Publications by authors named "Jorge E Esteves"

8 Publications

  • Page 1 of 1

Person-centered body-centered approaches in osteopathic care for chronic pain conditions.

Ther Adv Musculoskelet Dis 2021 8;13:1759720X211029417. Epub 2021 Jul 8.

Foundation Centre for Osteopathic Medicine Collaboration, Italy National Centre, Pescara, Italy.

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http://dx.doi.org/10.1177/1759720X211029417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8274118PMC
July 2021

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

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

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

Influence of perceived difficulty of cases on student osteopaths' diagnostic reasoning: a cross sectional study.

Chiropr Man Therap 2017 1;25:32. Epub 2017 Dec 1.

Research Centre, University College of Osteopathy, 275 Borough High Street, London, UK.

Background: Diagnostic reasoning refers to the cognitive processes by which clinicians formulate diagnoses. Despite the implications for patient safety and professional identity, research on diagnostic reasoning in osteopathy remains largely theoretical. The aim of this study was to investigate the influence of perceived task difficulty on the diagnostic reasoning of students osteopaths.

Methods: Using a single-blinded, cross sectional study design, sixteen final year pre-registration osteopathy students diagnosed two standardized cases under two context conditions (complex versus control). Context difficulty was manipulated via verbal manipulation and case order was randomized and counterbalanced across subjects to ensure that each case was diagnosed evenly under both conditions (i.e. half of the subjects performed either case A or B first). After diagnosis, participants were presented with items (literal, inferred and filler) designed to represent analytical and non-analytical reasoning. Response time and error rate for each item were measured. A repeated measures analysis of variance (concept type x context) was performed to identify differences across conditions and make inferences on diagnostic reasoning.

Results: Participants made significantly more errors when judging literal concepts and took significantly less time to recognize filler concepts in the complex context. No significant difference in ability to judge inferred concepts across contexts was found.

Conclusions: Although speculative and preliminary, our findings suggest the perception of complexity led to an increased reliance on analytical reasoning at the detriment of non-analytical reasoning. To reduce the associated cognitive load, osteopathic educational institutions could consider developing the intuitive diagnostic capabilities of pre-registration students. Postgraduate mentorship opportunities could be considered to enhance the diagnostic reasoning of professional osteopaths, particularly recent graduates. Further research exploring the influence of expertise is required to enhance the validity of this study.
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http://dx.doi.org/10.1186/s12998-017-0161-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5709833PMC
July 2018

Emotional processing and its relationship to chronic low back pain: results from a case-control study.

Man Ther 2013 Dec 5;18(6):541-6. Epub 2013 Jun 5.

British School of Osteopathy, 275 Borough High Street, London SE1 1JE, United Kingdom. Electronic address:

Chronic low back pain (CLBP) is a common, yet challenging condition for both patients and clinicians. Several studies have demonstrated a strong association between CLBP and psychological factors such as anxiety, fear-avoidance, self-efficacy, catastrophizing and depression. These factors are closely linked with emotional states; however, it is unknown whether CLBP patients process their emotions differently from asymptomatic individuals. The aim of this case-control study was to investigate the relationship between CLBP and emotional processing. A sample of 110 participants comprising of 55 patients with chronic back pain and 55 individuals without a history of CLBP were assessed using the Emotional Processing Scale (EPS-25). The EPS-25 generates an overall score, and also scores pertaining to five individual emotional processing factors--avoidance, suppression, unregulated emotion, impoverished emotional experience and signs of unprocessed emotion. Chronic back pain patients scored significantly higher in the overall EPS-25 score (p < 0.001) with an effect size of 0.33. In addition, there were significant differences in four factors--impoverished emotional experience, unregulated emotion, unprocessed emotion, and suppression, with effect sizes ranging from 0.20 to 0.44. The results suggest that dysfunctional emotional processing, particularly with regard to the suppression of emotions, is associated with CLBP. Clinicians should critically consider the role of emotional processing in their patients' evaluation and management. Future research using a prospective cohort should assess the role of emotional processing as a predictor in the development of chronic back pain.
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http://dx.doi.org/10.1016/j.math.2013.05.008DOI Listing
December 2013
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