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FAQs ncor.uk

FAQs www.ncor.org.uk. Questions. What is osteopathy? Does osteopathy work? Is it safe? Is it better than other ‘treatments’?. What is osteopathy?. What is osteopathy?. Osteopathic International Alliance take two pages in the WHO report to describe osteopathy and osteopaths 2 types:

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FAQs ncor.uk

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  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/)

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

  21. 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

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

  23. Evidence about risk

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

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

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

  27. 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)

  28. 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

  29. 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

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

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

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

  33. 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

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

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