Osteopathy Journal Articles

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    Preliminary development of a complex intervention for osteopathic management of dysfunctional breathing
    (Elservier, 2016-04-27) Benjamin, Jordan Guy; Bacon, Catherine; Verhoeff, Wesley; Moran, Robert; Unitec Institute of Technology
    BACKGROUND: Breathing retraining (BRT) is commonly used during osteopathic consultations as an adjunct to osteopathic manual therapy (OMT) for assessment and treatment of breathing-related dysfunction. Although BRT and OMT are widely recognised within osteopathy and other allied health disciplines, there are few descriptions of clinically applicable protocols in the literature. OBJECTIVE: To describe the development of a dual-protocol framework (BRT and OMT) for assessment and treatment of dysfunctional breathing. DESIGN: Development and evaluation of a complex intervention. METHODS: Cyclical, iterative processes of development, feasibility and piloting, evaluation and subsequent redevelopment were applied in the design of two conceptual protocols for BRT and OMT. RESULTS: The resulting BRT protocol consists of progressive steps of breathing practice in three body positions (neutral, flexion, extension), followed by a guide for more advanced breathing challenges that can be tailored towards the individual. The OMT protocol provides a semi-standardised assessment and treatment plan, which details body regions for assessment of somatic dysfunction and a list of techniques that can be selected according to practitioner clinical judgement, based on patient presentation and preferences, and clinical context. CONCLUSIONS: Here we present a clinically applicable guide for a complex intervention entailing assessment and management of dysfunctional or abnormal breathing. Implementation of this protocol within the clinical setting is now recommended, along with ongoing development, and further randomised clinical trials assessing its efficacy, effectiveness, and acceptability.
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    The reliability of a quality appraisal tool for studies of diagnostic reliability (QAREL)
    (BioMed Central Ltd, 2013-09-19) Lucas, Nicholas; Macaskil, Petra; Irwig, Les; Moran, Robert; Rickards, Luke; Turner, Robin; Bogduk, Nikolai; Unitec Institute of Technology
    Background The aim of this project was to investigate the reliability of a new 11-item quality appraisal tool for studies of diagnostic reliability (QAREL). The tool was tested on studies reporting the reliability of any physical examination procedure. The reliability of physical examination is a challenging area to study given the complex testing procedures, the range of tests, and lack of procedural standardisation. Methods Three reviewers used QAREL to independently rate 29 articles, comprising 30 studies, published during 2007. The articles were identified from a search of relevant databases using the following string: “Reproducibility of results (MeSH) OR reliability (t.w.) AND Physical examination (MeSH) OR physical examination (t.w.).” A total of 415 articles were retrieved and screened for inclusion. The reviewers undertook an independent trial assessment prior to data collection, followed by a general discussion about how to score each item. At no time did the reviewers discuss individual papers. Reliability was assessed for each item using multi-rater kappa (κ). Results Multi-rater reliability estimates ranged from κ = 0.27 to 0.92 across all items. Six items were recorded with good reliability (κ > 0.60), three with moderate reliability (κ = 0.41 - 0.60), and two with fair reliability (κ = 0.21 - 0.40). Raters found it difficult to agree about the spectrum of patients included in a study (Item 1) and the correct application and interpretation of the test (Item 10). Conclusions In this study, we found that QAREL was a reliable assessment tool for studies of diagnostic reliability when raters agreed upon criteria for the interpretation of each item. Nine out of 11 items had good or moderate reliability, and two items achieved fair reliability. The heterogeneity in the tests included in this study may have resulted in an underestimation of the reliability of these two items. We discuss these and other factors that could affect our results and make recommendations for the use of QAREL.
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    The efficacy of surface electromyographic biofeedback assisted stretching for the treatment of chronic low back pain : A case-series
    (Churchill Livingstone, 2014-01) Moore, Aimee M.; Mannion, Jamie; Moran, Robert; Unitec Institute of Technology
    Individuals with low back pain (LBP) commonly present with an impaired flexion erelaxation (FR) response, characterised as continued lumbar muscle activation at maximal voluntary flexion. The aim of the present investigation was to explore the effectiveness of a surface electromyographic assisted stretching (SEMGAS) programme in improving FR. Nine volunteers with chronic LBP and an impaired FR took part in weekly biofeedback SEMGAS sessions and performed a home-based stretching programme, for 5 weeks. FR, Oswestry Disability Index, Numeric Pain Rating Scale and Sit and Reach were recorded pre and post-intervention as well as at a 4e6-week follow-up. Of the nine participants included, three improved FR to statistically significant levels. These three participants also achieved a clinically important change in pain intensity scores. The results suggest that SEMGAS may provide benefits to some individuals with chronic LBP and impaired FR, although larger scale investigation of SEMGAS alone is indicated.