Publications by authors named "Francesco Cerritelli"

48 Publications

The Challenges and Perspectives of the Integration Between Virtual and Augmented Reality and Manual Therapies.

Front Neurol 2021 30;12:700211. Epub 2021 Jun 30.

Foundation COME Collaboration, Pescara, Italy.

Virtual reality (VR) and augmented reality (AR) have been combined with physical rehabilitation and psychological treatments to improve patients' emotional reactions, body image, and physical function. Nonetheless, no detailed investigation assessed the relationship between VR or AR manual therapies (MTs), which are touch-based approaches that involve the manipulation of tissues for relieving pain and improving balance, postural stability and well-being in several pathological conditions. The present review attempts to explore whether and how VR and AR might be integrated with MTs to improve patient care, with particular attention to balance and to fields like chronic pain that need an approach that engages both mind and body. MTs rely essentially on touch to induce tactile, proprioceptive, and interoceptive stimulations, whereas VR and AR rely mainly on visual, auditory, and proprioceptive stimulations. MTs might increase patients' overall immersion in the virtual experience by inducing parasympathetic tone and relaxing the mind, thus enhancing VR and AR effects. VR and AR could help manual therapists overcome patients' negative beliefs about pain, address pain-related emotional issues, and educate them about functional posture and movements. VR and AR could also engage and change the sensorimotor neural maps that the brain uses to cope with environmental stressors. Hence, combining MTs with VR and AR could define a whole mind-body intervention that uses psychological, interoceptive, and exteroceptive stimulations for rebalancing sensorimotor integration, distorted perceptions, including visual, and body images. Regarding the technology needed to integrate VR and AR with MTs, head-mounted displays could be the most suitable devices due to being low-cost, also allowing patients to follow VR therapy at home. There is enough evidence to argue that integrating MTs with VR and AR could help manual therapists offer patients better and comprehensive treatments. However, therapists need valid tools to identify which patients would benefit from VR and AR to avoid potential adverse effects, and both therapists and patients have to be involved in the development of VR and AR applications to define truly patient-centered therapies. Furthermore, future studies should assess whether the integration between MTs and VR or AR is practically feasible, safe, and clinically useful.
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http://dx.doi.org/10.3389/fneur.2021.700211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8278005PMC
June 2021

Cross-cultural adaptation and psychometric properties of the Italian version of the Body Perception Questionnaire.

PLoS One 2021 27;16(5):e0251838. Epub 2021 May 27.

Traumatic Stress Research Consortium, Kinsey Institute, Indiana University, Bloomington, Indiana, United States of America.

Background/objective: The purpose of this study was to cross-culturally adapt the Body Perception Questionnaire Short Form (BPQ-SF) into Italian and to assess its psychometric properties in a sample of Italian subjects.

Methods: A forward-backward method was used for translation. 493 adults were recruited for psychometric analysis. Structural validity was assessed with confirmatory factor analysis and a hypothesis testing approach. Internal consistency was assessed by Cronbach's alpha and McDonald's omega. Measurement invariance analysis was applied with an age-matched American sample.

Results: The single-factor structure fit the awareness subscale (RMSEA = .036, CFI = .983, TLI = .982). Autonomic reactivity (ANSR) was well-described by supra- and sub-diaphragmatic subscales (RMSEA = .041, CFI = .984, TLI = .982). All subscales were positively correlated (r range: .50-.56) and had good internal consistency (McDonald's Omega range: .86-.92, Cronbach's alpha range: .88-.91). Measurement invariance analysis for the Awareness model showed significant results (p<0.001) in each step (weak, strong and strict) whereas the ANSR showed significant results (p<0.001) only for the strong and strict steps.

Conclusions: Our results support the Italian version of the BPQ as having consistent psychometric properties in comparison with other languages.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251838PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8158925PMC
May 2021

The neonatal assessment manual score (NAME) for improving the clinical management of infants: a perspective validity study.

Ital J Pediatr 2021 Mar 7;47(1):53. Epub 2021 Mar 7.

RAISE lab, Foundation COME Collaboration, Corso Europa 29 - 66054 Vasto (Italy), Pescara, Italy.

Background And Objectives: The Neonatal Assessment Manual scorE (NAME) was developed to assist in the clinical management of infants in the neonatal ward by assessing their body's compliance and homogeneity. The present study begins its validation process.

Methods: An expert panel of neonatal intensive care unit (NICU) professionals investigated the NAME face and content validity. Content validity was assessed through the content validity index (CVI). Construct validity was assessed using data collected from 50 newborns hospitalized in the NICU of "Vittore Buzzi" Children Hospital of Milan, Italy. Kendall's τ and ordinal logistic regressions were used to evaluate the correlation between the NAME scores and infants' gestational age, birth weight, post-menstrual age, weight at the time of assessment, and a complexity index related to organic complications.

Results: The CVIs for compliance, homogeneity, and the whole scale were respectively 1, 0.9, and 0.95. Construct validity analysis showed significant positive correlations between the NAME and infants' weight and age, and a negative correlation between the NAME and the complexity index (τ = - 0.31 [95% IC: - 0.47, - 0.12], p = 0.016 and OR = 0.56 [95% IC: 0.32, 0.94], p = 0.034 for categorical NAME; τ = - 0.32 [95% IC: - 0.48, - 0.14], p = 0.005 for numerical NAME).

Conclusions: The NAME was well accepted by NICU professionals in this study and it demonstrates good construct validity in discriminating the infant's general condition. Future studies are needed to test the NAME reliability and predictive capacity.
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http://dx.doi.org/10.1186/s13052-021-01012-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7938573PMC
March 2021

Osteopathy modulates brain-heart interaction in chronic pain patients: an ASL study.

Sci Rep 2021 Feb 25;11(1):4556. Epub 2021 Feb 25.

Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti-Pescara, Via dei Vestini, 33, Chieti Scalo, Italy.

