Exploring Osteopathy: FAQs, Evidence, and Guidelines

1. FAQs www.ncor.org.uk

2. Questions • What is osteopathy? • Does osteopathy work? • Is it safe? • Is it better than other ‘treatments’?

3. What is osteopathy?

4. What is osteopathy? • Osteopathic International Alliance take two pages in the WHO report to describe osteopathy and osteopaths • 2 types: • Osteopathic Physicians • Osteopaths

5. What is osteopathy? • Osteopathy means different things to different people • If osteopaths can’t define osteopathy they should at least be able to describe what they do

6. What is osteopathy? • Standardised data collection survey and clinical audit (2009) • In the UK there are just over 5,000 registered osteopaths, 9% responded. ref: www.ncor.org.uk/audit

7. Survey results • Osteopathic patients are: • ~56% female • most are treated for low back pain 36% • 51% have acute pain, 15% sub-acute and 31% chronic

8. Survey results • Most commonly used treatments are: • - Soft tissue manipulation (78%), • - Articulation (73%), • - HVT (38%), • - Cranial osteopathic techniques (26%), - MET (18%) • - Functional (14%)

9. What is osteopathy? • It is a multi-component complex intervention delivered by health care practitioners in primary care • The components of osteopathy are combined and delivered as a package of care in a consultation and can include:

10. What is osteopathy? • A case history • Examination • Discussion of findings • Discussion of treatment and care plan • Consent • Manual therapy • Health care advice • Self-management support • Listening and talking (psychosocial care)

11. Questions • What is osteopathy? • Does osteopathy work? • Is it safe? • Is it better than other ‘treatments’?

12. Does osteopathy work? • Question a bit like asking: • Is BREXIT a good idea? • Does surgery work? • Questions are too big: Work for whom work, for what condition, when and for how long ?

13. ‘Osteopathic’ research ? • Osteopathic research done by osteopaths for osteopaths? • Any research done by other musculoskeletal health professionals? • Shared techniques, shared research?

14. Does osteopathy work? • We can only answer this when we can define osteopathy but in reality we focus on: • Techniques e.g. HVT • Conditions e.g. Low back pain

15. Evidence

16. Evidence • Effectiveness of ‘osteopathy’ (for what)? • Effectiveness of techniques used by osteopaths • Effectiveness of techniques for conditions? • What benefits are important to patients?

17. Effectiveness data • Systematic reviews • Randomised controlled trials • Prospective cohort studies Guidelines compiled for managing musculoskeletal conditions

18. Guidelines • UK NICE Guidelines for Low back pain and sciatica (2016) • Recommend the use of manual therapy (including osteopathy) as part of a package of care.

19. Rationale for recommendation of manual / physical therapy for: Low back pain Examples of evidence (http://www.ncor.org.uk/research/evidence-for-osteopathy/)

22. Rationale for recommendation of manual / physical therapy for:Neck pain Examples of evidence

24. Summary of evidence • Growing body of evidence • Evidence base is positive • Quality of evidence is getting better • NCOR website for up to date information http://www.ncor.org.uk/wp-content/uploads/2013/06/Table-of-evidence-for-manual-therapy.pdf

25. Questions • What is osteopathy? • Does osteopathy work? • Is osteopathy safe? • Is it better than other ‘treatments’?

26. Evidence about risk

27. Evidence of riskAdverse events and patient incidences in manual therapy • Why research this?

28. Why research this? • Understanding risk and types of risk • Clinical decision making • Comparison with other health care providers • Patient informed consent

29. Clinical Risk in osteopathy and management S. Vogel et al. July 2012 http://www.ncor.org.uk/wp-content/uploads/2012/10/croam

32. Adverse events in manual therapy: findings • Major/serious adverse events are rare • We estimate 1 vascular insult per 50,000 patients or per100,000 cervical manipulations (Carnes et al 2009) • Those likely to have a CVA are likely to seek treatment prior to the accident due to the nature of the symptoms (Cassidy et al 2008)

33. Adverse events in manual therapy: findings • Minor adverse events are common ~46% • of all patients after MT treatment • Most minor and moderate adverse events • resolve within 48 hours • Adverse events are most likely to be reported after the first treatment

34. Summary • There is good evidence of beneficial effects for techniques used by osteopaths particularly manipulation • The techniques used by osteopaths have low risk of serious incidents associated with them. • We need to do more large scale research

35. Questions • What is osteopathy? • Does osteopathy work? • Is osteopathy safe? • Is osteopathy better than other ‘treatments’?

36. Is osteopathy better than other treatments? For what ? For whom? And when?

37. Acknowledging limitations of practice • Seeking informed consent • Advising patients about alternatives • Patient choice

38. Acknowledging limitations of practice • Acknowledging lack of knowledge • There are many unknowns in the medical profession • Communicating effectively and eloquently is part of being an osteopath

39. Making research accessible and relevant so it can be easily used • www.ncor.org.uk