1. FAQs

2. Questions What is osteopathy? Does osteopathy work? Is it safe?
Is it better than other ‘treatments’?

3. What is osteopathy?

4. What is osteopathy?
Osteopathic International Alliance take two pages in the WHO report to describe osteopathy and osteopaths
2 types:
Osteopathic Physicians
Osteopaths

5. What is osteopathy?
Osteopathy means different things to different people
If osteopaths can’t define osteopathy they should at least be able to describe what they do

6. What is osteopathy?
Standardised data collection survey and clinical audit (2009)
In the UK there are just over 5,000 registered osteopaths, 9% responded.
ref:

7. Survey results Osteopathic patients are: ~56% female
most are treated for low back pain 36%
51% have acute pain, 15% sub-acute and 31% chronic

8. Survey results - Soft tissue manipulation (78%), - Articulation (73%),
Most commonly used treatments are:
- Soft tissue manipulation (78%),
- Articulation (73%),
- HVT (38%),
- Cranial osteopathic techniques (26%), - MET (18%)
- Functional (14%)

9. What is osteopathy?
It is a multi-component complex intervention delivered by health care practitioners in primary care
The components of osteopathy are combined and delivered as a package of care in a consultation and can include:

10. What is osteopathy? A case history Examination Discussion of findings
Discussion of treatment and care plan
Consent
Manual therapy
Health care advice
Self-management support
Listening and talking (psychosocial care)
We need to decide on the generalisability of research. Just because it may not be ‘osteopathy’ it does not mean that the research is not relevant.
Of course different people may have different views and answers to these questions.
Osteopathy is a small profession in the big wide world of health care.
In reality there is not much research done by osteopaths for osteopaths
Osteopathy from a research perspective
Osteopathy is a complex intervention which includes many components, we need to be able to appraise how relevant other research is to our profession and practice and the treatment we provide for treating certain conditions such as neck or lower back pain services
Lets consider the largest RCT done in the UK, the UK BEAM trial.

11. Questions What is osteopathy? Does osteopathy work? Is it safe?
Is it better than other ‘treatments’?
In the second part of the presentation we will review the research that over the last few years NCOR (with the GOSC) has facilitated. NCOR has gathered and produced some really important research, about evidence and risk. I will present a quick round up of this to illustrate how research can be applied to everyday practice
Finally I shall talk a little about the future.

12. Does osteopathy work? Question a bit like asking:
Is BREXIT a good idea?
Does surgery work?
Questions are too big: Work for whom work, for what condition, when and for how long ?

13. ‘Osteopathic’ research ?
Osteopathic research done by osteopaths for osteopaths?
Any research done by other musculoskeletal health professionals?
Shared techniques, shared research?
We need to decide on the generalisability of research. Just because it may not be ‘osteopathy’ it does not mean that the research is not relevant.
Of course different people may have different views and answers to these questions.
Osteopathy is a small profession in the big wide world of health care.
In reality there is not much research done by osteopaths for osteopaths
Osteopathy is a complex intervention which includes many components, we need to be able to appraise how relevant other research is to our profession and practice and the treatment we provide for treating certain conditions such as neck or lower back pain services
Lets consider the largest RCT done in the UK, the UK BEAM trial.

14. Does osteopathy work?
We can only answer this when we can define osteopathy but in reality we focus on:
Techniques e.g. HVT
Conditions e.g. Low back pain
We need to decide on the generalisability of research. Just because it may not be ‘osteopathy’ it does not mean that the research is not relevant.
Of course different people may have different views and answers to these questions.
Osteopathy is a small profession in the big wide world of health care.
In reality there is not much research done by osteopaths for osteopaths
Osteopathy is a complex intervention which includes many components, we need to be able to appraise how relevant other research is to our profession and practice and the treatment we provide for treating certain conditions such as neck or lower back pain services
Lets consider the largest RCT done in the UK, the UK BEAM trial.

15. Evidence

16. Evidence Effectiveness of ‘osteopathy’ (for what)?
Effectiveness of techniques used by osteopaths
Effectiveness of techniques for conditions?
What benefits are important to patients?
We still have some questions before we start searching for evidence

17. Effectiveness data Systematic reviews Randomised controlled trials
Prospective cohort studies
Guidelines compiled for managing musculoskeletal conditions
Particularly relevant are these types of studies and these inform the development of guidelines which consider all forms of research for managing musculoskeeltal conditions

18. Guidelines UK NICE Guidelines for Low back pain and sciatica (2016)
Recommend the use of manual therapy (including osteopathy) as part of a package of care.

19. Rationale for recommendation of manual / physical therapy for: Low back pain
Examples of evidence (

20. Date
Authors
Type of study
Evidence for:
2012
Rubinstein et al SR
26 RCTs
6070 people
SMT is as effective as other common therapies for chronic low back pain and safe
20 RCTs
2674 people
Evidence was low quality showed little effect for those with acute low back pain but it is safe
Furlan et al
10 RCTS
SMT and mobilisation were superior to no treatment and placebos for low back pain
2013
Licciardone et al
RCT
455 people
OMT patients significantly better outcomes than sham OMT and ultrasound for chronic low back pain
Von Heymann et al
100 people
SMT treatment effects greater than placebo and diclofenac for acute low back pain
2004
UK BEAM trial team
1334 people
Manipulation package showed sustained beneficial outcomes at after 3 and 12 months

