Introduction to Osteopathic Manipulative Medicine Research · Introduction to Osteopathic...
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Introduction to Osteopathic
Manipulative Medicine Research
Michael A. Seffinger, DO, FAAFP
Vice-Chair, American Osteopathic Association Bureau of Osteopathic Clinical Education and Research
Associate Professor and Chair Department of Neuromusculoskeletal Medicine/Osteopathic Manipulative
Medicine College of Osteopathic Medicine of the Pacific
Western University of Health Sciences Pomona, CA
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Objectives
Participants will learn:
• Definitions of Osteopathic Research
• Research Contributions from Drs. Burns, Denslow, Korr and Johnston
• DO vs. MD outcomes studies from the 20th Century
• Five Clinical Trials evaluating efficacy of OMT on metabolic processes
• Resources for more information
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Definitions of OMM Research
• Institutional
• Autonomics and Immune Functions
• Spinal Cord Facilitation
• OMT efficacy
• Whole patient care
• Any and all research at a COM?
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Definitions of OMM Research
AOA Bureau of Research:
• I estigator has to state relevance of proposed project to
Osteopathic philosophy and
principles, theories, mechanisms
or pra ti e.
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Contributions
• Louisa Burns, DO
• J. Stedman Denslow, DO
• Irvin M. Korr, PhD
• William L. Johnston, DO
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Louisa Burns,
DO
50 years
devoted to
osteopathic
research
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Louisa Burns DO, 1870-1958
– Pioneer career osteopathic researcher
– Director, AT Still Research Institute 1917-1935
– Paid as AOA researcher until 1950
– Experimentally induced spinal fixations in
animals & then noted the effects of these
lesions on brain, heart, GI, reproductive
organs, lungs, kidneys (S-V Reflexes)
– V-S Reflexes
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Wilbur Cole, DO
• Studied with Dr.
Burns 1948-50
• Reproduced her
experiments and
data
• Internal Validation
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Faculty and National Leaders
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J.S. Denslow, DO (1906-?)
– Did numerous studies documenting & quantifying muscle, muscle reflex & autonomic changes in areas of so ati d sfu tio osteopathi lesio .
– Refle A ti it i the “pi al E te sors , utilized EMG/palpation correlation: documented spinal muscle reflex changes in areas of osteopathic lesions.
– Standard Terminology Proponent
– Facilitation of spinal cord
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J. S. Denslow, DO
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I.M. Korr, Ph.D. (1909-2004)
– Performed studies documenting changes in
galvanic skin resistance as a result of disturbances
in autonomic function, in areas of skin of subjects
associated with palpatory findings of somatic
dysfunction
– Axoplasmic flow & the trophic function of nerves
– Facilitation of spinal cord (with Denslow)
– Sympatheticotonia
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Bringing modern peer reviewed research into the scientific literature
from the osteopathic perspective
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Measurement of Electrical Skin
Resistance
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Korr IM, Wright HM, Thomas PE. Effects of experimental myofascial insults on cutaneous patterns of sympathetic activity in man. J Neural Transmission 1962;23:330-355.
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Korr IM. The spinal cord as organizer of disease processes: the peripheral automonic nervous system. JAOA 1979;79:82-90.
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I.M. Korr, Ph.D (1909-2004)
– Promoted entire DO – patient interaction as
research paradigm, not just OMT
– The “e o d Great Philosopher of Osteopathi Medi i e
– Took “till’s a ato i al fou datio a d added physiological function to it.
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William L. Johnston, DO, FAAO (1921-
2003)
• Reliability Studies
• Validity Studies
• Viscerosomatic Reflexes
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DO vs. MD
Patient Care
Research
from the
20th Century
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DO vs. MD Care
• 1918 - Spanish Influenza Epidemic
• 1932 - Unit II L.A. County Osteopathic
Hospital
• 1999 - NEJM- LBP RCT
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Influenza epidemic 1918
n=110,120; 2445 DOs
Medical care Osteopathic
Manipulation
Overall
Mortality
5% 0.25%
Mortality with
pneumonia
complication
30-60% 10%
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Unit II L.A. County Hospital 1928
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LA County Osteopathic Hospital
U it II
• MD u it U it I had 3574 beds
• DO U it II had o l 196 beds (1928)
• Every 10th patient was assigned to Unit II
• But DOs saw one-seventh of total # patients
(many pts. transferred over)
• DOs Delivered 1/3 of the OB patients
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LA Cou t U it II
• 6,000 inpatients per year
• 200 outpatients per day
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LA County Osteopathic Hospital
1933
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LA County Hospital DO vs. MD care
1930-32
MD + DO
• 9.7% mortality
• 16 days average
LOS
• 4% oro er’s cases
DO only
• 5.53% mortality
• 9.7 days average
LOS
• 4% oro er’s cases
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A Comparison of Osteopathic Spinal Manipulation with
Standard Care for Patients with Low Back Pain, 1999,
Andersson G, et al.
