Person-centered osteopathic practice: patients' personality (body, mind, and soul) and health (ill-being and well-being)

Reported biological effects following Osteopathic Manipulative Treatment: A comprehensive mapping review

BACKGROUND AND PURPOSE

Osteopathic Manipulative Treatment (OMT) is a therapeutic whole-body approach mainly focused on correcting somatic dysfunctions. The aim of this scoping review is to systematically map the literature regarding the documented biological effects observed following OMT.

METHODS

The 2020 JBIRM version and the PRISMA-ScR were followed for the conceptualization and reporting of this review. The protocol was registered on the "Open Science Framework Registry" (https://doi.org/10.17605/OSF.IO/MFAUP). We searched for original articles published on Medline, Embase, and Scopus, from inception to the present.

RESULTS

Overall, 10,419 records were identified. After duplicate removal, screening for title and abstract, and specific exclusions with reasons, a total of 146 studies were included. Wide differences were detected among studies in their geographical localization, study design, temporal distribution, participants' condition, OMT protocols, and documented biological effects. Such variety in frequency distribution was properly described through descriptive statistics.

CONCLUSIONS

Biological modifications that appear to be induced by OMT have been detected in several body systems, but mostly in neurophysiological correlates and musculoskeletal changes. Results suggest a growing interest over the years on this topic, especially in the last two decades. More efforts in research are recommended to highlight whether such changes specifically depend on OMT, and to demonstrate its specific contribution to clinical practice.

Historical Osteopathic Principles and Practices in Contemporary Care: An Anthropological Perspective to Foster Evidence-Informed and Culturally Sensitive Patient-Centered Care: A Commentary

Historical osteopathic principles and practices (OPP)-considering the patient as a dynamic interaction of the body, mind, and spirit and incorporating the body's self-healing ability into care-are inherited from traditional/complementary and alternative (CAM) principles. Both concepts are familiar to contemporary osteopathic practitioners, but their incorporation into healthcare for evidence-informed, patient-centered care (PCC) remains unclear. Further, a polarity exists in the osteopathic profession between a 'traditional-minded' group following historical OPP despite evidence against those models and an 'evidence-minded' group following the current available evidence for common patient complaints. By shifting professional practices towards evidence-based practices for manual therapy in line with the Western dominant biomedical paradigm, the latter group is challenging the osteopathic professional identity. To alleviate this polarity, we would like to refocus on patient values and expectations, highlighting cultural diversity from an anthropological perspective. Increasing an awareness of diverse sociocultural health assumptions may foster culturally sensitive PCC, especially when including non-Western sociocultural belief systems of health into that person-centered care. Therefore, the current medical anthropological perspective on the legacy of traditional/CAM principles in historical OPP is offered to advance the osteopathic profession by promoting ethical, culturally sensitive, and evidence-informed PCC in a Western secular environment. Such inclusive approaches are likely to meet patients' values and expectations, whether informed by Western or non-Western sociocultural beliefs, and improve their satisfaction and clinical outcomes.

Effectiveness of osteopathic interventions in patients with non-specific neck pain: A systematic review and meta-analysis

OBJECTIVE

The aim of this systematic review and meta-analysis is to evaluate whether osteopathic manipulative interventions can reduce pain levels and enhance the functional status in patients with non-specific neck pain (NS-NP).

METHODS

A systematic review and meta-analysis was conducted following the 2020 PRISMA statement. Randomized controlled trials (RCTs) were searched in five databases, assessed through a standardized form, and evaluated using the "13 items Cochrane risk of bias (RoB) tool". Effect sizes (ES) were calculated post-treatment, and the quality of evidence was assessed through GRADE criteria.

RESULTS

Five articles were included in the review, and none of these was completely judged at low RoB. Four of these were included in the meta-analysis. Osteopathic interventions compared to no intervention/sham treatment showed statistically significant results for pain levels (ES = -1.57 [-2.50, -0.65]; P = 0.0008) and functional status (ES = -1.71 [-3.12, -0.31]; P = 0.02). The quality of evidence was "very low" for all the assessed outcomes. Other results were presented in a qualitative synthesis.

CONCLUSIONS

Osteopathic interventions could be effective for pain levels and functional status improvements in adults with NS-NP. However, these findings are affected by a very low quality of evidence. Therefore, further high-quality RCTs are necessary to improve the quality of evidence and generalize the results.

