Standardization of the hospital record for osteopathic structural examination: Part 2. Effects of an educational intervention on documentation of palpatory and structural findings and diagnosis

The purpose of this two-part study was to develop and test an instructional videotape for use in the osteopathic hospital setting; to standardize a procedure for documentation of palpatory and structural findings and diagnoses; and to examine the program's influence on the correlation of palpable and structural findings with a diagnostic impression of somatic dysfunction. To that end, the authors analyzed results of a survey of the medical records of 20 osteopathic training hospitals. Patients' charts were randomly pulled before and after house staff who performed admitting hospital examinations viewed an educational videotape. The videotape emphasized that the structural and palpatory screening examination should simply answer the question, "Is there a problem in the musculoskeletal system?" Chi-square analysis was used to evaluate the frequency of documentation of altered structural findings (structure, motion, tissue changes) and the diagnostic impression of somatic dysfunction and their correlation. Based on more than 300 reviewed charts, the authors found that the frequency of documentation of structural and palpatory examination was not significantly altered after house staff viewed the videotape. A sequence of hospital-based instruction in osteopathic principles and practices has been initiated at more than 50 osteopathic medical institutions, and the problems related to continuing medical education and clinical research in osteopathic medicine are discussed.

Standardization of the hospital record for osteopathic structural examination: recording of musculoskeletal findings and somatic dysfunction diagnosis

The diagnosis of somatic dysfunction is supported by the recording of positive musculoskeletal findings (altered structure, motion, tissue). We conducted a national survey to assess the status of the documentation of this relationship in the hospital setting. The 26 participating osteopathic training hospitals submitted 719 admitting physical examination forms, of which 417 (58%) met study criteria (adult patients on medicine or surgical service with a musculoskeletal examination documented on the chart). On 234 charts (56%), at least one positive finding was recorded but no diagnosis of somatic dysfunction was stated. Of 14 charts with a diagnosis of somatic dysfunction, 10 had a positive musculoskeletal finding recorded. The relationship between positive musculoskeletal findings and somatic dysfunction is not being documented on osteopathic training hospital admitting physical examination forms. Proper documentation of a somatic dysfunction diagnosis and related positive musculoskeletal findings will enable multisite research on the relationship between somatic dysfunction and other health problems documented on the hospital medical record. A multiple data collection system that is workable, reliable, and reproducible was developed as a result of this study.

Paraspinal muscle evoked cerebral potentials in patients with unilateral low back pain

Cerebral somatosensory evoked potentials (SEPs) were elicited by magnetic stimulation of paraspinal muscles unilaterally at the L2 and L5 levels in 20 healthy subjects and 16 patients with low back pain and unilateral muscle spasm. A magnetic coil with a mean diameter of 4.7 cm was placed tangentially to the skin. The stimulus strength was sufficient to induce a visible muscle twitch without producing muscle contraction in the legs. The potentials recorded over the scalp consisted of several components (P30, N40, P55, N70, and P90) and were elicited in all subjects. In both healthy and patient subjects, paraspinal muscle evoked potentials were readily elicited. Vibration applied to paraspinal muscles, as well as voluntary contraction of paraspinal muscles, was associated with attenuation of the evoked potentials. This finding suggests that muscle spindle receptors provide the afferent input responsible for the early components of the magnetically evoked cerebral potentials. In patients with unilateral muscle spasm, the amplitudes of P30-N40, N40-P50, and P50-N70 were decreased significantly on the affected side when compared with values on stimulation of the unaffected side, as well as those obtained from control subjects. The cerebral evoked potentials returned to normal amplitude when the muscle spasm subsided following a period of time and after the application of spinal manipulative therapy. The technique has potential for quantitative evaluation of muscle spasm in low back pain.