In this study we used a combination of measures including regional cerebral blood flow (rCBF) and heart rate variability (HRV) to investigate brain-heart correlates of longitudinal baseline changes of chronic low back pain (cLBP) after osteopathic manipulative treatment (OMT). Thirty-two right-handed patients were randomised and divided into 4 weekly session of OMT (N = 16) or Sham (N = 16). Participants aged 42.3 ± 7.3 (M/F: 20/12) with cLBP (duration: 14.6 ± 8.0 m). At the end of the study, patients receiving OMT showed decreased baseline rCBF within several regions belonging to the pain matrix (left posterior insula, left anterior cingulate cortex, left thalamus), sensory regions (left superior parietal lobe), middle frontal lobe and left cuneus. Conversely, rCBF was increased in right anterior insula, bilateral striatum, left posterior cingulate cortex, right prefrontal cortex, left cerebellum and right ventroposterior lateral thalamus in the OMT group as compared with Sham. OMT showed a statistically significant negative correlation between baseline High Frequency HRV changes and rCBF changes at T2 in the left posterior insula and bilateral lentiform nucleus. The same brain regions showed a positive correlation between rCBF changes and Low Frequency HRV baseline changes at T2. These findings suggest that OMT can play a significant role in regulating brain-heart interaction mechanisms.
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http://dx.doi.org/10.1038/s41598-021-83893-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907192PMC
February 2021

Osteopathic manipulative treatment and the Spanish flu: a historical literature review.

J Osteopath Med 2021 02;121(2):181-190

Museum of Osteopathic Medicine, A.T. Still University , Kirksville , MO , USA.

Context: The Spanish flu pandemic of 1918 was approached with a variety of management techniques available at that time, including osteopathic care in addition to standard medical care.

Objective: To analyze the osteopathic manipulative treatment (OMT) techniques used for the management of patients affected by the Spanish flu according to four themes: the principles and procedures used, frequency and length of OMT, reported side effects, and advice for patients.

Methods: A structured review of the literature was performed by hand-searching texts at the Museum of Osteopathic Medicine International Center for Osteopathic History in Kirksville, Missouri, and online via PubMed (National Library of Medicine), ScienceDirect (Elsevier), and Google Scholar (Google, Inc). The literature search was carried out between February and March 2020. Three keywords were selected from the medical subject headings database of the National Library of Medicine: manipulation, osteopathic; influenza pandemic, 1918-1919; epidemics. Articles were then reviewed for relevance by screening for articles published between 1900 and 1940 that contained at least 1 of the following keywords in their title: Spanish influenza, flu, epidemic, grippe, pneumonia, or osteopathic management/treatment. All articles that provided information about OMT and advice met the inclusion criteria. Articles that did not report descriptions of manipulative intervention were excluded.

Results: Our search yielded 63 articles: 23 from the hand-search and 40 from the electronic search. No electronic source was selected for the review because none met inclusion criteria. A total of 16 articles from the hand-searched set met inclusion criteria and were analyzed according to the four main themes stated in the objective. The range of OMT approaches reported to be administered to patients with Spanish flu suggests that early osteopathic physicians treated patients with this disease using OMT in addition to offering advice on healthy lifestyle behaviors.

Conclusion: Conclusions from this study are limited by the historical and descriptive nature of the data gathered, which lacked the rigor of modern-day scientific studies. However, this review could lead to future research inquiries on the effectiveness of these approaches. Osteopathic physicians and osteopaths should embrace their historical osteopathic heritage by continuing the work of our predecessors and combining their hands-on experience and osteopathic principles with modern medical treatment and rigorous scientific standards.
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http://dx.doi.org/10.1515/jom-2020-0112DOI Listing
February 2021

Osteopathic Manipulative Treatment and Cardiovascular Autonomic Parameters in Rugby Players: A Randomized, Sham-Controlled Trial.

J Manipulative Physiol Ther 2021 05 9;44(4):319-329. Epub 2021 Jan 9.

Stress Physiology Lab, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy; Stress Control Lab, Collegio Italiano di Osteopatia, Parma, Italy.

Objective: The purpose of this study was to investigate the effects of osteopathic manipulative treatment (OMT) on cardiovascular autonomic parameters after a rugby match.

Methods: Resting and reactivity (ie, response to orthostasis) measures of mean arterial pressure, heart rate, and heart rate variability were assessed in 23 male players after a single session of OMT, both 18 to 20 hours after a rugby match and in a corresponding no-match condition, in a randomized, sham-controlled, crossover design.

Results: Signs of reduced heart rate variability and elevated mean arterial pressure and heart rate were found 18 to 20 hours after a rugby match compared with the no-match condition. A significant increase in heart rate variability and a significant reduction in mean arterial pressure were observed after OMT in both the after-match and no-match conditions. Heart rate and heart rate variability responses to orthostasis were not affected by previous match competition, but were significantly larger after OMT compared with sham treatment.

Conclusion: This study suggests the presence of cardiovascular autonomic alterations in rugby players after a competitive match, which may be indicative of prolonged fatigue and incomplete recovery. In these players, favorable changes in cardiovascular autonomic parameters were observed following a single session of OMT.
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http://dx.doi.org/10.1016/j.jmpt.2020.09.002DOI Listing
May 2021

Thematic Analysis of Attitudes Held by a Group of Italian Osteopaths Toward Osteopathic Evaluation, Treatment, and Management in the Neonatal and Pediatric Field: A Qualitative Study.

J Manipulative Physiol Ther 2021 02 9;44(2):164-175. Epub 2021 Jan 9.

Clinical-Based Human Research Department, COME Collaboration ONLUS, Pescara, Italy.

Objective: The purpose of this study was to investigate the attitudes held by a group of Italian osteopaths toward osteopathic evaluation, treatment, and management in the neonatal and pediatric field.

Methods: A thematic analysis with elements of grounded-theory approaches was used. Purposive sampling was used to recruit expert osteopaths in the neonatal and pediatric field. Data were gathered from July 2017 to January 2018 by individual semistructured interviews and transcribed verbatim. A thematic analysis of the data was then performed. The Consolidated Criteria for Reporting Qualitative Research checklist was used to structure the design of this qualitative study.

Results: Eight osteopaths participated. Data analysis generated 3 main themes: the role of the osteopath in the collaborative process of care, osteopathic diagnostic-clinical reasoning in the neonatal and pediatric field, and osteopathic treatment in the neonatal and pediatric field.

Conclusion: The present study highlights that Italian osteopaths may prefer interprofessional and integrative activities aimed at supporting adaptive capacity and resilience for pediatric patients.
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http://dx.doi.org/10.1016/j.jmpt.2020.07.004DOI Listing
February 2021

Brain Connectivity Changes after Osteopathic Manipulative Treatment: A Randomized Manual Placebo-Controlled Trial.

Brain Sci 2020 Dec 11;10(12). Epub 2020 Dec 11.

Networks Unit, IMT School for Advanced Studies Lucca, 55100 Lucca, Italy.

