The patient experience of osteopathic healthcare

'Thrown at twins' - A qualitative study exploring the lived experience of Australian osteopaths who regularly treat paediatric patients

BACKGROUND

and purpose: Little is known about the training and experience of osteopaths who treat paediatric patients, and graduates report feeling unprepared for this aspect of practice. The purpose of this study was to investigate the lived experience of Australian osteopaths who regularly treat these patients, in order to better understand their individual educational pathways and their management of this population.

MATERIALS AND METHODS

Osteopaths who reported regularly treating paediatric patients were recruited through the Osteopathy Research and Innovation Network (ORION) national practice-based network. Semi-structured interviews were completed, transcribed and thematically analysed using the principles of Descriptive Phenomenology to compile qualitative data.

RESULTS

Ten osteopaths were interviewed, whose age ranged from 33 to 71 years and with 15-46 years of clinical experience. Proportion of paediatric patients ranged from 20 to 90 % of participants' caseload according to self-report. Seven themes were identified that reflected the lived experience of treating paediatric patients: 1) Variable pathways to practice, 2) Challenges and rewards, 3) Scope of practice, 4) Team-based care, 5) Importance of entry-level skills, 6) Family-centred care, and 7) Success.

CONCLUSION

The study found a diversity of educational pathways, that paediatric practice was highly rewarding, the scope of practice was based on diagnostic skills and experience, the practitioners had extensive team-based professional networks, practice reflected a family-centred care model, and personal measures of success were multifactorial. These results give insight into this area of practice to guide further research.

Therapeutic approaches and conceptions of practice of osteopaths in Australia - a national cross-sectional study and exploratory factor analysis of the Osteo-TAQ

BACKGROUND

Health professionals develop their own approach to patient care based on education, experience and philosophical stance. Literature suggests that this practice approach informs patient care, and clinical outcomes. The Osteopaths' Therapeutic Approaches Questionnaire (Osteo-TAQ) is a novel 36-item instrument developed from qualitative grounded theory research with osteopaths in the United Kingdom. The aim of the study was to develop evidence for the structural and construct validity of the Osteo-TAQ in the Australian osteopathic profession and provide initial descriptive data about the therapeutic approaches of osteopaths in Australia.

METHODS

A cross-sectional study design was used to collect data from registered osteopaths in Australia using the Osteo-TAQ and analysed with Exploratory Factor Analysis (EFA). The EFA utilised parallel analysis to determine the number of factors to extract and McDonald's omega calculated as the reliability estimation statistic.

RESULTS

691 Australian osteopaths provided data for the study, representing 25% of the Australian osteopathic profession. Empirically the number of factors to extract based on the parallel analysis was seven. Two- and three-factor solutions were evaluated given the underpinning theory identifying two conceptions of practice and three interrelated therapeutic approaches. Both the two- and three-factor solutions were consistent with the underpinning theory with acceptable reliability estimations for each factor. Descriptive data suggested the most common element of the therapeutic approach of Australian osteopaths was establishing rapport, while the least common was 'only talking' with their patients.

CONCLUSIONS

This study provides evidence for the structural, content and construct validity of the Osteo-TAQ in an Australian osteopathic practitioner population. The results support both a two- and three-factor structure for the Osteo-TAQ in an Australian osteopathic population, with each factor demonstrating acceptable reliability estimations supporting the items comprising each factor as measuring a single construct. From a theoretical and empirical perspective, it can be inferred that the Osteo-TAQ tool encapsulates an osteopaths' conception of practice (professional artistry and technical rational) and three main therapeutic approaches to patient care: Educator, Communicator and Treater. Further research is required to explore each of these therapeutic approaches to better understand how they relate to an individual osteopath's conception of practice, and their associations with other measures of practice including clinical outcomes.

Assessing patient experience of the tenets of osteopathic medicine

CONTEXT

Previous studies document that both osteopathic physicians and third-party observers identify an approach to the patient that is consistent with the philosophy and tenets of osteopathic medicine, often without investigating whether patients identify or are satisfied with it. Osteopathic physicians and the medical education community understand the distinctiveness of an osteopathic approach to the patient. Understanding the outcomes of an osteopathic approach to patient care includes confirming whether patients experience the tenets of osteopathic medicine in physician visits and, if so, how it relates to their experience of physician empathy and satisfaction with the visit.

OBJECTIVES

The objectives of this study were to assess patient experience of the tenets of osteopathic medicine, physician empathy, and satisfaction with the visit and to compare the results for patients who saw DOs with those who saw MD physicians.

