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Osteopathic manipulative treatment in the management of headaches associated with musculoskeletal dysfunction: Systematic review and meta-analysis
No full textOsteopathic manipulative treatment (OMT) can be utilized as a primary or adjunctive treatment for headaches associated with musculoskeletal disorders. Although previous systematic reviews investigated the effectiveness of manual therapies for treating headaches, they did not focus specifically on OMT or perform a pooled meta-analysis to evaluate the effectiveness of outcomes. The aim of this study is to systematically evaluate the effectiveness of OMT for managing headaches associated with musculoskeletal dysfunction and to assess the associated harm outcomes. In September 2023, the following databases were searched for randomized controlled trials (RCTs) of adult patients with headaches associated with musculoskeletal dysfunction who were treated with OMT: Allied and Complementary Medicine Database, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica (EMBASE), Osteopathic Medicine Digital Library (OSTMED), Ovid Emcare, Ovid MEDLINE, Physiotherapy Evidence Database (PEDro), PsycINFO, and PubMed. The search terms included osteopathic manipulative medicine, manual therapy, osteopath, headache, concussion, and head injury. The studies had to compare OMT techniques (e.g., articulatory [ART]; high-velocity, low-amplitude [HVLA]; soft tissues [ST]) to another form of treatment or a different type of OMT technique. Our primary outcomes included headache severity, headache frequency, disability associated with headaches, quality of life, and return to work (RTW); harm outcomes included all-cause dropout (ACD) rates, dropouts due to inefficacy, and adverse effects. The Cochrane Risk of Bias (ROB) tool was utilized to assess the ROB in the reviewed studies, and the quality of evidence was assessed utilizing the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Outcomes data were pooled for analysis and reported as standardized mean difference (SMD) and 95% confidence interval (CI). Our search identified 11,657 RCTs. After removing duplicates and screening titles and abstracts, 167 underwent full-text review, and 18 were included in our review. None of the reviewed RCTs met all of the Cochrane ROB criteria. Moderate-quality evidence indicated that combined ART-HVLA (SMD=-0.61, 95% CI=-1.0 to-0.23) and ST HVLA-ART (SMD=-0.48, 95% CI=-0.83 to-0.13) effectively reduced the severity of headache. Moderate-quality evidence also indicated that the combined techniques of ART-HVLA (SMD=-0.43, 95% CI=-0.74 to-0.13) and ST-ART-HVLA (SMD=-0.62, 95% CI=-0.89 to-0.35) effectively reduced the frequency of headaches. Moderate-quality evidence indicated that quality of life was improved with combined ART-HVLA (SMD=0.57, 95% CI=0.14 to 0.99). Low-quality evidence indicated no significant associations of OMT with disability or harm outcomes (all p\u3e0.26). Results of our systematic review and meta-analysis suggested that a combination of multiple types of OMT techniques effectively reduced the frequency and severity of headaches and improved quality of life. However, high-quality RCTs with large sample sizes utilizing a variety of technique modalities and combinations of technique modalities are necessary to better evaluate the effectiveness of OMT for managing headaches
Understanding COMLEX-USA Level-1 as a Pass/Fail examination: impact and opportunities
No full textContext: In late 2020, the National Board of Osteopathic Medical Examiners (NBOME) announced that the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) Level 1 would discontinue reporting numeric scores, only providing a Pass/Fail designation. The National Board of Medical Examiners (NBME) changed the core reports for the United States Medical Licensing Examination (USMLE) Step-1 to Pass/Fail in early 2020. Subsequently, residency program directors were reported to migrate toward increased reliance on COMLEX-USA Level 2CE and USMLE Step 2CK scores, the prestige of medical schools, and the status of the authors of letters of reference during their review of residency applicants. Objectives: Funded by an American Association of Colleges of Osteopathic Medicine (AACOM) research grant, A.T. Still University - Kirksville College of Osteopathic Medicine (ATSU-KCOM) and the Arkansas College of Osteopathic Medicine (ARCOM) generated a series of five hypotheses to investigate the perceived impact of the transition to Pass/Fail scoring. Methods: Both institutional review boards (IRBs) provided exempt status for this study. The hypotheses were examined through surveys distributed to current osteopathic medical students (OMS), recent graduates (classes of 2021 and 2022), academic advisors, and college of osteopathic medicine (COM) curriculum committee members in this cohort study. The investigative process consisted of two surveys: an initial survey to collect data on all five hypotheses and a focused, follow-up survey designed to better understand the impact of the scoring change. The surveys