The effects of osteopathic manipulative treatment (OMT) on functional brain connectivity in healthy adults is missing in the literature. To make up for this lack, we applied advanced network analysis methods to analyze resting state functional magnetic resonance imaging (fMRI) data, after OMT and Placebo treatment (P) in 30 healthy asymptomatic young participants randomized into OMT and placebo groups (OMTg; Pg). fMRI brain activity measures, performed before (T0), immediately after (T1) and three days after (T2) OMT or P were used for inferring treatment effects on brain circuit functional organization. Repeated measures ANOVA and post-hoc analysis demonstrated that Right Precentral Gyrus (F (2, 32) = 5.995, < 0.005) was more influential over the information flow immediately after the OMT, while decreased betweenness centrality in Left Caudate (F (2, 32) = 6.496, < 0.005) was observable three days after. Clustering coefficient showed a distinct time-point and group effect. At T1, reduced neighborhood connectivity was observed after OMT in the Left Amygdala (L-Amyg) (F (2, 32) = 7.269, < 0.005) and Left Middle Temporal Gyrus (F (2, 32) = 6.452, < 0.005), whereas at T2 the L-Amyg and Vermis-III (F (2, 32) = 6.772, < 0.005) increased functional interactions. Data demonstrated functional connectivity re-arrangement after OMT.
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http://dx.doi.org/10.3390/brainsci10120969DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7764238PMC
December 2020

Heart Rate Variability in the Perinatal Period: A Critical and Conceptual Review.

Front Neurosci 2020 25;14:561186. Epub 2020 Sep 25.

Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy.

Neonatal intensive care units (NICUs) greatly expand the use of technology. There is a need to accurately diagnose discomfort, pain, and complications, such as sepsis, mainly before they occur. While specific treatments are possible, they are often time-consuming, invasive, or painful, with detrimental effects for the development of the infant. In the last 40 years, heart rate variability (HRV) has emerged as a non-invasive measurement to monitor newborns and infants, but it still is underused. Hence, the present paper aims to review the utility of HRV in neonatology and the instruments available to assess it, showing how HRV could be an innovative tool in the years to come. When continuously monitored, HRV could help assess the baby's overall wellbeing and neurological development to detect stress-/pain-related behaviors or pathological conditions, such as respiratory distress syndrome and hyperbilirubinemia, to address when to perform procedures to reduce the baby's stress/pain and interventions, such as therapeutic hypothermia, and to avoid severe complications, such as sepsis and necrotizing enterocolitis, thus reducing mortality. Based on literature and previous experiences, the first step to efficiently introduce HRV in the NICUs could consist in a monitoring system that uses photoplethysmography, which is low-cost and non-invasive, and displays one or a few metrics with good clinical utility. However, to fully harness HRV clinical potential and to greatly improve neonatal care, the monitoring systems will have to rely on modern bioinformatics (machine learning and artificial intelligence algorithms), which could easily integrate infant's HRV metrics, vital signs, and especially past history, thus elaborating models capable to efficiently monitor and predict the infant's clinical conditions. For this reason, hospitals and institutions will have to establish tight collaborations between the obstetric, neonatal, and pediatric departments: this way, healthcare would truly improve in every stage of the perinatal period (from conception to the first years of life), since information about patients' health would flow freely among different professionals, and high-quality research could be performed integrating the data recorded in those departments.
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http://dx.doi.org/10.3389/fnins.2020.561186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7544983PMC
September 2020

Does Osteopathic Manipulative Treatment Induce Autonomic Changes in Healthy Participants? A Thermal Imaging Study.

Front Neurosci 2020 18;14:887. Epub 2020 Aug 18.

Faculty of Medicine and Dental Surgery, Sapienza University of Rome, Rome, Italy.

Osteopathic manipulative treatment (OMT) has been demonstrated to be an effective therapy in several clinical conditions and age groups. Despite the clinical effectiveness, lack of robust data in terms of neurobiological, specifically autonomic, mechanisms of action is observed. Preliminary studies showed a parasympathetic effect leading to a trophotropic effect of OMT. However, these data are limited to heart rate variability (HRV) analysis. In order to study further the role of OMT on the autonomic nervous system, a cross-over randomized controlled trial RCT has been designed to test the effect of osteopathic treatment compared to sham therapy on a range of autonomic parameters. Thermal images, HRV and skin conductance data were collected on a sample of healthy adults. The study design consisted of two sessions (OMT and SHAM), 1 treatment per week, lasting 35 min each, composed of 5 min of baseline, 25 min of treatment, and 5 min of post-touch. During the baseline and the post-treatment, participants received no touch. Thirty-seven participants (aged 27 ± 5 years old, male ratio 40%) completed the study. Multivariate analysis showed a significant parasympathetic effect of group as well as of epoch on thermographic data of the nose (estimate 0.38; 95% CI 0.12-0.63; < 0.01), left (0.17; 0.06-0.27; <0.001) and right (0.16; 0.07-0.24; <0.001) perioral as well as on the forehead (0.07; 0.01-0.12; <0.01) regions but not for the chin (0.08; -0.02 to 0.18; 0.13). Consistent with a parasympathetic effect, analyses demonstrated a difference between OMT and sham groups on the nuHF ( < 0.001) and DFA-a1 ( < 0.01) as well as on skin conductance (<0.01). The present research supports the hypothesis that a single session of OMT as compared to sham induces autonomic consequences in healthy non-symptomatic adults. Clinicaltrial.gov identifier: NCT03888456, https://clinicaltrials.gov/ct2/show/NCT03888456.
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http://dx.doi.org/10.3389/fnins.2020.00887DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7461826PMC
August 2020

Neonatal Assessment Manual Score: Is There a Role of a Novel, Structured Touch-Based Evaluation in Neonatal Intensive Care Unit?

Front Pediatr 2020 6;8:432. Epub 2020 Aug 6.

Division of Neonatology, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy.

Despite the technological improvements in monitoring preterm infants in the neonatal intensive care unit, routine care in the neonatal ward is primarily based on manual procedures. Although manual clinical procedures play a critical role in neonatology, little attention has been paid to palpation as a clinical assessment tool. Palpation is a clinical evaluation tool that relies mostly on the senses of touch and proprioception. Based on recent studies investigating the role and clinical effectiveness of touch in full-term and preterm babies, this paper proposes an evaluative touch-based procedure-the Neonatal Assessment Manual Score (NAME) model-that could be useful in the neonatal ward and describes its rationale. The operator applies gentle light pressures to the infant's body. In essence, the touch stimulates low-threshold afferent fibers that could influence the interoceptive cerebral network and the autonomic nervous system, thus altering the blood flow and breathing rhythm. These events could change how bodily fluids distribute among body segments and hence the body volume. The volume modification could be felt manually through haptic perception owing to the high sensitivity of the fingers. On the basis of their clinical conditions and stage of development, infants will respond differently to the applied pressures. Evaluating the infant's response, the operator produces a score of "bad," "marginal," or "good" for communicating quickly and clearly the infant's conditions to other professionals. Because the NAME model is intended for every professional who is used to touch-based procedures, if future studies confirmed its validity and reliability in clinical practice, the NAME model could become a part of the neonatal ward routine care for better assessing and managing the infant's conditions, even during emergencies.
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http://dx.doi.org/10.3389/fped.2020.00432DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7424031PMC
August 2020

Perspectives on tissue adaptation related to allostatic load: Scoping review and integrative hypothesis with a focus on osteopathic palpation.

