectiveness and eco- nomic assessment of osteopathic care has not been established by our study. Furthermore, a lack of evi- dence in the literature showing the cost-effectiveness of osteopathic treatment remains [43, 44]. However, the results note a high degree of patient satisfaction with osteopathic treatment. Beyond clinical outcomes, patient-centered care, which is also a key aspect within the osteopathic approach, has been proven to be one of the most promising and effective scopes within health care [45–47] for its major relevance towards the estab- lished therapeutic relationship, application of a holistic approach to solve patients’ distress and tailoring of a patient’s treatment based on their context .
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There is a need to evaluate the effectiveness of this service to these patients using rigorous research that can be applied to practice. A comparative review of the clin- ical trial literature of SMT or massage or osteopathy in the treatment of low back pain reveals an evidence base for SMT and massage, both modalities in use by osteo- paths, but a lack of research into whole osteopathic practice as demonstrated in the survey data mentioned. A Cochrane review of SMT in low back pain concluded that despite over 800 publications addressing this issue, evidence for the effect on low back pain is equivocal . The Cochrane review of 13 clinical trials of massage found that there is evidence that it may be beneficial for subacute and chronic low back pain in conjunction with exercise . A systematic review and meta-analysis of osteopathic clinical trials up to 2003  concluded that patients had significant improvements from osteopathic intervention, but that many of the results are from trials with small numbers and the intervention is often a sin- gle modality or technique.
The 75-item survey is administered every 4 years to members of Osteopathy Australia to inform the organi- sation’s activities. The items were developed by an exter- nal survey company with input by the management of Osteopathy Australia and the majority of survey items pertained only to details relevant to Osteopathy Austra- lia’s organizational activities. The instrument covered a range of topics relevant to osteopathic practice of which ten items were included in our analysis including socio- demographic characteristics (including annual income), practice locality, practice characteristics (including fee structures, hours worked per week, duration of treat- ment sessions), and satisfaction with patient load. Re- sponse options were primarily using Likert scales (e.g. Never – Always) or fixed variable responses (e.g. prac- tice location item listed each Australian state). Survey items which allowed open responses included years in practice, patient visits per week (new and ongoing), hours worked per week, fees charged per treatment.
Self-determined United Kingdom patients do select- ively seek complementary care outside of the National Health Service, with osteopaths being one of the regu- lated healthcare professionals who are sought out; some of whom are contracted to work within the National Health Service . The 5000 United Kingdom osteo- paths carry out approximately seven million encounters a year and are statutory regulated by the General Osteo- pathic Council . The General Osteopathic Council are responsible for setting the professional standards and codes of practice for the United Kingdom osteopathic profession. The current Osteopathic Practice Standards came into force in September 2012 and is nearly identi- cal to General Medical Council’s guidance on good med- ical practice. Within the Osteopathic Practice Standards, the concept of SDM is explicitly referred to; standard A5 states that osteopaths must “work in partnership with patients to find the best treatment for them”; guidance note 1 states, “You should encourage patients to ask questions about their treatment and to take an active part in the treatment plan and any decisions that need to be made ”. This obligation remains within draft revised guidelines (relisted as A3.2) that are scheduled for publication in September 2019.
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An osteopath’s occupation offers a considerable source of job satisfaction. Although experienced osteopaths are largely satisfied with osteopathic practice, stress levels within the research group were still at a mild to moderate level. Experienced osteopaths find time pressures, too much work to do in a limited time and administration of practice and staff frequently stressful in their work. The occupational stressors that had the biggest contribution to stress levels are unlikely to occur in isolation. Financial stressor, particularly ‘earning enough money in osteopathic practice’ was of concern to many osteopaths. Time and money are interrelated if a practitioner increases their income by seeing more patients, then workload increases and time pressures will therefore increase. Other severe stressors, such as the threat of litigation occurred infrequently.
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this situation, apart from the background music, it is impossible to control many of the variables that could affect the patients’ state of relaxation. One of these variables includes the amount of conversation or its content occurring between practitioners and participants. In addition, the ability of the patient to relax may have also been impaired if they were not being treated by their usual practitioner that day. Other patients may have found it easier to relax as they may have developed a good rapport with their practitioner. Future research should aim to eliminate many of these problems by collecting data from patients treated by the same practitioner. This research can be conducted at a private Osteopathic practice, with a sole practitioner administering treatment to all the participants, or alternatively using a single student practitioner. This would not eliminate the variability of personal interaction entirely, but would serve to eliminate the variables associated with the use of multiple practitioners.