collected respondent feedback based on a Likert Scale. Standard descriptive statistics were assembled and analyzed. Qualitative responses were coded into thematic elements to examine response patterns. Results: The initial survey collected responses from 302 respondents (23.2 »% response rate) based on a scale from 1 (strongly disagree) to 4 (strongly agree). The survey results revealed the means for the following items based on a 4-point Likert scale (1=Strongly Disagree; 2=Disagree; 3=Agree; 4=Strongly Agree): (1) Increase chances of matching into residency: 2.35; (2) Pass/Fail is a positive change: 2.71; (3) Pass/Fail will reduce competition in competitive residency programs: 1.94; (4) clinical skills will be more strongly considered: 2.60; and (5) new score reports provide a robust analysis of strengths and weaknesses in basic science: 2.24. Almost half (46 »%) of the respondents expressed negative sentiments toward the Pass/Fail change. Reasons included more emphasis on COMLEX-USA Level 2CE, decreased motivation to perform on COMLEX-USA Level 1, and the perceived disadvantages that resulted during the residency match process. Conclusions: Among the survey respondents, many, especially students, do not view the change as favorable. Respondents cited the primary reasons for their unfavorable perception as a lack of motivation to perform on COMLEX-USA Level 1 and the added stress of performing on COMLEX-USA Level 2CE. Additionally, respondents viewed the change as negatively impacting their audition rotations and subsequent residency competitiveness
Craniocervical Posture and Cervical Curvature Variations in Adult Females with Different Vertical Facial Patterns: A Cross-Sectional Study
No full textThis study aimed to determine whether there are relationships between vertical facial patterns, cervical posture, and cervical curvature types. Ninety-two adult females with skeletal Class I relationships were retrospectively analyzed and divided into hypodivergent, normovergent, and hyperdivergent groups based on the mandibular plane angle to the nasion–sella line. Variables representing craniocervical posture (sagittal vertical axis, SVA; cervical inclination angle, CIA) and cervical curvature were measured. Differences in craniocervical posture among the groups were assessed. Cervical curvatures were classified into lordotic, straight, kyphotic, or sigmoid categories. The distribution of cervical curvature types among the groups was compared, and correlations between vertical facial patterns, craniocervical postures, and cervical curvature measurements were calculated. The results indicated that the hyperdivergent group exhibited increased SVA and decreased CIA compared to the normovergent and hypodivergent groups. Significant differences in cervical curvature types were observed among the groups. Lordotic curvature was most common in the normovergent group, while straight curvature was predominant in the hypodivergent and hyperdivergent groups. A significant correlation was found between an increased mandibular plane angle and a forward head position (increased SVA and decreased CIA). In conclusion, there are relationships between vertical facial patterns, cervical posture, and cervical curvature types. Therefore, careful assessment of craniocervical posture and cervical curvature is necessary in lateral cephalograms for orthodontic evaluation. However, cervical curvature measurements show minimal correlation with the mandibular plane angle
Anterior open bite: Key points to excellence in finishing for aesthetics, function, and long-term stability
No full textAchieving excellent finishing in anterior open bite (AOB) patients requires well-defined treatment goals established during the diagnostic phase, along with the development of an appropriate visualized treatment objective. In the presence of condylar degeneration or temporomandibular joint instability, the initial use of a stabilization splint is recommended to arrest degeneration and achieve joint stabilization prior to orthodontic treatment. Successful AOB treatment depends on the application of appropriate mechanics, such as the proper use of temporary anchorage devices. In the finishing phase, three-dimensional patient data accurately integrated from cone-beam computed tomography, face scan, and intraoral scan data allows for accurate problem assessment and more precise execution of high-quality finishing. For AOB patients exhibiting temporomandibular joint instability, reassessment of mandibular stabilization is necessary during the finishing stage, followed by a closely monitored retention period
Implications and Opportunities of Expanding Enrollment in Dental Education through New Schools and Existing Programs
No full textIntegrating Median Nerve Sonography and Clinical Wrist Examinations for Dental Practitioners at Risk for Carpal Tunnel Syndrome