A Content Analysis of Osteopaths’ Attitudes for a More Inclusive Clinical Practice towards Transgender People

Objectives. The aim of this qualitative study was to explore the attitudes, beliefs, and preferences of Italian osteopaths regarding the management of transgender patients through a content analysis of emergent data from semi-structured interviews. Methods. This study was a content analysis based on the Standards for Reporting Qualitative Research guidelines. Purposive sampling of 10 Italian osteopaths was applied. Data were collected through semi-structured interviews, from March to April 2021, and subsequently transcribed verbatim with the content analysis carried out as an iterative process. Results. One participant was excluded during the first interview due to them being unsuitable for this study. Data saturation was reached after two interviews with the remaining nine participants. Data analysis revealed four main themes: microaggressions, acceptance and non-judgement, person-centered treatment, and education implementation. Conclusions. This study presents cisgender Italian osteopaths’ attitudes in the care of transgender people, revealing the desire to embrace and apply osteopathic tenets regardless of the patient’s gender identity.

¿Qué es la medicina alternativa, complementaria e integrativa?

El concepto de medicina alternativa fue creado por la medicina occidental para identificar prácticas médicas diferentes a la medicina convencional, tales como la medicina tradicional china y acupuntura, homeopatía, terapia neural, medicina osteopática y quiropráctica, medicina ayurveda y la medicina tradicional indígena, que también tienen fundamentos filosóficos, científicos y terapéuticos. Desafortunadamente, con el tiempo se estableció la creencia de que la medicina alternativa comprende todas las prácticas médicas que no son parte de la medicina convencional, lo que ha causado muchas inexactitudes y controversias. La medicina surgió como necesidad de auto preservación del ser humano y que considera a la salud como bienestar completo y a la enfermedad, como pérdida de esta condición. A lo largo de su evolución han emergido diversas racionalidades y algunas de ellas se han convertido en sistemas médicos. La medicina convencional se estructuró en Occidente, fundamentada en racionalidades médicas existentes para la época y enfocada en modificar la enfermedad, lo que resultó en marcadas diferencias conceptuales con sistemas de tratamiento ya existentes que se centraban en el individuo y en modificar los procesos de la enfermedad. Todos los sistemas médicos han generado un impacto en diversos campos sociales. Asimismo, han surgido tendencias y estrategias de integración de la medicina convencional con otros sistemas médicos comoLa electroacupuntura de Voll, la homotoxicología, el balance polar electromagnético, la antroposofía, la sintergética y la biofotónica. Actualmente se considera que el objetivo de la medicina es integrar y complementar conocimientos de diferentes racionalidades médicas dentro del concepto de una sola medicina. Teniendo en cuenta lo anterior, el objetivo del presente artículo es clarificar los conceptos de las diferentes formas de medicina, plantear algunas definiciones al respecto, y proponer una definición de medicina alternativa, complementaria e integrativa.

Osteopathy and Mental Health: An Embodied, Predictive, and Interoceptive Framework

Globally, mental and musculoskeletal disorders present with high prevalence, disease burden, and comorbidity. In order to improve the quality of care for patients with persistent physical and comorbid mental health conditions, person-centered care approaches addressing psychosocial factors are currently advocated. Central to successful person-centered care is a multidisciplinary collaboration between mental health and musculoskeletal specialists underpinned by a robust therapeutic alliance. Such a collaborative approach might be found in osteopathy, which is typically utilized to treat patients with musculoskeletal disorders but may arguably also benefit mental health outcomes. However, research and practice exploring the reputed effect of osteopathy on patients with mental health problems lack a robust framework. In this hypothesis and theory article, we build upon research from embodied cognition, predictive coding, interoception, and osteopathy to propose an embodied, predictive and interoceptive framework that underpins osteopathic person-centered care for individuals with persistent physical and comorbid mental health problems. Based on the premise that, for example, chronic pain and comorbid depression are underlined by overly precise predictions or imprecise sensory information, we hypothesize that osteopathic treatment may generate strong interoceptive prediction errors that update the generative model underpinning the experience of pain and depression. Thus, physical and mental symptoms may be reduced through active and perceptual inference. We discuss how these theoretical perspectives can inform future research into osteopathy and mental health to reduce the burden of comorbid psychological factors in patients with persistent physical symptoms and support person-centered multidisciplinary care in mental health.