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In the sixth section, we discussed one patient’s and two osteopaths’ experiences and perceptions of FtP hearings, and ways in which such experiences affect how the wider population of osteopaths perceived FtP and regulation. While FtP hearings were seen to be well managed and fair, neither the patient nor the osteopaths involved described them as producing satisfactory outcomes. This was, in part, due to the complexity and ambiguity associated with interpreting whether osteopaths’ practice complies with the OPS. While our findings are based upon a small number of interviews, they reflect research conducted for the GOsC by Moulton Hall Ltd (see Annex B to Item 4 of the report to the Osteopathic Practice Committee, 2 October 2014) and Leach and colleagues (2011). Our survey data also suggests that few osteopaths (23%) ‘are confident in the GOsC disciplinary procedures to produce fair outcomes’, with osteopaths who had been subject to complaints made against them to the GOsC, significantly less likely to agree with this statement (mean 2.72 vs 2.96).
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practice parameters, communication, and care delivery parameters including regulation . We considered existing questionnaires on physicians’  or other health professionals’  knowledge of osteopathy, con- tinuing education and sources of information about osteopathy  or CAM for the pediatric population , experiences of collaboration with CAM practi- tioners , referrals [19, 20, 22], communication and professional relationships , and sociodemographic variables related to collaboration [19–22]. This first ver- sion was pretested with two physicians, one pediatrician, three osteopaths, and an expert on IPC and question- naire development. The modified version was piloted (procedure and duration) in individual face-to-face cog- nitive interviews with two physicians, two pediatricians and four osteopaths. It took 8 to 10 minutes to complete the survey. The final version of the questionnaires cov- ered: a) knowledge about osteopathic practice parame- ters including 10 questions regarding general aspects, 10 questions concerning belief in the active role of osteop- athy for specific pediatric conditions, and one question re- garding sources of information about osteopathy (physician version only); b) communication aspects in- cluding interpersonal relationships, referrals, and commu- nication methods (7 questions); c) influence of regulation of osteopathy on IPC (1 question); and d) sociodemographic data: gender, years of experience, type of practice, discipline, personal consultation of an osteopath (physician version), and presence of a physician in the working environment (osteopath version). Qualitative comments could be added by participants at the end of the questionnaire.
Most articles have failed to show the reliability of pal- pation in evidence-based clinical practice . Assessing tenderness with palpation can have higher reliability [5,6,8] because patients may contribute to the abnormal findings, whereas identifying anatomical landmarks and other diagnostic tests have been inconsistent [2,4,6,9-13]. Some studies state that the reliability of the palpatory examination has been shown to improve if consensus training is performed prior to testing [5,6,8]. However, a review by Seffinger et al  discussed that this was not always demonstrated. Degenhardt et al  explained that because patients ’ bodies are not static, reliability of palpa- tion can be difficult. The author continued to state that “ the neuromusculoskeletal system changes according to
Abstract: Chronic heart failure is a progressive, debilitating disease, resulting in a decline in the quality of life of the patient and incurring very high social economic costs. Chronic heart failure is defined as the inability of the heart to meet the demands of oxygen from the peripheral area. It is a multi-aspect complex disease which impacts negatively on all of the body systems. Presently, there are no texts in the modern literature that associate the symptoms of exercise intolerance of the patient with a dysfunction of the fascial system. In the first part of this article, we will discuss the significance of the disease, its causes, and epidemiology. The second part will explain the pathological adaptations of the myofascial system. The last section will outline a possible osteopathic treatment for patients with heart failure in order to encourage research and improve the general curative approach for the patient.
Osteopathic teaching institutions focussed on ongoing assessment over a period of years as the students developed their clinical competence, both in class and in clinics. The final examinations are but the culmination of this long process and the participants were therefore concerned about those who fall at this final hurdle. They were well aware of the need to reduce performance anxiety and of the steps that failed candidates could take to redeem themselves. Few revealed much knowledge of research findings in the area of student assessment in the health professions and tended to rely on traditional methods of assessment, such as written examinations, long cases and research theses. However, for some of the study participants, their experiential learning as practitioners of assessment led to recognition of the potential of other approaches, such as portfolio assessment, and recognition also that assessment of complex learning demands striking a balance between pre-defined criteria and professional judgement.
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Overall, practice quiz questions were highly valued, but they were significantly more likely to be rated Essential by OMS1s than by OMS2s (p < 0.005 - post-hoc Bonferroni-adjusted required α <0.017), and by OMS2s than by OMS3s (p < 0.005 - post-hoc Bonferroni- adjusted required α <0.017) (Fig. 1). Practice quiz ques- tions can be provided within vodcasts, and depending on the software, can be physically interactive or non- physically interactive. With physically interactive ques- tions, the user must stop and click a button with their mouse or enter a response in order to proceed through a vodcast. For non-physically interactive questions, the user can pause and work through a question, or con- tinue, and perhaps work on the question later. Another option is to provide practice questions as a separate file. At SOMA, there are faculty that use each of these methods. Responses to the prompt Which of the follow- ing scenarios regarding practice quiz questions within vodcasts do you prefer? are summarized in Fig. 2. There was a statistically significant difference between the re- sponses of OMS1s and OMS2,3s, with OMS1s overwhelm- ingly preferring physically interactive questions (Clicking in order to proceed rated more highly by OMS1s p < 0.001, Having practice questions separate from vodcast and Nonin- teractive questions within vodcast rated more highly by OMS2s and OMS3s p < 0.001 and p < 0.005, respectively - post-hoc Bonferroni-adjusted required α <0.017).