METHODS

More than 2000 patients at four outpatient clinic facilities were surveyed after a clinical visit on 22 prompts regarding their experiences of physician behaviors, physician empathy, and their own satisfaction with the encounter. Adult patients who were treated by an osteopathic or allopathic physician for a nonemergency encounter and who were not pregnant were included in the analysis. Survey results for 1,330 patient-physician encounters were analyzed utilizing linear regression models comparing constructs representing patient experiences of the tenets of osteopathic medicine (Tenets), physician empathy (Physician Empathy), satisfaction (Satisfaction) with the encounter, as well as additional demographic and encounter variables.

RESULTS

Approximately 23.8 % of patients approached during the study period completed a survey (n=2,793), and among those, 54.7 % of patients who consented to the study and who saw a physician provider (n=1,330/2,431) were included. Significant (p≤0.01), positive associations among patient experiences of Satisfaction with the visit and Physician Empathy were observed among those who saw both DO and MD physicians. Patients experienced the Tenets during encounters with both DO and MD physicians, but linear regression showed that their experience of the Tenets was significantly (p≤0.01) and positively explained by their experience of Physician Empathy (β=0.332, p=0.00, se=0.052) and Satisfaction with the visit (β=0.209, p=0.01, se=0.081) only when the physician was a DO.

CONCLUSIONS

Patients identified physician behaviors consistent with the Tenets and positively associated their experiences of Physician Empathy and Satisfaction with the visit regardless of physician training background. Patient experience of the Tenets significantly explained their experiences of Physician Empathy and Satisfaction after visits with a DO but not after visits with an MD.

Low back pain patients' perceived effectiveness of utilizing complementary and alternative medicine: a systematic review of qualitative studies

OBJECTIVES

The purpose of this systematic review of qualitative studies is to explore patients' perceived effectiveness of utilizing complementary and alternative medicine (CAM) for the treatment and/or management of low back pain (LBP).

METHODS

MEDLINE, EMBASE, AMED, and CINAHL were systematically searched from database inception until May 2020. Eligible articles included qualitative data about LBP patients' perceptions of using CAM.

RESULTS

Of 1,567 items, 1,542 items were excluded; the remaining 25 articles were included in this review. Three themes emerged as follows: physical benefits; mental health benefits; and negative or no perceived effectiveness of CAM on patients with LBP.

CONCLUSIONS

This study explores perceptions of CAM effectiveness among patients with LBP. These findings provide valuable information to CAM and non-CAM practitioners regarding the importance of individualized patient care based on their preferences, values, needs, and perspectives. Further exploration could include practitioners' perceptions of CAM and their impact on the patient-practitioner relationship.

What Makes an Osteopathic Treatment Effective From a Patient's Perspective: A Descriptive Phenomenological Study

OBJECTIVES

This study aimed to describe patients' perspectives on their experience in osteopathic treatment, to contribute toward developing interpretative models on effectiveness.

METHODS

A descriptive phenomenological approach was used. The data were collected through a semistructured interview. To capture the variability of the phenomenon, a purposive sample of 12 participants with previous experience of osteopathic care was selected. The data analysis was carried out in an inductive way, and it was parallel to the recruitment to continuously monitor the data saturation.

RESULTS

Data saturation was reached with 12 participants (female = 9; male = 3). Participants' age ranged from 27 to 82 years old (mean: 55.25 ± 17.15; median: 59; kurtosis: -0.82). Participants had different reasons for consultation. The analysis showed 1 overarching theme, "Osteopathy is a path of awareness," 3 themes, and 12 categories. Themes were: (1) "The experience of pain produces awareness of the need for care," (2) "Osteopathy is a journey to be shared over time," and (3) "The effectiveness of the osteopathic treatment is the discovery of the person's unity by experience."

CONCLUSION

Participants affirm that osteopathy is a path of awareness that starts from an experience of pain; leads them to contact an osteopath; and ends with their experience of the unity of body, mind, and spirit.

The role of osteopathy in the Swiss primary health care system: a practice review

OBJECTIVES

The aim of this study was to describe osteopathic activity and scope of practice to understand the current and future role of osteopathy in the Swiss healthcare system.

DESIGN

A questionnaire survey that included a patient record-based retrospective clinical audit.

SETTING/POPULATION

Osteopaths with a national diploma (n=1086) were invited by mail to participate in an online survey. Osteopathic assistants (n=84) were identified through their national association.