The role of touch in osteopathic practice: A narrative review and integrative hypothesis

INTRODUCTION

Osteopathy relies on a touch-based approach to promote health. This narrative review aims to analyze the role of touch in clinical osteopathic practice.

METHODS

A database search was conducted using MEDLINE, EMBASE, PEDro and Google Scholar. Peer-reviewed papers without specifying limits on dates and design were included.

RESULTS

47 articles met the inclusion criteria and were used to elucidate two main themes: Biological and psychological effects of touch; Touch in the context of osteopathic clinical reasoning.

DISCUSSION

Touch is one of the tools to achieve a collaborative interaction with the patient, to substantiate clinical information, and to detect somatic dysfunctions: neuro-myofascial active areas that might act as an osteopath-patient interface to transmit the biological and physiological effects of touch.

CONCLUSION

The findings of the review support a shared decision-making process, in which touch is one of the osteopath-patient dyad 's leading communication tools to develop a tailor-made osteopathic approach.

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.

"If you don't use or understand visceral osteopathy you're not a real osteopath": Professional identity in Australian osteopathy through the lens of a single traditional technique

BACKGROUND/CONTEXT

Manual therapists utilise a range of techniques in the clinical practice to manage predominantly musculoskeletal complaints. There are, however, a number of practitioners who utilise techniques that are directed towards the bodies' visceral structures. Osteopaths are one such professional group that utilise these techniques in their practice. Like many health professions, the identity of the osteopathy profession is evolving, and the techniques osteopaths use form part of this identity.

OBJECTIVE

Explore free text responses to a questionnaire about the use of techniques directed towards the viscera.

METHODS/DESIGN

Australian osteopaths who were part of a practice-based research network, were invited to complete a survey about their use of techniques applied to the viscera. Participants were also invited to provide free-text responses to a number of items related to the use of these techniques. Free-text responses were thematically analysed.

PARTICIPANTS

137 participants completed the survey.

RESULTS

Three themes were identified: being an osteopath; applying visceral techniques in practice - evidence conflicts with practice; and, inadequate education in visceral techniques.

CONCLUSIONS

Participant responses resonated with the internal (own world views, beliefs) and external (external perceptions of the profession, education) influences that underpin the theory of a professions' identity. Our work demonstrates that the Australian osteopathy profession exhibits an identity similar to other manual therapies - the profession is somewhat fragmented in its views about its practice. Additional research is required to explore whether other manual therapy techniques used by osteopaths elicit similar responses and how those external to the profession perceive it.

The role of personality in posttraumatic stress disorder, trait resilience, and quality of life in people exposed to the Kiss nightclub fire

Objective

To evaluate the relationship among personality (according to Cloninger’s psychobiological model), posttraumatic stress disorder (PTSD) symptoms, trait resilience and quality of life (QoL) in people who were exposed to the Kiss nightclub fire.

Methods

188 participants were assessed with the Posttraumatic Checklist–civilian version (PCL-C), the Resilience Scale (RS), the Temperament and Character Inventory (TCI), the World Health Organization Quality of Life–Bref (WHOQOL-Bref), and the WHOQOL-100 Spirituality, religiousness, and personal beliefs (WHOQOL-100-SRPB). Data were analyzed in a dimensional approach, with correlation analysis, multiple linear regression and Structural Equation Modeling (SEM), with PCL-C, RS, and WHOQOL-Bref dimensions as dependent variables.

Results

Multiple linear regression showed that PTSD symptoms were predicted by harm avoidance (β = .34, p < .001), self-directedness (β = -.28, p < .01), and self-transcendence (β = .24, p < .01). Trait resilience was predicted by harm avoidance (β = -.38, p < .01), self-directedness (β = .20, p < .05), and self-transcendence (β = .18, p < .05). Also, PTSD symptoms had considerable negative effect on all dimensions of QoL. Self-transcendence was a positive predictor of subjective and spiritual QoL. SEM showed that QoL was predicted by PTSD symptoms (β = -.52, p < .001), trait resilience (β = .30, p < .001), cooperativeness (β = .135, p = 0.40), and self-directedness (β = .27, p < .01). The effect of self-directedness on QoL was mediated by PTSD symptoms and trait resilience. PTSD symptoms also mediated the relationship between trait resilience and QoL, and RS mediated the relationship of personality and PTSD symptoms.

