Knowledge of osteopathic manipulative medicine and osteopathic physicians in a New York South Asian community

Context Research regarding patient awareness of osteopathic manipulative medicine (OMM) can help identify barriers and factors limiting patient knowledge. Levels of knowledge about OMM and osteopathic physicians have been studied in New York’s Chinese and Korean populations, but have not previously been investigated in the South Asian population. Objectives To assess the knowledge of OMM and osteopathic physicians within a South Asian community of New York. Methods A cross-sectional study was designed in which a culturally appropriate survey, provided in both English and Hindi, was administered to study participants in order to measure knowledge of osteopathic medicine. The study utilized convenience sampling and distributed surveys to individuals who identified themselves of South Asian descent at high traffic sites in Hicksville, New York. The survey contained 10 questions, assessing the individual’s knowledge of osteopathic medicine. The Kruskal–Wallis and Chi-Square tests were employed to determine statistical significance of the data obtained from the surveys. Results The survey was conducted on 100 participants in Hicksville, New York. The respondent demographics included 53 males and 47 females with an average age of 41.2 ± 16.3 years old. There were 34 (34%) participants who had heard of osteopathic manipulative medicine (OMM) and 26 (26%) participants who had knowledge of doctor of osteopathic medicine (DO) physicians. Respondents were found more likely to have knowledge of DOs if they were born in the United States (US) vs. other countries (US, 8 of 14 [57.1%] vs. others, 18 of 86 [20.9%]; p=0.006) or lived longer in the US (11 of 26 [42.3%], p=0.039). Participants who spoke a non-English primary language were also found less likely to have knowledge of DOs as they made up 46 of the 58 respondents who indicated no knowledge (79.3%, p=0.042). Conclusions A general lack of knowledge of DOs and OMM exists within the South Asian community of Hicksville, New York and lower levels of awareness were found among participants who were male, born outside the US, had a language other than English as their primary language, and had spent less time in the US. Additional educational resources may be implemented to increase awareness of DOs and OMM among this and similar communities.

Osteopathic considerations for breastfeeding women

Extensive benefits of breastfeeding have been identified and although many women initiate breastfeeding, discontinuation is common when problems arise. In this article, the authors review the pertinent anatomy of the breast with osteopathic considerations to help osteopathic physicians identify myofascial, vascular, lymphatic, or innervation somatic dysfunctions to support the breastfeeding mothers’ long term breastfeeding goals, optimize breastmilk supply, and potentially prevent or treat problems that could interfere with lactation. Observations from the authors’ academic mother-baby osteopathic manipulation clinic are also included.

The Osteopathic Approach During the 1918 Influenza Pandemic, Featuring Newly Analyzed Case Reports

Osteopathic physicians played a pivotal role in treating patients suffering from the H1N1 influenza A virus of the 1918 Influenza Pandemic. This article focuses on case reports and questionnaire answers from the Journal of the American Osteopathic Association (JAOA), now the Journal of Osteopathic Medicine (JOM), and Osteopathic Physician concerning the modalities, techniques, and efficacy of osteopathic treatments of the 1918 pandemic. There are 19,565 patients who are represented in this analysis. The results are compared to the often-cited 110,120 patient cases reported by the JOM in 1920. Several different approaches, including lymphatic and visceral techniques, were widely used at the time, and their historic incorporation into patient treatment is explored. There is a discussion of the geographic location and characteristics of the practices. Statistical breakdown of mortality rate, the most commonly used approaches, somatic dysfunctions commonly treated, physician anecdotes, and other common remedies used by osteopathic physicians, are noted additionally. A comparison is done of the literature regarding the osteopathic approach for COVID-19. The newly analyzed case reports in this article demonstrate a similar mortality rate as in the 1920 JAOA article and illustrate the geographical distribution, treatment approaches, and personal stories of osteopaths during the pandemic.

