RELATION OPERATOR-PATIENT:
CAN OSTEOPATH CHARACTERISTICS
INFLUENCE THE TREATMENT?
E. Ratti1, C. Arienti 1, S. Daccò1 1Department of Research, Istituto Superiore di
Osteopatia, Milan, Italy
INTRODUCTION 1/5
• Clinical research is based on use of “randomized controlled
trials” (RCTs)
Difficulties:
- Select the control group;
-Develop a “false” treatment appropriate,
credible, ineffective and indistinguishable from
active treatment
PLACEBO EFFECT
Fulda K. G., Slicho T., Stoll S. T. Patient expectations for placebo treatments commonly
used In Osteopathic Manipulative Treatment (OMT) clinical trials: a pilot study.
Osteopath Med Prim Care. 2007; 1:3.
INTRODUCTION 2/5
PLACEBO EFFECT
• There is a response;
• It depends on the non-specific effects of the treatment - Length of trial - The doctor - the placebo itself - unconscious wishes of the subject - the quality and strength of the relationship
between Operator and Patient
They may influence the response, and affect the results of treatment
Licciardone J. C., Russo D. P. Blinding protocols, treatment credibility and expectancy:
methodologic issues in clinical trials of Osteopathic Manipulative Treatment.
J Am Osteopath Assoc. 2006; 106 (8): 457-63.
DOCTOR-PATIENT RELATIONSHIP
This system includes:
*personal beliefs,*previous experience,
*fears, *expectations, *trust and *emotions
(about the doctor and the patient)
The medical professionalism is the heart of this report.
The key elements are:
*“being” of the operator, *his individual characteristics, *his interpersonal qualities and abilities:
-personality
-empathy
Gallagher T. H., Levinson W. A prescription for protecting the doctor-patient relationship.
Am J Manag Care. 2004; 10 (2 pt 1): 61-8.
INTRODUCTION 3/5
INTRODUCTION 4/5
Personality Set of psychical characteristic and
behavior patterns of the operator.
Empathy Ability of the operator to relate to
the patient with compassion,
taking his prospective, becoming
sensitive to the experiences he
previously had.
Haslam N. Humanising medical practice: the role of empathy. Med J Aust. 2007;
188 (4): 263-4.
West C. P., Shanafelt T. D. The influence of personal and environmental factors on
professionalism in medical education. BMC Med Educ. 2007; 7: 29.
GOAL
The objective of the study is to
investigate the influence of
personality and empathic
capacity on the efficacy of the
treatment.
METHODS 1/2
SETTING
“Centro Studi e Ricerca Osteopatica” of the Institute of
Osteopathy in Milan
Since March 2010 to January 2011
PATIENTS
115 volunteers between 18 and 80 years old, male and
female having a musculoskeletal problems or diseases
90 in the first group
25 in the second group
METHODS 2/2
EXCLUSION CRITERIA
Diagnosis of psychiatric disorders and/or
neurological central problems
OPERATORS
Trainees attending the 4th or 5th full-time, male and
female and aged between 20 and 40.
STUDY DESIGN
Operators complete Jefferson Scale
Questionnaire EPQ-R
Treated with black box.
Patients first visit (T0)
5 treatments (T1-T2-T3-T4-T5)
Request the NRS
Before the OMT Before and after the OMT
First group Second group
TEST
• NRS.
• JEFFERSON SCALE: questionnaire for the empathy.
20 statements with a level of agreement based on a 7-
point Likert scale (between 1 = disagreement and 7=
very agreement).
• EPQ-R: personality questionnaire.
106 questions with binary responses (yes or no).
It was considered only the extroversion.
Glaser K.M., Markham F., Adler H.M., McManus R.P., Hojat M.
Relationships between scores on the Jefferson Scale of physician
empathy, patient perceptions of physician empathy, and humanistic
approaches to patient care: a validity study. Med Sci Monit, 2007; 13(7):
CR291-294.