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The purpose of this pilot investigation was to introduce the notion of the OCPA tool as a global assessment of osteopathic learner performance in the on-campus, student-led teaching clinic. The OCPA has been mooted for inclusion in the suite of assessment tools used to make learner progress and competency decisions. As a formative assessment and feedback tool it was expected the OCPA would aid learner’s learning and provide a clear record of their progress at regular intervals. 22 At this time of administration the year 4 learners were in their
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The language associated with the 1950s Fryette biomechanical model, 64 a model commonly taught in the United States and Europe, typically uses complex ‘positional’ labels to describe segmental dysfunction. This model is still used in many current osteopathic texts, 1, 5, 27, 100 despite having been largely discredited. 101-105 Even though these positional terms are qualified as describing motion restriction or motion preference rather than joint positions, 1 the positional labels of dysfunction that include ‘flexed and rotated’ vertebra, ‘anteriorly rotated’ innominate bones, or ‘superiorly subluxed’ first ribs inevitably imply the erroneous concept of a ‘bone out of place’. Using such language may confirm the impression of a serious structural disorder in the mind of a fearful and suffering patient, leading to catastrophizing, fear avoidance behaviour and unnecessary dependency on treatment.
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13. Pizzolorusso G, Turi P, Barlafante G, Cerritelli F, Renzetti C, Cozzolino V, D'Orazio M, Fusilli P, Carinci F, D'Incecco C: Effect of osteopathic manipulative treatment on gastrointestinal function and length of stay of preterm infants: an exploratory study. Chiropr Man Therap 2011, 19:15. 14. Ward RC, Hruby RJ, Jerome JA, Jones JM, Kappler RE, Kuchera ML, Kuchera WA, Patterson MM, Rubin BR, Association AO: Foundations for Osteopathic Medicine, 2nd Revised edition edn. Lippincott Williams; 2002.
There is increasing pressure on methods of complementary and alternative medicine to adhere to the rules of evidence based medicine [1,2] and to follow the research roadmap for complementary and alternative medicine . Osteopathic manipulation still is under critical scrutiny and needs evidence-based assessment. This treatment has been shown moderately effective in patients with low-back pain, whereby several methods of pain scoring [4-6], pain pressure thresholds , neural mechano- sensitivity , or biomechanical parameters during flexion were assessed . Also a favourable effect of osteopathic manipulation on cervical hysteresis  and inter-vertebral range of motion  has been reported.
For the majority of IEPS items, university was not a significant variable in the ordinal regression models - it is reasonable to conclude that Australian osteopathy students have similar perceptions of their own and other professions with regard to interprofessional practice and education. SCU students were more likely to agree with item 7 Individuals in my profession are very positive about their contributions and accomplishments (OR 2.81, small). Conversely VU students were more likely to agree with item 9 Individuals in other professions think highly of my profession (OR 2.33, small) and item 18 Individuals in other professions often seek the advice of people in my profession (OR 2.74, small). Where associations were identified for these three items, they are difficult to explain without exploring the student’s responses in a qualitative approach, and the small OR’s suggest there may only be a minimal association between the university a student attended, and their response to the three items.
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improvements including a decrease in sensory and motor latency and an increase in response amplitudes. This in turn indicates the improvement of nerve conduction velocities and decrease of conduction blocks by improving the nerve axons functions. Another study was done by Sucher et al., (2005)  using 20 cadaver limbs (ten males and ten females). The method was performed with four study protocols introducing static loading (weights) and osteopathic manipulation (OM) and reversing of the sequence of procedures in order to see the effect on the transverse carpal ligament by measuring the width of the transverse carpal arch. Greater responses were noted for all the interventions specifically for the female group. Furthermore, application of OM prior to the weights was founded to be more effective in lengthening of the TCL than the reverse method. This OM had included distal and proximal transverse carpal extensions which applied a transverse distraction force across the carpal canal in order to lengthen the TCL. Secondly, Guy-wire maneuver which involved maximum abduction along with the extension to the thumb and the little finger adding a greater stretch to flexor pollicis longus and flexor digitorum profundus tendon of the little finger pulling TCA further apart. Thirdly opponens roll maneuver which was described earlier . Out of all the maneuvers, combined distal transverse extension with Guy-wire maneuver had shown the greatest response as the manual technique.