J Bodyw Mov Ther 2020 Jul 15;24(3):212-220. Epub 2020 Mar 15.

Clinical-based Human Research Department, Research Division, Foundation COME Collaboration, Pescara, Italy.

Introduction: Osteopathic care may support an individual's adaptive capacity, including allostatic regulation and tissue changes in both health and disease. The palpatory findings which osteopaths claim are related to tissue changes may be linked to allostatic load. However, this putative link has not been formally investigated.

Methods: We conducted a scoping review to critically appraise the relevant literature on the relationship between allostatic processes and tissue alterations. This review evaluates the use and relevance of palpatory findings in osteopathic care. We searched on PubMed, EMBASE, Cochrane library for research exploring the links between tissue adaptation, allostasis and osteopathic palpatory findings (OPF).

Results: Recent studies provide insights into the role of allostatic regulation on body systems' responses related to tissue alterations. These results provide new insights into the relevance of OPF to clinical practice.

Discussion: We build upon the findings of our review to propose a putative model for OPF in clinical practice.

Conclusion: Although the clinical phenomena associated with OPF may be biologically plausible, it lacks the necessary underpinning research evidence. Arguably, the classical focus on the diagnosis of palpable tissue changes fails to integrate biological, social and neuropsychological aspects such as stress responses. Tissue alterations related to stress and allostatic load markers have been less studied. Tissue changes involved in the adaptive process may be useful to practitioners in the field of manual therapy, particularly in osteopathy. We propose that OPF are one of the multidimensional aspects that may inform osteopathic decision-making. However, they should be considered within a biopsychosocial perspective and taking into account concepts of allostatic load and regulation.
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http://dx.doi.org/10.1016/j.jbmt.2020.03.006DOI Listing
July 2020

The Italian Osteopathic Practitioners Estimates and RAtes (OPERA) study: How osteopaths work.

PLoS One 2020 2;15(7):e0235539. Epub 2020 Jul 2.

National Institute of Health, Rome, Italy.

The scope of practice of the osteopathic profession in Italy is underreported. The first part of the present study investigated the Italian osteopaths' profile, focusing on the socio-demographic information and geographical distribution together with the main characteristics of their education. The OPERA-IT study highlighted that the majority of respondents declared to work as sole practitioners (58.4%), while the remaining declared to work as part of a team. Since teamwork and networking are recognized as fundamental aspects of healthcare, the present study aims to compare the osteopathic practice, diagnostic and treatment modalities of osteopaths who work as a sole practitioner and osteopaths who work as part of a team to highlight possible differences. Moreover, patients' characteristics will be presented. The OPERA-IT study population was chosen to provide a representative sample. A web campaign was set up to inform the Italian osteopaths before the beginning of the study. The OPERA IT study used a previously tested questionnaire. The questionnaire was translated into Italian following the World Health Organization recommendation. The questionnaire was composed of 57 items grouped in five sections, namely: socio-demographics, osteopathic education and training, working profile, organization, and management of the clinical practice and patient profile. The survey was delivered online through a dedicated platform. The survey was completed by 4,816 individuals. Osteopaths who work as sole practitioners represented the majority of the sample (n = 2814; 58.4%). Osteopaths who work as part of a team declared to collaborate mostly with physiotherapists (n = 1121; 23.3%), physicians with speciality (n = 1040; 21.6%), and other osteopaths (n = 943; 19.6%). The two groups showed heterogeneous characteristics. Significative differences were observed in all the factors, namely: geographical distribution, age, gender, training, working contract and working place, daily consultations and time for each consultation, fees, and the average waiting period to book an appointment. The principal component analysis supported a ten-component model and explained 80.5% of the total variance. The analysis showed that osteopaths working as sole practitioners have an increased probability (OR = 0.91; CI 95%: 0.88-0.94; p<0.01) of using systemic diagnostic and treatment techniques and have distinct clinical features with higher probability (OR = 0.92; 0.88-0.96; p<0.01) of spending less time with patients, being paid less but treating a higher number of patients per week. The most represented patients' age groups were 41-64 years old (n = 4452; 92.4%) and 21-40 years old (n = 4291; 89.1%). Similarly, the most reported new patients' age groups were 41-64 years old (n = 4221; 87.7%) and 21-40 years old (n = 3364; 69.9%). The most common presenting complaints were back pain, neck pain, cervical radiculopathy, sciatica, shoulder pain, and headaches. Osteopathic practice in Italy seems to be characterised by interprofessional collaboration, mostly with physiotherapists. Our results highlighted two different profiles in terms of sociodemographic characteristics and work modalities between osteopaths who work as sole practitioners and those who work as part of a team. Although according to the respondents, people of all ages consult Italian osteopaths, the majority of patients are adults. Most of them have been referred to osteopathy by other patients or acquaintances. Patients seek osteopathic care mostly for musculoskeletal related complaints.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0235539PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332305PMC
September 2020

The Spanish Osteopathic Practitioners Estimates and RAtes (OPERA) study: A cross-sectional survey.

PLoS One 2020 15;15(6):e0234713. Epub 2020 Jun 15.

Belgium National Centre, Foundation COME Collaboration, Mechelen, Belgium.

Background: Despite the growth of the osteopathic profession in Spain in the last few years, reliable information regarding professional profile and prevalence is still lacking. The Osteopathic Practitioners Estimates and RAtes (OPERA) project was developed as a European-based survey dedicated to profiling the osteopathic profession across Europe. The present study aims to describe the characteristics of osteopathic practitioners, their professional profile and the features of their clinical practice.

Methods: A voluntary, validated online-based survey was distributed across Spain between January and May 2018. The survey, composed of 54 questions and 5 sections, was formally translated from English to Spanish and adapted from the original version. Because there is not a unique representative osteopathic professional body in Spain, a dedicated website was created for this study, and participation was encouraged through both specific agreements with national registers/associations and an e-based campaign.