Conclusion

The study gives insights on prediction of PTSD severity, trait resilience and QoL from temperament and character traits, in a sample of people exposed to the Kiss nightclub fire. Harm avoidance was the most influent trait on PTSD symptoms and trait resilience. Self-directedness was the most import trait related to QoL, still that it was more related to PTSD severity than personality traits. Self-transcendence had positive effects on both PTSD symptoms and trait resilience, indicating a coping style that may coexist with psychopathology.

Personality Typology in Patients with Traumatic Limb Fractures

The notion that personality impacts health is not new. According to Grossarth-Maticek and Eysenck’s theoretical approach, the main factor for health is the ability for self-regulation, which seems to moderate the effects of some physical risk factors.

The aim of this study was to evaluate personality characteristics of patients hospitalized for traumatic limb’s fractures which have been operatively treated. To our knowledge, it is the first study of this type in the region.

The evaluated sample comprises two groups of examinees: patients hospitalized at the Traumatology Clinic for surgery after fractured limbs (N=30) and healthy people (N=120) as control, previously examined. Two psychometric tests were used: Grossarth-Maticek questionnaire and Eysenck Personality Questionnaire (EPQ).

Obtained results showed that the personality characteristics of patients with traumatic limb fractures belong generally to the “healthy type 4” of Grossarth-Maticek typology, similarly as the control. It correlates to the low N (neuroticism) and moderate E (extraversion) scales in the Eysenck typology.

We showed that gender and age highly influence the scores obtained from the questionnaire.

The type of personality could influence reactions in life situations, coping with stress and consequently to be a trigger for any disorder, even traumatic fractures

Aspiring personality: Patients waiting for obesity treatment

The aim of the present study was to investigate differences in temperament and character between patients (N = 70) waiting for obesity surgery and the general population. Patients waiting for obesity surgery scored higher in Harm-Avoidance, Reward Dependence, Persistence, and Cooperativeness and also lower in Self-Directedness.

Italian and Swedish adolescents: differences and associations in subjective well-being and psychological well-being

BACKGROUND

One important aspect of subjective judgments about one's well-being (i.e., subjective well-being: life satisfaction, positive affect, and negative affect) is that cultural features, such as, nationality seem to shape cognitive judgments about the "the ideal life." In this comparative study we examined differences in subjective well-being and psychological well-being between Italian and Swedish adolescents and tested if the relationship between the three constructs of subjective well-being (i.e., satisfaction with life, positive affect, and negative affect) and psychological well-being was moderated by the adolescents' nationality.

METHOD

Italian (n = 255) and Swedish (n = 277) adolescents answered to the Satisfaction with Life Scale, the Positive Affect Negative Affect Schedule, and Ryff's Scales of Psychological Well-Being. Differences between samples were tested using a Multiple Analysis of Variance. We also conducted a multiple group analysis (Italy and Sweden) using Structural Equation Modelling to investigate the relationship between all three subjective well-being constructs and psychological well-being.

RESULTS

Italian adolescents scored significantly higher in satisfaction with life than Swedish adolescents. Additionally, across countries, girls scored significantly higher in negative affect than boys. In both countries, all three constructs of subjective well-being were significantly associated to adolescents' psychological well-being. Nevertheless, while the effect of the relationship between affect and psychological well-being was almost the same across countries, life satisfaction was more strongly related to psychological well-being among Swedish adolescents.

CONCLUSIONS

The present study shows that there are larger variations between these two cultures in the cognitive construct of subjective well-being than in the affective construct. Accordingly, associations between the cognitive component, not the affective component, of subjective well-being and psychological well-being differ between countries as well.

Harm Avoidance and Self-Directedness Characterize Fibromyalgic Patients and the Symptom Severity

OBJECTIVE

Evidence in the literature suggests peculiar personality traits for fibromyalgic (FM) patients, and it has been suggested that personality characteristics may be involved in patients' different symptomatic events and responses to treatment. The aim of the study is to investigate the personality characteristics of Italian FM patients and to explore the possibility of clustering them considering both personality traits and clinical characteristics.