QUESTIONNAIRE

The survey was constructed from previous surveys and tested for face validity with experts, osteopaths and patient representatives. The questionnaires were completed online in English, German and French between April and August 2017. Osteopaths anonymously reported information about themselves, their practice, and the treatment and care for four randomly selected patients they managed in 2016.

RESULTS

The response rate from the survey was 44.5% (521/1171). Data on osteopathic care were collected for 1144 patients and 3449 consultations. In 2016, osteopaths saw approximately 6.8% of the Swiss population for 1700 000 consultations and an overall estimated cost of 200 million Swiss francs. 76% of patients sought care directly without a referral from another care provider. Few osteopaths (<1%) work in a hospital setting and 46% work in isolation in private practice. Infants (under 2 years old) made up 10% of all patients and 9% of patients were ≥65 years. Patients most commonly sought treatment for musculoskeletal conditions (81%) with the spine being the most frequent location (66%). Treatments also included exercise advice (34.2%) and lifestyle management (35.4%). Fewer than 1 patient out of 10 were referred to another health profession or provider.

CONCLUSIONS

In Switzerland, osteopathic care represents an important first line management for musculoskeletal conditions that alleviates some of the burden of care in the Swiss primary healthcare system.

Profile of osteopathic practice in Spain: results from a standardized data collection study

Background

There is limited research regarding patients’ profiles and consumer attitudes and habits of osteopathy in Spain. The purpose of this study was to profile patients who regularly receive osteopathic care in Spain using an internationally developed standardized data collection tool.

Method

During the period between April 2014 and December 2015, a UK-developed standardized data collection tool was distributed to Spanish osteopaths who voluntarily agreed to participate in this cross-sectional study.

Results

Thirty-six osteopaths participated in this study and returned a total of 314 completed datasets. Of 314 patients, 61% were women and 39% were men, with a mean age of 40 years (SD 17.02 years, range 0 to 83 years). Forty-four percent were full-time salaried workers, and in 78% of cases, receiving osteopathic treatment was the patient’s own choice. Chronic spinal pain presentations were the most frequent reasons for consultation. Seventy-five percent of patients presented with a coexisting condition, mainly gastrointestinal disorders and headaches. The main treatment approach consisted of mobilization techniques, followed by soft tissue, cranial and high velocity thrust techniques. Improvement or resolution of the complaint was experienced by 93% of patients after a small number of sessions. Adverse events were minor and occurred in 7% of all cases.

Conclusion

This is the first study carried out in Spain analyzing the profile of patients who receive osteopathic care. The typical patient who receives osteopathic care in Spain is middle-aged, presents mainly with chronic spinal pain, and voluntarily seeks osteopathic treatment. Osteopathic treatment produces a significant improvement in the majority of cases with a low rate of minor adverse events reported.

Electronic supplementary material

The online version of this article (10.1186/s12906-018-2190-0) contains supplementary material, which is available to authorized users.

Patients with multimorbidity and their experiences with the healthcare process: a scoping review

BACKGROUND

The number of patients with multimorbidity (two or more conditions) is increasing. Observational research has shown that having multiple health problems is associated with poorer outcomes in terms of health, quality of care, and costs. Thus, it is imperative to understand how patients with multimorbidity experience their healthcare process. Insight into patient experiences can be used to tailor healthcare provision specifically to the needs of patients with multimorbidity.

OBJECTIVE

To synthesize self-reported experiences with the healthcare process of patients with multimorbidity, and identify overarching themes.

DESIGN

A scoping literature review that evaluates both qualitative and quantitative studies published in PubMed, Embase, MEDLINE, and PsycINFO. No restrictions were applied to healthcare setting or year of publication. Studies were included if they reported experiences with the healthcare process of patients with multimorbidity. Patient experiences were extracted and subjected to thematic analysis (interpretative), which revealed overarching themes by mapping their interrelatedness.

RESULTS

Overall, 22 empirical studies reported experiences of patients with multimorbidity. Thematic analysis identified 12 themes within these studies. The key overarching theme was the experience of a lack of holistic care. Patients also experienced insufficient guidance from healthcare providers. Patients also perceived system-related issues such as problems stemming from poor professional-to-professional communication.

CONCLUSIONS

Patients with multimorbidity experience a range of system- and professional-related issues with healthcare delivery. This overview illustrates the diversity of aspects that should be considered in designing healthcare services for patients with multimorbidity.