Results: A total of 517 osteopaths participated in the study, of which 310 were male (60%). The majority of respondents were aged between 30-39 years (53%) and 98% had an academic degree, mainly in physiotherapy. Eighty-five per cent of the respondents completed a minimum of four-year part-time course in osteopathy. Eighty-nine per cent of the participants were self-employed. Fifty-eight per cent of them own their clinic, and 40% declared to work as sole practitioner. Thirty-one per cent see an average of 21 to 30 patients per week for 46-60 minutes each. The most commonly used diagnostic techniques are movement assessment, palpation of structures/position and assessment of tenderness and trigger points. Regarding treatment modalities, articulatory/mobilisation techniques followed by visceral techniques and progressive inhibition of neuromuscular structures is often to always used. The majority of patients estimated by the respondents sought osteopathic treatment for musculoskeletal problems mainly localised on the lumbar and cervical region. The majority of respondents manifest a robust professional identity and a collective desire to be regulated as a healthcare profession.

Conclusions: This study represents the first published document to determine the characteristics of the osteopathic practitioners in Spain using large, national data. To date, it represents the most informative document related to the osteopathic community in Spain. It brings new information on where, how, and by whom osteopathy is practised in the country. The information provided could potentially influence the development of the profession in Spain.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0234713PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7295231PMC
September 2020

Effects of osteopathic treatment versus static touch on heart rate and oxygen saturation in premature babies: A randomized controlled trial.

Complement Ther Clin Pract 2020 May 8;39:101116. Epub 2020 Feb 8.

Division of Neonatology, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy.

Background: Osteopathic manipulative treatment (OMT) has been successfully tested in the context of preterm infants. No studies, however, have been conducted to investigate the OMT immediate effects on physiological measurements, such as partial oxygen saturation (SpO2) and heart rate (HR). The purpose of the present study was to assess the effect of osteopathic treatment on SpO2 and HR values and to compare it with 10 min of static touch.

Materials And Methods: Ninety-six preterm infants (41 male), aged 33.5 weeks (±4.3) with mean weight at birth of 2067gr (±929) were recruited from the neonatal intensive care unit (NICU) of the Buzzi Hospital in Milan, and randomly allocated to two groups: OMT and Static Touch. Each protocol session consisted of: a) 5-min Pre-touch baseline recording, b) 10-min touch procedure, c) 5-min post-touch recording. Primary and secondary outcomes were, respectively, the baseline changes of HR and SpO2.

Results: The 2 × 2 repeated measure ANOVA for HR showed a statistically significant effect (F (1,94) = 5.34; p < 0.02), revealing that the OMT group decreases the HR value at T2 (p = 0.006). In contrast, SpO2 analysis showed an increase of SpO2 value where the OMT group demonstrated higher values at T2 (p = 0.04).

Conclusion: Results from the present study suggest that a single osteopathic intervention may induce beneficial effects on preterm physiological parameters.

Trial Registration: ClinicalTrials.gov identifier: NCT03833635 - Date: February 7, 2019.
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http://dx.doi.org/10.1016/j.ctcp.2020.101116DOI Listing
May 2020

Effect of manual approaches with osteopathic modality on brain correlates of interoception: an fMRI study.

Sci Rep 2020 02 21;10(1):3214. Epub 2020 Feb 21.

Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.

The present randomised placebo controlled trial explored the extent to which osteopathic manipulative treatment (OMT) affects brain activity, particularly the insula, during both an "interoceptive awareness" and "exteroceptive awareness" task in a sample of 32 right-handed adults with chronic Low Back Pain (CLBP) randomly assigned to either the OMT or sham group. Patients received 4 weekly sessions and fMRI was performed at enrolment (T0), immediately after the first session (T1) and at 1 month (T2). The results revealed that the OMT produced a distinct and specific reduction in BOLD response in specific brain areas related to interoception, i.e., bilateral insula, ACC, left striatum and rMFG. The observed trend across the three time points appears uncharacteristic. At T1, a marginal increase of the BOLD response was observed in all the above-mentioned areas except the rMFG, which showed a decrease in BOLD response. At T2, the response was the opposite: areas related to interoception (bilateral insula and ACC) as well as the rMFG and left striatum demonstrated significant decreased in BOLD response. The findings of this study provide an insight into the effects of manual therapies on brain activity and have implications for future research in the field.
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http://dx.doi.org/10.1038/s41598-020-60253-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7035282PMC
February 2020

Comparison between two ocular cleansing modalities in a population of newborns admitted to Neonatal Intensive Care Unit with clinical signs of conjunctivitis: a randomized controlled trial.

Minerva Pediatr 2019 Dec;71(6):500-504

Neonatal Intensive Care Unit, V. Buzzi Children's Hospital, ASST-FBF-Sacco, Milan, Italy -

Background: Neonatal conjunctivitis is frequent and could benefit from daily cleansing with saline. Anyway super infections can occur and therefore antibiotics are frequently needed. Recently alternative therapies (e.g. Echinacea angustifolia) are used for neonatal conjunctivitis to try to reduce antibiotics therapy. The aim of the study was to verify if the use of gauze containing Echinacea angustifolia compared to standard sodium-chloride at the onset of conjunctivitis symptoms is effective in reducing the clinical symptoms and the risk for superinfections.

Methods: The study was randomized and controlled. Neonates admitted in a tertiary level Neonatal Intensive Care Unit (NICU), with clinical signs of conjunctivitis during hospital stay, were randomized in two groups: group A (3 times daily ocular cleansing for 48 h with sterile gauze; group B (3 times daily ocular cleansing for 48 h with Iridium® baby gauze (Neoox) containing Echinacea angustifolia and pineapple sativus). An eye swab for cultural analysis was taken at time of presentation (T0) prior to treatment and at the end of ocular cleansing (T1).

Results: Sixty-three neonates were enrolled (GrA=30 and GrB=33). At T0, eye specimen positivity was found in 16/30 (48%) in group A and in 18/33 (55%) in group B (P=0.9). No statistical differences among groups at T0 regarding culture positivity. After 48 h, babies in Gr A have significantly fewer positive swabs compared to group B (group A: 18/29, group B: 10/32; P=0.009). Neonates in group B who had negative swab at T0 had a significantly reduced risk to have positive culture at T1 (OR 0.28, CI: 0.10-0,80, P=0.01), also considering confounding factors (birth weight, gestational age, mode of delivery) (adjusted OR 0.15, CI: 0.03-0.52, P<0.01). No differences in regard to antibiotic needs (P=0.95) during the course of conjunctivitis between groups.