STATISTICAL ANALYSIS
• To value the efficiency of the treatment
• To value the correlation between empathy/
extroversion and pain level.
p<0,05 was considered statistically significant;
p<0,001 was considered high statistically
significant.
Table 2
Operators’ features
Features No.
Age 24
3
Sex (M:F) 10:12
Study year(5
:4
) 8:14
Estimated hours of practice 200,23
200,73
Psychological therapies 5:22
EPQ-R results (ESTROVERSION) 14,91
3,61
Jefferson Scale results (EMPATHY) 108,54
9,08
RESULTS 1/5
Values0-20: extroversion levels
Values1-22: operators
Values0-140: empathy levels
Values1-22: operators
RESULTS 2/5
Table 3
Patients’ features
(first group)
Features No. (90)
Age 45,73
16,77
Sex (M:F) 48:42
Symptomatology
Neck pain 26
Low back pain 36
Back pain 9
Sholder pain 6
Knee pain 4
Sacro-iliac pain 4
Thigh and hip pain 2
Ankle and foot pain 2
Wrist pain 1
Pain:
Acute (< 3 month) 10
Cronic (> 3 month) 80
Drug therapies (YES:NO) 30:60
Medications as needed (YES:NO) 53:37
Manual therapies (YES:NO) 10:80
Table 4
Patients’ features
(second group)
Features No. (25)
Age 46,12
17,88
Sex (M:F) 10:15
Symptomatology
Neck pain 1
Low back pain 15
Back pain 3
Sholder pain 0
Knee pain 1
Sacro-iliac pain 0
Thigh and hip pain 2
Ankle and foot pain 2
Wrist pain 1
Pain:
Acute (< 3 month) 3
Cronic (> 3 month) 22
Drug therapies (YES:NO) 7:18
Medications as needed (YES:NO) 14:11
Terapie manuali (YES:NO) 0:25
RESULTS 3/5
No. P
T0-T2 2.44
2.22 < 0.001
T0-T5 4.17
2.46 < 0.001
EXTROVERSION EMPATHY
T0-T2 - 0.14 0.02
T0-T5 - 0.01 - 0.29
Differing levels of pain between the times 0 and 2 and between times 0 and 5
Results of the correlation between the delta and the previously calculated values of
extroversion and empathy of the operators, obtained through the test (EPQ-R and
JSPE)
RESULTS 4/5
FIRST GROUP
No. P
T0 i-T0 f 0.92
1,22 < 0,001
T1 i-T1 f 1.56
1,00 < 0,001
T2 i-T2 f 1.21
1,04 < 0,001
T3 i-T3 f 1.40
1,11 < 0,001
T4 i-T4 f 1.46
1,71 < 0,001
T5 i-T5 f 0.92
0,83 < 0,001
ESTROVER
SIONE
EMPATIA
T0 i-T0 f - 0,41 0,23
T1 i-T1 f - 0,09 - 0,05
T2 i-T2 f 0,35 -0,18
T3 i-T3 f 0,03 -0,22
T4 i-T4 f 0,15 0,21
T5 i-T5 f -0,12 0,25 Differing levels of pain collected at the
beginning and end of treatment with T-Test
Results of the correlation between the delta and the
previously calculated values of extroversion and
empathy of the operators, obtained through the test
(EPQ-R and JSPE)
RESULTS 5/5
SECOND GROUP
DISCUSSION 1/2
There is an high significance in reducing the
symptoms of the patient, confirming the efficacy of
Osteopathic Treatment
DISCUSSION 2/2
There is not correlation between the reduction of the
symptomatology referred and empathy/extroversion of the
operator.
LIMITS
The values obtained from the
tests are too similar each other
and very high.
The relationship is based on
several components:
• The patient
• The operator
• The communication.
TIPS
Operators of both genre
with different ages.
Single-blind.
Control group with only
relational treatment.