DESIGN

The study used a cross-sectional methodology and involved a control group. A self-assessment procedure was used for data gathering. The study included 87 female FM patients and 83 healthy females. Patients were approached and interviewed in person during a psychiatric consultation. Healthy people were recruited from general practices with previous telephone contact.

MAIN OUTCOME MEASURES

Participants responded to the Hospital Anxiety and Depression Scale, the Temperament and Character Inventory, the Fibromyalgia Impact Questionnaire and the Short-Form-36 Health Survey.

RESULTS

FM patients scored significantly different from healthy participants on the Harm avoidance (HA), Novelty seeking (NS) and Self-directedness (SD). Two clusters were identified: patients in Cluster1 (n = 37) had higher scores on HA and lower scores on RD, SD, and Cooperativeness and reported more serious fibromyalgia and more severe anxious-depressive symptomatology than did patients in Cluster2 (n = 46).

CONCLUSION

This study confirms the presence of certain personality traits in the FM population. In particular, high levels of HA and low levels of SD characterize a subgroup of FM patients with more severe anxious-depressive symptomatology. According to these findings, personality assessment could be useful in the diagnostic process to tailor therapeutic interventions to the personality characteristics.

The genetic and environmental structure of the character sub-scales of the temperament and character inventory in adolescence

BACKGROUND

The character higher order scales (self-directedness, cooperativeness, and self-transcendence) in the temperament and character inventory are important general measures of health and well-being [Mens Sana Monograph 11:16-24 (2013)]. Recent research has found suggestive evidence of common environmental influence on the development of these character traits during adolescence. The present article expands earlier research by focusing on the internal consistency and the etiology of traits measured by the lower order sub-scales of the character traits in adolescence.

METHODS

The twin modeling analysis of 423 monozygotic pairs and 408 same sex dizygotic pairs estimated additive genetics (A), common environmental (C), and non-shared environmental (E) influences on twin resemblance. All twins were part of the on-going longitudinal Child and Adolescent Twin Study in Sweden (CATSS).

RESULTS

The twin modeling analysis suggested a common environmental contribution for two out of five self-directedness sub-scales (0.14 and 0.23), for three out of five cooperativeness sub-scales (0.07-0.17), and for all three self-transcendence sub-scales (0.10-0.12).

CONCLUSION

The genetic structure at the level of the character lower order sub-scales in adolescents shows that the proportion of the shared environmental component varies in the trait of self-directedness and in the trait of cooperativeness, while it is relatively stable across the components of self-transcendence. The presence of this unique shared environmental effect in adolescence has implications for understanding the relative importance of interventions and treatment strategies aimed at promoting overall maturation of character, mental health, and well-being during this period of the life span.

Attention-Deficit/Hyperactivity Disorder: Focus upon Aberrant N-Methyl-D-Aspartate Receptors Systems

Attention-deficit/hyperactivity disorder (ADHD) pathophysiology persists in an obscure manner with complex interactions between symptoms, staging, interventions, genes, and environments. Only on the basis of increasing incidence of the disorder, the need for understanding is greater than ever. The notion of an imbalance between central inhibitory/excitatory neurotransmitters is considered to exert an essential role. In this chapter, we first review how the default mode network functions and dysfunction in individuals diagnosed with ADHD. We also present and briefly review some of the animal models used to examine the neurobiological aspects of ADHD. There is much evidence indicating that compounds/interventions that antagonize/block glutamic acid receptors and/or block the glutamate signal during the "brain growth spurt" or in the adult animal may induce functional and biomarker deficits. Additionally, we present evidence suggesting that animals treated with glutamate blockers at the period of the "brain growth spurt" fail to perform the exploratory activity, observed invariably with control mice, that is associated with introduction to a novel environment (the test cages). Later, when the control animals show less locomotor and rearing activity, i.e., interest in the test cages, the MK-801, ketamine and ethanol treated mice showed successively greater levels of locomotion and rearing (interest), i.e., they fail to "habituate" effectively, implying a cognitive dysfunction. These disturbances of glutamate signaling during a critical period of brain development may contribute to the ADHD pathophysiology. As a final addition, we have briefly identified new research venues in the interaction between ADHD, molecular studies, and personality research.