Conclusions: Our data suggest that these gauzes containing Echinacea angustifolia might help in avoiding super-infections, contaminations and in reducing ocular bacterial load.
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http://dx.doi.org/10.23736/S0026-4946.19.05659-7DOI Listing
December 2019

Dynamic touch reduces physiological arousal in preterm infants: A role for c-tactile afferents?

Dev Cogn Neurosci 2019 10 21;39:100703. Epub 2019 Aug 21.

Research Centre for Brain & Behaviour, School of Natural Sciences & Psychology, Liverpool John Moores University, UK.

Preterm birth is a significant risk factor for a range of long-term health problems and developmental disabilities. Though touch plays a central role in many perinatal care strategies, the neurobiological basis of these approaches is seldom considered. C-Tactile afferents (CTs) are a class of unmyelinated nerve fibre activated by low force, dynamic touch. Consistent with an interoceptive function, touch specifically targeted to activate CTs activates posterior insular cortex and has been reported to reduce autonomic arousal. The present study compared the effect of 5 min of CT optimal velocity stroking touch to 5 min of static touch on the heart-rate and oxygen saturation levels of preterm infants between 28- & 37-weeks gestational age. CT touch produced a significant decrease in infants' heart-rates and increase in their blood oxygenation levels, which sustained throughout a 5-min post-touch period. In contrast, there was no significant change in heart-rate or blood oxygenation levels of infants receiving static touch. These findings provide support for the hypothesis that CTs signal the affective quality of nurturing touch, providing a neurobiological substrate for the apparent beneficial effects of neonatal tactile interventions and offering insight for their optimisation.
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http://dx.doi.org/10.1016/j.dcn.2019.100703DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6969366PMC
October 2019

Self-directed learning and practice of Italian osteopathic students during summer break: a cross-sectional survey.

BMC Complement Altern Med 2019 Aug 6;19(1):201. Epub 2019 Aug 6.

Clinical-based Human Research Department, Research Division, COME Collaboration, Pescara, Italy.

Background: Self-directed learning is a student-centered approach based on the students' evaluation about their own learning needs. Self-directed practice is a component of the self-directed learning which focus on achieving manual and practical skills. Given the abundance of manual skills that students need to develop in the osteopathic curriculum, self-directed practice has become an attractive methodology. Most of the Italian osteopathic educational institutions recognize two types of educational curriculum: T1, for students without a healthcare background; and T2 for students who are already healthcare professionals. The aim of the present study is to investigate the attitudes of Italian osteopathic students toward self-directed practice during the summer break highlighting the possible differences between T1 and T2 students.

Methods: A web-based closed-ended survey was administered to the students attending one of the Italian osteopathic educational institutions which accepted to participate in the research.

Results: Two hundred sixty-eight students on 2549 participated to the survey. 64.92% of the students reported to have performed self-directed practice during the summer break. The main difficulty encountered by students in approaching self-directed practice was 'lack of people to exercise with'. Most of the students performed self-directed practice between 1 to 5 h per week. The most common clinical condition encountered was Low Back Pain. The anatomical area most approached was lumbar spine. The most commonly simulated tests were the articular mobility tests. The techniques in which students trained the most were muscle energy techniques. Significant difference was found in self-engagement to the self-directed practice between T1 and T2 students (p = 0.026), and in the reasons to perform self-directed practice (p = 0.027).

Conclusions: The results of this study could be useful to reveal some aspects of students' academic education and future clinical practice. Therefore this paper can be a useful tool for the institutions to develop strategies to overcome the reported problems students have towards self-directed practice. For example it should be discussed the possibility for the students to observe some senior osteopaths during their practice or to plan to maintain an open tutored didactic environment during the summer break as an extracurricular activity.
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http://dx.doi.org/10.1186/s12906-019-2619-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683383PMC
August 2019

The Italian Osteopathic Practitioners Estimates and RAtes (OPERA) study: A cross sectional survey.

PLoS One 2019 25;14(1):e0211353. Epub 2019 Jan 25.

National Institute of Health, Rome, Italy.

The prevalence of osteopathic practitioners, their professional profile and features of their clinical practice, particularly where statutory regulation does not yet exist, are still significantly underreported. The Osteopathic Practitioners Estimates and RAtes (OPERA) project was developed as an European-based census dedicated to profiling the osteopathic profession across Europe. The present study aimed to describe the osteopathic practitioners and the profession in Italy. A voluntary, online based, closed-ended survey was distributed across Italy in the period between February and June 2017. An e-based campaign was set up to reach the Italian osteopathic professionals. Participants were asked to complete the forms by filling in the information regarding the demographics, working status and professional activities, education, consultation fees, patient complaints, treatment and management. The survey was completed by 4816 individuals. 196 people started the survey but did not finish, which corresponds to a 4% attrition rate. The majority of respondents were males (66.7%). The modal age group was 30-39 (40.0%). 73.8% of respondents had a previous academic degree, mainly in the fields of sports science (36.4%) and physiotherapy (25.3%). 25.6% declared not to have a previous academic degree. The majority of respondents declared to work alone (58.4%), while the remaining declared to work in association with other professionals. The osteopaths /citizens ratio was 8.0 osteopaths/100,000 citizens. The profile of osteopaths in Italy seems to be characterised by a self-employed young adult male working mostly as a sole practitioner, who has been trained as osteopath through a part-time curriculum and had a previous degree mostly in the fields of sports science or physiotherapy. These results provide important insights into the osteopathic profession in Italy. The varied professional educational backgrounds need to be considered with regard to the implementation of a professional licensing process and future pre-registration education in the country. The number of respondents is an estimate of the actual number of Italian osteopaths. Only the completion of the regulatory process and the creation of the mandatory official register will allow to know the number of Italy based osteopaths.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0211353PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6347434PMC
October 2019

Reduced Dynamic Coupling Between Spontaneous BOLD-CBF Fluctuations in Older Adults: A Dual-Echo pCASL Study.

Front Aging Neurosci 2018 23;10:115. Epub 2018 Apr 23.

Department of Neuroscience, Imaging and Clinical Sciences, Università degli Studi G. d'Annunzio Chieti e Pescara, Chieti, Italy.