No full textObjective: The goal of this study was to conduct a multimodal wrist examination among dental practitioners. The purposes were twofold: (1) to describe bilateral wrist function and sonographic measures, including exploratory intraneural blood flow measures, and (2) to identify if otherwise healthy dental practitioners present with early signs and symptoms of carpal tunnel syndrome (CTS). Materials and Methods: This exploratory cross-sectional study examined both wrists of dental practitioners without CTS. Measurements included symptoms, grip strength, wrist motion, median nerve cross-sectional area (CSA, cm2), anterior-to-posterior distance (mm), intraneural peak systolic velocity (PSV, cm/sec) and power Doppler intensity quantification (PDI-Q) ratio. Results: A cohort of 23 dental practitioners were examined (age: 50.4 ± 10.9 years). Dominant wrists exhibited stronger grip (p \u3c .001, Cohen d = 0.79), more flexion (p = .014, Cohen d = 0.56), and less extension (p = .01, Cohen d = −0.59). Intraneural blood flow was detected in all dominant (100%, n = 23/23) and 91% of nondominant (n = 21/23) wrists. There were no side-to-side differences in median nerve CSA (p = .625–.88), anterior-to-posterior distance (p = .39), PSV (p = .24) or PDI-Q ratio (p = .61). Conclusion: This exploratory study of healthy dental practitioners may suggest early signs and symptoms of CTS, such as decreased grip strength, enlarged median nerve, and ischemic changes in intraneural blood flow, which warrants further study. Routine examination may lead to early detection of changes and risk reduction for injury
Dance as a Sensory-Based Occupation to Improve Regulation Skills in a Pediatric Population
Get PDFDance is integrated into every culture. There are several psychosocial, cognitive, and physical benefits to dancing. The sensory system is highly involved in dance. Further, many children have difficulties with sensory processing and regulation. There are finite programs outside of therapeutic services to address this gap in utilizing sensory strategies. Limited research has been conducted to determine if dance is an effective approach for improving sensory regulation. A 10-week program was designed for eight participants, ages 4 to 8 by an occupational therapy doctoral student. The program utilized the Alert Program®, breathing techniques, yoga positions, tactile input, proprioceptive input, and vestibular input. A pre- and post- measure was taken using the Sensory Processing Measure- 2. In addition, parents completed a weekly questionnaire after the conclusion of each session to identify their child’s regulation skills and behaviors. Eight children volunteered their participation in the program. Several of them had identified difficulties with sensory processing. Only four completed post-measures were obtained. The results indicated that there was minimal change in their scores after the conclusion of a 10-week program. However, parent reports identified increased ability among participants to participate in self-regulation strategies. The reduced sample size may impact the generalizability of the results. In addition, inconsistent attendance and parent reporting may inaccurately represent the results. Further studies would need to be conducted to determine if extracurricular activities, specifically dance, can be utilized in conjunction with therapeutic services to improve regulation skills among children
Treating Lateral Epicondylopathy With Dry Needling and Exercise: A Case Series
No full textContext: Lateral epicondylopathy (LE) is a common overuse injury affecting elbow, wrist, and hand function. It is characterized by weakness and pain in the muscles and tendons of the forearm responsible for the extension of your wrist and fingers. Trigger point dry needling is a technique reported to be beneficial in managing pain and dysfunction after LE diagnosis. LE is also commonly treated with conservative treatment, such as joint and soft tissue mobilization, self-care home programs, and anti-inflammatory use. We explored a different dry needling approach consisting of in situ dry needling with electric stimulation combined with targeted therapeutic exercise to treat LE in 3 cases. Case Presentation: Three patients were referred for dry needling once a week for 6 weeks and home-based exercise therapy for LE. They were clinically evaluated using grip strength, a visual analog scale to assess pain, and Patient-Rated Tennis Elbow Evaluation Test scores. These were measured at 4 time points (weeks 0, 2, 4, and 6). Management and Outcomes: The dry needling intervention incorporated 8 locations in the upper-extremity with 2 electric stimulation channels. The patients had reduced pain as measured by a visual analog scale, increased function as measured by the Patient-Rated Tennis Elbow Evaluation Test, and increased grip strength over 6 weeks. Conclusions: This case series illustrates the use of dry needling and a home exercise program to provide a favorable outcome in a patient with LE. Patients had an 80% to 100% reduction in pain and similar improvements in function that were significantly beyond the minimum clinically important difference. This dry needling approach is a safe and effective treatment of LE in the short term
Where are the Black men in osteopathic medical schools?