21. FOR EXAMPLE: BEAM 4 arm trial, ~330 people each arm total recruited 1334
GP care, exercise, manipulation and exercise (private and NHS), manipulation (private and NHS).
This trial involved osteopaths, physios and chiropractors. The results were hugely important to each profession it was the biggest trial at the time provided robust statistical evidence that manipulation had a positive beneficial effect for those with sub acute and chronic low back pain.
UK BEAM trial helped inform UK NICE Guidelines (National Institute for Clinical Excellence) that recommended the use of manipulative treatment for persisting low back pain.
‘Consider offering a course of manual therapy including spinal manipulation, comprising up to a maximum of nine sessions over a period of up to 12 weeks.’
These guidelines have helped osteopathy achieve better recognition in the wider health care community.
Good collaborative bit of research usefull for all musculoskeletal professions

22. Rationale for recommendation of manual / physical therapy for: Neck pain
Examples of evidence

23. Date
Authors
Type of study
Evidence for:
2012
Posadzki & Ernst SR
5 RCTs
348 people
SMT more effective than drug therapy, placebo, usual care and no treatment for tension type headache
Vincent et al
27 RCTs
MT contributes to improved pain and function in adults with non-specific neck pain.
2010
Gross et al
17 RCTs
Positive evidence for SMT and mobilisation and exercise for improving neck pain
2009
Hurwitz et al
30 SRs
Manual therapy and exercise are more effective than alternative strategies for patients with neck pain
2004
Bronfort et al
22 RCTs
SM may be an effective treatment option with a short term effect similar to amytryptiline for migraine. For cervicogenic headache neck exercise and SMT effective in short and long term

24. Summary of evidence Growing body of evidence Evidence base is positive
Quality of evidence is getting better
NCOR website for up to date information
What NCOR / GOSC did was instigate 4 projects from 2007 onwards:
A systematic review of adverse events in manual therapy
Communicating risk and obtaining consent in osteopathic practice
Insurance claim trends and patient complaints to the osteopathic regulator
4) Prospective cohort study to investigate osteopaths' attitudes to managing and assessing risk in clinical settings and patients' experiences and responses to osteopathic treatment.

25. Questions What is osteopathy? Does osteopathy work?
Is osteopathy safe?
Is it better than other ‘treatments’?
In the second part of the presentation we will review the research that over the last few years NCOR (with the GOSC) has facilitated. NCOR has gathered and produced some really important research, about evidence and risk. I will present a quick round up of this to illustrate how research can be applied to everyday practice
Finally I shall talk a little about the future.

26. Evidence about risk

27. Evidence of risk Adverse events and patient incidences in manual therapy
Why research this?
Read and go to next slide which considers why

28. Why research this? Understanding risk and types of risk
Clinical decision making
Comparison with other health care providers
Patient informed consent
What NCOR / GOSC did was instigate 4 projects from 2007 onwards:
A systematic review of adverse events in manual therapy
Communicating risk and obtaining consent in osteopathic practice
Insurance claim trends and patient complaints to the osteopathic regulator
4) Prospective cohort study to investigate osteopaths' attitudes to managing and assessing risk in clinical settings and patients' experiences and responses to osteopathic treatment.

29. Clinical Risk in osteopathy and management S. Vogel et al. July 2012
Here I will just report the findings from the systemic review that was conducted into adverse events in manual therapy. This was the first of the series of adverse events projects commissioned by the GOSC and facilitated via NCOR
This review was conducted in 2008/9 and published in 2010, and even now some of this data can be updated as you will see later in conference

30. Here I will just report the findings from the systemic review that was conducted into adverse events in manual therapy. This was the first of the series of adverse events projects commissioned by the GOSC and facilitated via NCOR
This review was conducted in 2008/9 and published in 2010, and even now some of this data can be updated as you will see later in conference

31. Our initial searches yielded nearly 20,000 potentially relevant articles.
Fortunately after sifting and scrutiny using our exclusion and inclusion criteria we selected 60 papers containing original research about manual therapies and adverse events, we found 36 trials of manual therapy that reported data on adverse events and we analysed data from 9 prospective cohort studies.

32. Adverse events in manual therapy: findings
Major/serious adverse events are rare
We estimate 1 vascular insult per 50,000 patients or per100,000 cervical manipulations (Carnes et al 2009)
Those likely to have a CVA are likely to seek treatment prior to the accident due to the nature of the symptoms (Cassidy et al 2008)
Serious adverse events are:
Death
Unresolving
Requiring further care

33. Adverse events in manual therapy: findings
Minor adverse events are common ~46%
of all patients after MT treatment
Most minor and moderate adverse events
resolve within 48 hours
Adverse events are most likely to be reported after the first treatment

34. Summary
There is good evidence of beneficial effects for techniques used by osteopaths particularly manipulation
The techniques used by osteopaths have low risk of serious incidents associated with them.
We need to do more large scale research
Perhaps this should be a research priority

35. Questions What is osteopathy? Does osteopathy work?
Is osteopathy safe?
Is osteopathy better than other ‘treatments’?
In the second part of the presentation we will review the research that over the last few years NCOR (with the GOSC) has facilitated. NCOR has gathered and produced some really important research, about evidence and risk. I will present a quick round up of this to illustrate how research can be applied to everyday practice
Finally I shall talk a little about the future.

36. Is osteopathy better than
other treatments?
For what ?
For whom?
And when?

37. Acknowledging limitations
of practice
Seeking informed consent
Advising patients about alternatives
Patient choice
Different communities e.g. Osteopaths, special interest groups, the public

38. Acknowledging limitations
of practice
Acknowledging lack of knowledge
There are many unknowns in the medical profession
Communicating effectively and eloquently is part of being an osteopath
Different communities e.g. Osteopaths, special interest groups, the public

39. Making research accessible and relevant so it can be easily used