Measurement of the dynamic coupling between spontaneous Blood Oxygenation Level Dependent (BOLD) and cerebral blood flow (CBF) fluctuations has been recently proposed as a method to probe resting-state brain physiology. Here we investigated how the dynamic BOLD-CBF coupling during resting-state is affected by aging. Fifteen young subjects and 17 healthy elderlies were studied using a dual-echo pCASL sequence. We found that the dynamic BOLD-CBF coupling was markedly reduced in elderlies, in particular in the left supramarginal gyrus, an area known to be involved in verbal working memory and episodic memory. Moreover, correcting for temporal shift between BOLD and CBF timecourses resulted in an increased correlation of the two signals for both groups, but with a larger increase for elderlies. However, even after temporal shift correction, a significantly decreased correlation was still observed for elderlies in the left supramarginal gyrus, indicating that the age-related dynamic BOLD-CBF uncoupling in this region is more pronounced and can be only partially explained with a simple time-shift between the two signals. Interestingly, these results were observed in a group of elderlies with normal cognitive functions, suggesting that the study of dynamic BOLD-CBF coupling during resting-state is a promising technique, potentially able to provide early biomarkers of functional changes in the aging brain.
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http://dx.doi.org/10.3389/fnagi.2018.00115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5925323PMC
April 2018

Effect of Continuous Touch on Brain Functional Connectivity Is Modified by the Operator's Tactile Attention.

Front Hum Neurosci 2017 20;11:368. Epub 2017 Jul 20.

Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti-PescaraChieti, Italy.

Touch has been always regarded as a powerful communication channel playing a key role in governing our emotional wellbeing and possibly perception of self. Several studies demonstrated that the stimulation of C-tactile afferent fibers, essential neuroanatomical elements of affective touch, activates specific brain areas and the activation pattern is influenced by subject's attention. However, no research has investigated how the cognitive status of who is administering the touch produces changes in brain functional connectivity of touched subjects. In this functional magnetic resonance imaging (fMRI) study, we investigated brain connectivity while subjects were receiving a static touch by an operator engaged in either a tactile attention or auditory attention task. This randomized-controlled single-blinded study enrolled 40 healthy right-handed adults and randomly assigned to either the operator tactile attention (OTA) or the operator auditory attention (OAA) group. During the five fMRI resting-state runs, the touch was delivered while the operator focused his attention either: (i) on the tactile perception from his hands (OTA group); or (ii) on a repeated auditory stimulus (OAA group). Functional connectivity analysis revealed that prolonged sustained static touch applied by an operator engaged with focused tactile attention produced a significant increase of anticorrelation between posterior cingulate cortex (PCC-seed) and right insula (INS) as well as right inferior-frontal gyrus but these functional connectivity changes are markedly different only after 15 min of touching across the OTA and OAA conditions. Interestingly, data also showed anticorrelation between PCC and left INS with a distinct pattern over time. Indeed, the PCC-left INS anticorrelation is showed to start and end earlier compared to that of PCC-right INS. Taken together, the results of this study showed that if a particular cognitive status of the operator is sustained over time, it is able to elicit significant effects on the subjects' functional connectivity patterns involving cortical areas processing the interoceptive and attentional value of touch.
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http://dx.doi.org/10.3389/fnhum.2017.00368DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5517483PMC
July 2017

Osteopathy for primary headache patients: a systematic review.

J Pain Res 2017 14;10:601-611. Epub 2017 Mar 14.

National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy.

Objective: This systematic review aimed to assess the efficacy, effectiveness, safety, and tolerability of osteopathic manipulative treatment (OMT) in patients with headache.

Background: Migraine is one of the most common and disabling medical conditions. It affects more than 15% of the general population, causing high global socioeconomic costs, and the currently available treatment options are inadequate.

Methods: We systematically reviewed all available studies investigating the use of OMT in patients with migraine and other forms of headache.

Results: The search of literature produced six studies, five of which were eligible for review. The reviewed papers collectively support the notion that patients with migraine can benefit from OMT. OMT could most likely reduce the number of episodes per month as well as drug use. None of the included studies, however, was classified as low risk of bias according to the Cochrane Collaboration's tool for assessing risk of bias.

Conclusion: The results from this systematic review show a preliminary low level of evidence that OMT is effective in the management of headache. However, studies with more rigorous designs and methodology are needed to strengthen this evidence. Moreover, this review suggests that new manual interventions for the treatment of acute migraine are available and developing.
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http://dx.doi.org/10.2147/JPR.S130501DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5359118PMC
March 2017

The role of gentle touch in perinatal osteopathic manual therapy.

Neurosci Biobehav Rev 2017 Jan 11;72:1-9. Epub 2016 Nov 11.

British School of Osteopathy, London, UK; Clinical-based Human Research Department, Centre for Osteopathic Medicine Collaboration, Pescara, Italy; Instituto Piaget, Lisbon, Portugal. Electronic address:

Osteopathic medicine is a system of manual diagnosis and treatment. While there is growing evidence that osteopathy is effective in a range of clinical conditions, the underlying biological basis of its therapeutic effects remain largely unknown. Given that the sense of touch plays a critical role in osteopathy, in this perspective article, with a particular focus on perinatal care, we explore the potential mechanisms by which stimulation of the skin senses can exert beneficial physiological and psychological effects, aiding growth and development. We propose that a class of low threshold mechanosensitive c-fibre, named c-tactile afferents, which respond optimally to gentle, slow moving touch are likely to play a direct and significant role in the efficacy of manual therapies. A greater understanding of the impact the type and quality of touch plays in therapeutic tactile interventions and in particular the neuroscience underpinning these effects will aid the development of more targeted, population specific interventions.
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http://dx.doi.org/10.1016/j.neubiorev.2016.11.009DOI Listing
January 2017

Osteopathic manipulative treatment in neurological diseases: Systematic review of the literature.

J Neurol Sci 2016 Oct 30;369:333-341. Epub 2016 Aug 30.

National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy.

Objective: The aim of the present systematic review is to critically evaluate the effectiveness of OMT as an adjuvant therapy in the management of patients with neurological diseases.

Methods: A systematic review was conducted and the findings were reported following the PRISMA statement. Twelve databases were searched for articles reporting the use of osteopathic manipulative treatment in neurological disorders. Each article was assessed using the Cochrane risk of bias tool and the Jadad score.

Results: 10 articles were included. OMT was used to test its efficacy and/or effectiveness in treating tension-type headache, migraine, cerebral palsy and gait analysis in patients affected by Parkinson's Disease. The general quality of the included trials ranged from very low, to low and moderate according to Cochrane standards. High heterogeneity between studies was found for the type of intervention, control and outcome measures used.

Conclusion: Results showed that studies on the efficacy and/or effectiveness of OMT treatments are scarce, heterogeneous, and of low methodological quality. Further studies should be conducted including a more pragmatic methodology, an exhaustive description of all investigated and concurrent interventions, and a systematic report of adverse events, so as to obtain robust and generalizable results.
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http://dx.doi.org/10.1016/j.jns.2016.08.062DOI Listing
October 2016

The paradox of sham therapy and placebo effect in osteopathy: A systematic review.