No full textOver the past decade, the American Association of Colleges of Osteopathic Medicine (AACOM) and the Association of American Medical Colleges (AAMC) have emphasized the need to enhance diversity within medical education. Despite concerted efforts, the representation of underrepresented populations in medicine (URiM), particularly Black men, remains alarmingly low. This commentary delves into the persisting challenges and potential solutions surrounding the lack of diversity of Black men in osteopathic schools. Black men, in particular, continue to be significantly underrepresented in osteopathic medical schools across the United States. Factors contributing to this disparity include limited access to resources, pervasive negative stereotypes, and biases within the medical community. Addressing these challenges necessitates multifaceted interventions such as mentorship programs, pipeline initiatives, and implicit bias training to enhance the recruitment and support for URiM applicants, particularly Black men. Institutions like Touro College of Osteopathic Medicine and A.T. Still University have underscored the importance of tailoring programs in fostering a sense of belonging and academic success among Black men aspiring to be osteopathic physicians. The creation of a supportive environment for Black men in osteopathic medical schools is not only crucial for promoting diversity but also crucial for improving patient health outcomes, because research consistently depicts enhanced patient outcomes and experiences with diverse healthcare teams. However, despite progress in some areas, Black men continue to face systemic barriers and biases that hinder the pursuit of a career in osteopathic medicine. Thus, increasing the representation of Black men in osteopathic medical schools requires a concerted effort from all stakeholders, including medical institutions, policymakers, and the broader medical community. By implementing targeted interventions, fostering a sense of belonging, and addressing systemic barriers, the medical community can work toward a more equitable and inclusive future in healthcare. Ultimately, promoting diversity is not only a matter of fairness but also essential for ensuring the delivery of high-quality, culturally competent care to all patients
Unit-Based Nurses’ Development of a Couplet Care Acuity Scoring Tool
No full textObjective: To evaluate content validity (CV) and interrater reliability (IRR) of an acuity scoring tool developed for the couplet care/postpartum/nursery patient population and to determine if there was agreement between supervisor or director scoring and staff scoring. Design: A scoring tool to assess the acuity of the couplet care/postpartum/nursery patients was developed. Setting: Two hospitals: one Level 2 hospital, one Level 3 hospital. Unit-based patient care councils participated in the development, and all couplet care nurses participated in scoring patients for testing. Measurements: The final tool was evaluated for CV and IRR using expert review, universal agreement scores, and discriminant content validation. Results: Regarding CV for the Couplet Care Acuity Scoring Tool, the average of the number of experts in agreement divided by the total number of experts across all items was 1.00. Regarding IRR, the intraclass correlation coefficient was 0.85, indicating that the tool is valid and reliable for the study sample. Conclusion: The tool was reliable and valid in this study. Future testing is needed with larger samples and different health care facilities