Poor match rates of osteopathic applicants into ACGME dermatology and other competitive specialties

Context There has been a steady increase in the number of osteopathic (DO) medical students in the United States without a corresponding increase in DO representation in competitive specialties. Objectives To investigate the trends and impact of the Accreditation Council for Graduate Medical Education (ACGME) single accreditation system on DO match rates into dermatology and other competitive specialty programs. Methods Information was collected through public databases (Electronic Residency Application Service [ERAS]; National Resident Matching Program [NRMP]; Association of American Medical Colleges [AAMC]; National Match Service, Inc. [NMS]; and the ACGME) to evaluate the match statistics of competitive specialties, including dermatology, otolaryngology, orthopedic surgery, neurosurgery, and plastic surgery. Residency program and medical school websites and residency communications were used to confirm whether the match placements were to programs that had traditionally been ACGME-accredited or former American Osteopathic Association (AOA) programs. Results From 2012 to 2016 (pre-unification), osteopathic graduates comprised only 0.5% of the matches the specific specialties studied here and only 0.9% of ACGME dermatology positions. Post-unification (2017–2019), DOs comprised 2.0% of the matches into these specialties and 4.4% of the total ACGME dermatology positions. This apparent increase is misleading, as it is solely due to the transition of formerly AOA programs to ACGME status. The true post-unification DO match rate to traditionally ACGME programs is actually 0.6% for all competitive specialties and 0.4% for dermatology. Post-unification, 27.6% of formerly AOA positions in these competitive specialties were filled by allopathic (MD) applicants. Conclusions DO match rates into dermatology and other competitive specialties were poor prior to GME unification and continue to remain low. This situation, when coupled with the closing of many AOA programs and MDs matching into former AOA positions, threatens the future of osteopathic physicians in competitive specialties. Osteopathic recognition is one way to potentially help preserve osteopathic representation and philosophy in the single accreditation system era. Programs should not be hesitant to consider osteopathic applicants for competitive specialties.

Osteopathic manipulative treatment and the Spanish flu: a historical literature review

Context The Spanish flu pandemic of 1918 was approached with a variety of management techniques available at that time, including osteopathic care in addition to standard medical care. Objective To analyze the osteopathic manipulative treatment (OMT) techniques used for the management of patients affected by the Spanish flu according to four themes: the principles and procedures used, frequency and length of OMT, reported side effects, and advice for patients. Methods A structured review of the literature was performed by hand-searching texts at the Museum of Osteopathic Medicine International Center for Osteopathic History in Kirksville, Missouri, and online via PubMed (National Library of Medicine), ScienceDirect (Elsevier), and Google Scholar (Google, Inc). The literature search was carried out between February and March 2020. Three keywords were selected from the medical subject headings database of the National Library of Medicine: manipulation, osteopathic; influenza pandemic, 1918–1919; epidemics. Articles were then reviewed for relevance by screening for articles published between 1900 and 1940 that contained at least 1 of the following keywords in their title: Spanish influenza, flu, epidemic, grippe, pneumonia, or osteopathic management/treatment. All articles that provided information about OMT and advice met the inclusion criteria. Articles that did not report descriptions of manipulative intervention were excluded. Results Our search yielded 63 articles: 23 from the hand-search and 40 from the electronic search. No electronic source was selected for the review because none met inclusion criteria. A total of 16 articles from the hand-searched set met inclusion criteria and were analyzed according to the four main themes stated in the objective. The range of OMT approaches reported to be administered to patients with Spanish flu suggests that early osteopathic physicians treated patients with this disease using OMT in addition to offering advice on healthy lifestyle behaviors. Conclusion Conclusions from this study are limited by the historical and descriptive nature of the data gathered, which lacked the rigor of modern-day scientific studies. However, this review could lead to future research inquiries on the effectiveness of these approaches. Osteopathic physicians and osteopaths should embrace their historical osteopathic heritage by continuing the work of our predecessors and combining their hands-on experience and osteopathic principles with modern medical treatment and rigorous scientific standards.

Characterizing the use of osteopathic manipulative medicine in the obstetric population by trimester and indications for use