Medicine (Baltimore) 2016 Aug;95(35):e4728

Clinical-based Human Research Department, COME Collaboration, Pescara Department of Neuroscience, Imaging and Clinical Sciences Institute for Advanced Biomedical Technologies (ITAB), "G. d'Annunzio" University of Chieti-Pescara, Chieti Accademia Italiana Osteopatia Tradizionale, Pescara National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy.

Background: Placebo, defined as "false treatment," is a common gold-standard method to assess the validity of a therapy both in pharmacological trials and manual medicine research where placebo is also referred to as "sham therapy." In the medical literature, guidelines have been proposed on how to conduct robust placebo-controlled trials, but mainly in a drug-based scenario. In contrast, there are not precise guidelines on how to conduct a placebo-controlled in manual medicine trials (particularly osteopathy). The aim of the present systematic review was to report how and what type of sham methods, dosage, operator characteristics, and patient types were used in osteopathic clinical trials and, eventually, assess sham clinical effectiveness.

Methods: A systematic Cochrane-based review was conducted by analyzing the osteopathic trials that used both manual and nonmanual placebo control. Searches were conducted on 8 databases from journal inception to December 2015 using a pragmatic literature search approach. Two independent reviewers conducted the study selection and data extraction for each study. The risk of bias was evaluated according to the Cochrane methods.

Results: A total of 64 studies were eligible for analysis collecting a total of 5024 participants. More than half (43 studies) used a manual placebo; 9 studies used a nonmanual placebo; and 12 studies used both manual and nonmanual placebo. Data showed lack of reporting sham therapy information across studies. Risk of bias analysis demonstrated a high risk of bias for allocation, blinding of personnel and participants, selective, and other bias. To explore the clinical effects of sham therapies used, a quantitative analysis was planned. However, due to the high heterogeneity of sham approaches used no further analyses were performed.

Conclusion: High heterogeneity regarding placebo used between studies, lack of reporting information on placebo methods and within-study variability between sham and real treatment procedures suggest prudence in reading and interpreting study findings in manual osteopathic randomized controlled trials (RCTs). Efforts must be made to promote guidelines to design the most reliable placebo for manual RCTs as a means of increasing the internal validity and improve external validity of findings.
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http://dx.doi.org/10.1097/MD.0000000000004728DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008597PMC
August 2016

Osteopathic manipulative treatment in gynecology and obstetrics: A systematic review.

Complement Ther Med 2016 Jun 7;26:72-8. Epub 2016 Mar 7.

Clinical-based Human Research Department (C.O.ME. Collaboration), Pescara, Italy. Electronic address:

Objective: The aim of the review was to evaluate the effects of the osteopathic manipulative treatment (OMT) on women with gynaecological and obstetric disorders.

Materials And Methods: An extensive search from inception to April 2014 was conducted on MEDLINE, Embase, the Cochrane library using MeSH and free terms. Clinical studies investigating the effect of OMT in gynaecologic and obstetric conditions were included as well as unpublished works. Reviews and personal contributions were excluded. Studies were screened for population, outcome, results and adverse effects by two independent reviewers using an ad-hoc data extraction form. The high heterogeneity of the studies led to a narrative review.

Results: 24 studies were included (total sample=1840), addressing back pain and low back functioning in pregnancy, pain and drug use during labor and delivery, infertility and subfertility, dysmenorrhea, symptoms of (peri)menopause and pelvic pain. Overall, OMT can be considered effective on pregnancy related back pain but uncertain in all other gynaecological and obstetrical conditions. Only three studies (12.5%) mentioned adverse events after OMT.

Conclusions: Although positive effects were found, the heterogeneity of study designs, the low number of studies and the high risk of bias of included trials prevented any indication on the effect of osteopathic care. Further investigation with more pragmatic methodology, better and detailed description of interventions and systematic reporting of adverse events are recommended in order to obtain solid and generalizable results.
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http://dx.doi.org/10.1016/j.ctim.2016.03.005DOI Listing
June 2016

Using the template for intervention description and replication (TIDieR) as a tool for improving the design and reporting of manual therapy interventions.

Man Ther 2016 Aug 11;24:85-9. Epub 2016 Mar 11.

Iberoamerican Cochrane Centre - Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; CIBEResp, Barcelona, Spain.

The detailed reporting of any research intervention is crucial to evaluate its applicability into a routinely practice-based context. However, it has been estimated that, especially in non-pharmacological interventions, the published literature typically includes incomplete intervention details. In the field of manual medicine, where interventions are delivered with a high degree of individualization and variability, poorly reported studies could compromise internal and external validity of the results. Among the various initiatives that have been undertaken to improve the intervention description, the Template for Intervention Description and Replication (TIDieR) has to be highlighted as the most promising. TIDieR offers both to researchers and clinicians a helpful and comprehensive guidance on how manual therapy interventions have to be designed and reported, taking into account the clinical complexity of manual therapy and the need to satisfy research gold standards.
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http://dx.doi.org/10.1016/j.math.2016.03.004DOI Listing
August 2016

Sensitization and Interoception as Key Neurological Concepts in Osteopathy and Other Manual Medicines.

Front Neurosci 2016 10;10:100. Epub 2016 Mar 10.

Department of Biomedical and Neuromotor Sciences, Bellaria Hospital, University of BolognaBologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, AUSL di BolognaBologna, Italy.

Historically, approaches used in manual medicine to explain patient reported symptoms have been focused on the so-called exteroceptive paradigm. Arguably, this mindset lacks an appropriate "reading system" able to interpret musculoskeletal disorders from a different perspective, where the properties of the nervous system are embraced into a more holistic and functional-related context. Interestingly, if the underpinning mechanisms of a given treatment scenario/effect are taking into account, the majority of research outcomes focuses on a proprioceptive/exteroceptive explanation, leaving ting aside the additional or even central role of interoception. Currently, to date, the application of theoretical knowledge acquired on the relatively recent neuroscientific concepts and evidence concerning of interoception, sensitization, touch, autonomic functions, inflammation, and pain into a clinical/research manual medicine scenario is lacking, even if theoretically, the impact on the possible etiological mechanisms and treatment effects seems to be important. Here, we propose the conceptual foundations for a new way of interpreting and reading patients' clinical reported outcomes scenario based on interoception and sensitization. We argue that this will provide a foundation to create the ground for future research focusing on the hypotheses that manual therapies, specifically osteopathy, can intercede with sensitization states, at all levels, using interoceptive pathways.
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http://dx.doi.org/10.3389/fnins.2016.00100DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4785148PMC
March 2016
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