– at least 3 weeks but less than 6 o ths
–20-59 years old, 155 patients
– variety of techniques, including thrust,
muscle energy, counterstrain,
articulation, and myofascial release
– Standard care vs. osteopathic
manipulation plus standard care
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Osteopathic Spinal Manipulation +
Standard care for Subacute LBP
-Andersson NEJM 11/4/99
OMT+PT+Meds
n 83
NSAIDS 24%
M. Relax. 6%
PT 0.2%
MD+PT+Meds
72
54%
25%
2.6%
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OMT + Standard Care vs. Standard
Care of Subacute LBP
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OMT + Standard Care vs. Standard
Care of Subacute LBP
• Results
–Outcomes for patients were no different, except that the osteopathic group required less medication and less PT
–About 90% of the patients were satisfied with the care they received in both groups
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5 Clinical Trials - Metabolic Perspective
• Inflammation
• Pancreatitis
• Ankle Sprain
• Infection
• Pneumonia
• Otitis Media
• Spleen pump
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Inflammation
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OMT AND PANCREATITIS
Radjieski, JAOA 5/1998
• Pilot study: 30 patients
• Hospitalized patients
• Random assignment: ½ OMT
• General joint mobilization
– Hips, shoulders
– Sacrum, spine, ribs
• Decreased length of stay
• Decreased analgesic use
• Increased patient satisfaction
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OMT for Ankle Sprain
• N= 55 adults with first or second degree acute
ankle sprain presenting to the emergency
department.
• Randomized to OMT or standard care.
• Results: OMT group had decreased edema,
pain and increased range of motion.
Eisenhart et al. Osteopathic manipulative treatment in the emergency department for patients with acute ankle injuries. JAOA 2003;103:417-421.
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Infection
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Hospitalized Elderly with Pneumonia
Stan. Care +/- OMM
Experimental Group
• 28 patients OMT +
OMM specialist
OMT protocol
Control Group
• 30 patients light
non-specific touch
for equal length of
time as OMT
(sham)
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OMT and the Hospitalized Elderly with
Pneumonia -Noll et al
0
1
2
3
4
5
6
7
8
9
Oral Abx IV Abx All Abx LOS
OMT
Touch
P=.005
P=.003
P=.014
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Otitis Media in Children
Subjects:
• 6 months – 6 yrs. old
• Recurrent Otitis Media
• 25 standard care plus OMT
• 32 control standard care only
Mills MV et al. Arch Pediatr Adolesc Med. Vol 157, Sep 2003 861-866
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Otitis Media in Children
• OMT group had
–Fewer episodes of AOM
–Fewer surgical procedures
–More mean surgery-free months
–Increased frequency of normal
tympanograms
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Spleen Pump
• 1934 study re-analyzed
• N= 100 infected patients
• OMT splenic pump increased immune cell
counts.
• Current investigations are looking at cell labeling
to identify immune activation from abdominal
pump OMT
Noll et al. Revisiting Castlio and Ferris-Swift’s Experiments on Direct Splenic Stimulation in Patients With Acute Infectious Disease. J Am Osteopath Assoc. 2008;108:71-79
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Special Considerations in Osteopathic
Manipulation Research
Blinding
Control
Placebo
Size – Power – Drop out control
Inclusion Criteria
Dependent Variables-Measures
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OMM vs. OMT
• Series of OMT, duration, frequency, order vs.
• Just one maneuver (i.e., L-spine HVLA)
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Where are the mentors?
• American Academy of Osteopathy
(www.academyofosteopathy.org) Louisa Burns
Osteopathic Research Committee
• National Osteopathic Research Center in Fort
Worth, Texas; see web site at
http://www.hsc.unt.edu/orc/
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OMM Research Manuals
• American Academy of Osteopathy at
www.academyofosteopathy.org resear h a d a ual
• ORC Research Manual http://www.hsc.unt.edu/ORC/ResearchManual.pdf
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OMT Research Literature Resources
• OSTMED.DR database
• JAOA articles www.jaoa.org
• Pu Med sear h ords osteopathi , a ual therap