Context Osteopathic manipulative medicine (OMM) has been shown to successfully alleviate some pregnancy-related pain. However, most of the published data focuses on the third trimester and postpartum period or musculoskeletal indications. Objective To explore OMM use among obstetrical providers and determine the frequency of use by trimester and by clinical indications across multiple types of women’s healthcare practices in Southern and Central Maine. Methods An anonymous, 43-item survey, presented in English, was emailed to 172 eligible providers (physicians, nurse practitioners, and certified nurse midwives with obstetrics privileges at one of two main delivery centers in southern and central Maine) via an encrypted database system in January 2018. Follow-up email reminders were sent weekly for three weeks. Questions addressed use of OMM for specific indications, knowledge of OMM, and perceived barriers use of OMM. Results The survey response rate was 73 of 172 (42%); 95% of respondents were physicians (n=69). Due to the low response rate of non-physicians, only data from physicians was included in the study. Data were summarized descriptively as frequencies (n [%]). The highest rates of OMM utilization were during the third trimester (35 [51.5%]) and postpartum (41 [60.3%]) periods, while the lowest rates of utilization were in the intrapartum (eight [11.9%]) and first trimester periods (26 [38.3%]). Osteopathic physicians (n=19) used OMM more frequently in the first, second, and third trimesters, as well as the intrapartum period (10 [52.6%]; 11 [57.9%]; 14 [73.7%]; and six [31.6%], respectively) compared with their allopathic physician (n=50) counterparts (nine [8%]; 15 [30%]; 21 [42%]; and two [4%], respectively). While osteopathic physicians reported higher frequencies of OMM use and referral for non-musculoskeletal indications such as constipation, edema, and nasal congestion (13 [68.4%]; 11 [57.9%]; 10 [52.6%], respectively), musculoskeletal complaints were the most frequently cited indication for OMM use among both osteopathic and allopathic physicians (low back, 67 [97.1%]; pelvis, 65 [94.2%]; coccyx, 50 [72.5%]; and head, 49 [71%]). Conclusion These results suggest that more education is needed about OMM use in the obstetric population, particularly during early trimesters and the intrapartum period, as well as for visceral and lymphatic complaints of pregnancy.

Osteopathic manipulative treatment (OMT) use among osteopathic physicians in the United States

Context Updated data on the use of Osteopathic Manipulative Treatments (OMT) by osteopathic physicians in the United States is overdue. This data would provide an up-to-date point of reference for evaluating the current use of OMT as a distinguishing feature of the osteopathic profession. Objective To determine the prevalence of OMT use, barriers to its use, and factors that correlate with increased use. Methods The American Osteopathic Association (AOA) distributed its triannual survey on professional practices and preferences of osteopathic physicians, including questions on OMT, to a random sample of 10,000 osteopathic physicians in August 2018 through Survey Monkey (San Mateo, CA). Follow-up efforts included a paper survey mailed to nonrespondents one month after initial distribution and three subsequent email reminders. The survey was available from August 15, 2018 to November 5, 2018. The OMT questions focused on frequency of OMT use, perceived barriers, and basic demographic information of osteopathic physician respondents. Statistical analysis (including a one sample test of proportion, chi-square, and Spearman’s rho) was performed to identify significant factors influencing OMT use. Results Of 10,000 surveyed osteopathic physicians, 1,683 (16.83%) responded. Of those respondents, 1,308 (77.74%) reported using OMT on less than 5% of their patients, while 958 (56.95%) did not use OMT on any of their patients. Impactful barriers to OMT use included lack of time, lack of reimbursement, lack of institutional/practice support, and lack of confidence/proficiency. Factors positively correlated with OMT use included female gender, being full owner of a practice, and practicing in an office-based setting. Conclusion Our data suggest that OMT use among osteopathic physicians in the US continues to decline. Barriers to its use appear to be related to the difficulty that most physicians have with successfully integrating OMT into the country’s insurance-based system of healthcare delivery. Follow-up investigations on this subject in subsequent years will be imperative in the ongoing effort to monitor and preserve the distinctiveness of the osteopathic profession.

Osteopathic Manipulative Treatment and Breastfeeding

ObjectiveOsteopathic physicians, or doctors of osteopathic medicine (DOs), routinely counsel patients on the clinical benefits of breastfeeding in their capacity as medical doctors. However, when a mother presents with a complaint of feeding difficulty in her newborn, osteopathic physicians are uniquely equipped to assess and treat the infant with osteopathic manipulative treatment (OMT).MethodsOMT is the practice of manual medicine developed by A.T. Still in the late 19th century, founded on the principle that the human body's structure and function are reciprocally interrelated. The osteopathic discipline encompasses a variety of musculoskeletal techniques, ranging from gentle myofascial release to high-velocity/low-amplitude thrusts. A complete osteopathic assessment of a breastfeeding infant should include evaluation of the skull and cranial base, cervical spine, thoracic spine, oral cavity and tongue, hyoid bone, and mandible.ResultsAll treatments directed at newborns, infants, and children are very gentle, following the tissues in their position of ease to allow for a release of the restriction. A variety of techniques can be employed, including condylar decompression, Still technique for cervical spine dysfunction, balancing of the hyoid bone, myofascial release of the thoracic inlet, and treatments in the cranial field.ConclusionOsteopathic manipulation should be initiated when the first-line interventions do not result in improved nursing, and other causes such as hypoglycemia or maternal factors have been excluded.