Somatic dysfunction and use of osteopathic manual treatment techniques during ambulatory medical care visits: A CONCORD-PBRN study

John C. Licciardone, Cathleen M. Kearns, Hollis H. King, Michael A. Seffinger, W. Thomas Crow, Peter Zajac, William H. Devine, Reem Y. Abu-Sbaih, Stephen J. Miller, Murray R. Berkowitz, Robin Dyer, Deborah M. Heath, Kevin D. Treffer, Natalie A. Nevins, Subhash Aryal

Research output: Contribution to journalArticle

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Abstract

Context: Osteopathic manual treatment (OMT) of somatic dysfunction is a unique approach to medical care that may be studied within a practice-based research network. Objective: To measure patient characteristics and osteopathic physician practice patterns within the Consortium for Collaborative Osteopathic Research Development-Practice-Based Research Network (CONCORD-PBRN). Design: Cross-sectional card study. Setting: Eleven member clinics within the CONCORD-PBRN coordinated by The Osteopathic Research Center. Patients: A total of 668 patients seen between January and March 2013. Main Study Measures: Patient age and sex; primary diagnoses; somatic dysfunction as manifested by tenderness, asymmetry, restricted motion, or tissue texture changes; and use of 14 OMT techniques. Results were stratified by anatomical region and adjusted for clustering within member clinics. Clustering was measured by the intracluster correlation coefficient. Results: Patient ages ranged from 7 days to 87 years (adjusted mean age, 49.2 years; 95% confidence interval [CI], 43.3-55.1 years). There were 450 females (67.4%) and 508 patient visits (76.0%) involved a primary diagnosis of disease of the musculoskeletal system and connective tissue. Structural examination was performed during 657 patient visits (98.4%), and 649 visits (97.2%) involved OMT. Restricted motion and tenderness were the most and least common palpatory findings, respectively. Cranial (1070 [14.5%]), myofascial release (1009 [13.7%]), muscle energy (1001 [13.6%]), and counterstrain (980 [13.3%]) techniques were most commonly used, accounting for more than one-half of the OMT provided. Pediatric patients were more likely than adults to receive OMT within the head (adjusted odds ratio [OR], 9.53; 95% CI, 1.28-71.14). Geriatric patients were more likely than adults to receive a structural examination (adjusted OR, 1.83; 95% CI, 1.09-3.07) and OMT (adjusted OR, 1.62; 1.02-2.59) within the lower extremity. Females were more likely than males to receive a structural examination (adjusted OR, 2.44; 95% CI, 1.44-4.16) and OMT (adjusted OR, 2.11; 95% CI, 1.26-3.52) within the sacrum and OMT within the pelvis (adjusted OR, 1.79; 95% CI, 1.12-2.88). Intracluster correlation coefficients for the 4 most commonly used OMT techniques ranged from 0.34 to 0.72. Conclusion: This study provides proof of concept of the feasibility of studying osteopathic medical practice on a national level by developing and growing the CONCORD-PBRN.

Original languageEnglish
Pages (from-to)344-355
Number of pages12
JournalJournal of the American Osteopathic Association
Volume114
Issue number5
DOIs
StatePublished - May 2014

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Ambulatory Care
Odds Ratio
Research
Confidence Intervals
Therapeutics
Cluster Analysis
Osteopathic Physicians
Physicians' Practice Patterns
Sacrum
Musculoskeletal System
Pelvis
Geriatrics
Connective Tissue
Lower Extremity
Cross-Sectional Studies
Head
Pediatrics
Muscles

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Licciardone, John C. ; Kearns, Cathleen M. ; King, Hollis H. ; Seffinger, Michael A. ; Crow, W. Thomas ; Zajac, Peter ; Devine, William H. ; Abu-Sbaih, Reem Y. ; Miller, Stephen J. ; Berkowitz, Murray R. ; Dyer, Robin ; Heath, Deborah M. ; Treffer, Kevin D. ; Nevins, Natalie A. ; Aryal, Subhash. / Somatic dysfunction and use of osteopathic manual treatment techniques during ambulatory medical care visits : A CONCORD-PBRN study. In: Journal of the American Osteopathic Association. 2014 ; Vol. 114, No. 5. pp. 344-355.
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abstract = "Context: Osteopathic manual treatment (OMT) of somatic dysfunction is a unique approach to medical care that may be studied within a practice-based research network. Objective: To measure patient characteristics and osteopathic physician practice patterns within the Consortium for Collaborative Osteopathic Research Development-Practice-Based Research Network (CONCORD-PBRN). Design: Cross-sectional card study. Setting: Eleven member clinics within the CONCORD-PBRN coordinated by The Osteopathic Research Center. Patients: A total of 668 patients seen between January and March 2013. Main Study Measures: Patient age and sex; primary diagnoses; somatic dysfunction as manifested by tenderness, asymmetry, restricted motion, or tissue texture changes; and use of 14 OMT techniques. Results were stratified by anatomical region and adjusted for clustering within member clinics. Clustering was measured by the intracluster correlation coefficient. Results: Patient ages ranged from 7 days to 87 years (adjusted mean age, 49.2 years; 95{\%} confidence interval [CI], 43.3-55.1 years). There were 450 females (67.4{\%}) and 508 patient visits (76.0{\%}) involved a primary diagnosis of disease of the musculoskeletal system and connective tissue. Structural examination was performed during 657 patient visits (98.4{\%}), and 649 visits (97.2{\%}) involved OMT. Restricted motion and tenderness were the most and least common palpatory findings, respectively. Cranial (1070 [14.5{\%}]), myofascial release (1009 [13.7{\%}]), muscle energy (1001 [13.6{\%}]), and counterstrain (980 [13.3{\%}]) techniques were most commonly used, accounting for more than one-half of the OMT provided. Pediatric patients were more likely than adults to receive OMT within the head (adjusted odds ratio [OR], 9.53; 95{\%} CI, 1.28-71.14). Geriatric patients were more likely than adults to receive a structural examination (adjusted OR, 1.83; 95{\%} CI, 1.09-3.07) and OMT (adjusted OR, 1.62; 1.02-2.59) within the lower extremity. Females were more likely than males to receive a structural examination (adjusted OR, 2.44; 95{\%} CI, 1.44-4.16) and OMT (adjusted OR, 2.11; 95{\%} CI, 1.26-3.52) within the sacrum and OMT within the pelvis (adjusted OR, 1.79; 95{\%} CI, 1.12-2.88). Intracluster correlation coefficients for the 4 most commonly used OMT techniques ranged from 0.34 to 0.72. Conclusion: This study provides proof of concept of the feasibility of studying osteopathic medical practice on a national level by developing and growing the CONCORD-PBRN.",
author = "Licciardone, {John C.} and Kearns, {Cathleen M.} and King, {Hollis H.} and Seffinger, {Michael A.} and Crow, {W. Thomas} and Peter Zajac and Devine, {William H.} and Abu-Sbaih, {Reem Y.} and Miller, {Stephen J.} and Berkowitz, {Murray R.} and Robin Dyer and Heath, {Deborah M.} and Treffer, {Kevin D.} and Nevins, {Natalie A.} and Subhash Aryal",
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language = "English",
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pages = "344--355",
journal = "Journal of the American Osteopathic Association",
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Licciardone, JC, Kearns, CM, King, HH, Seffinger, MA, Crow, WT, Zajac, P, Devine, WH, Abu-Sbaih, RY, Miller, SJ, Berkowitz, MR, Dyer, R, Heath, DM, Treffer, KD, Nevins, NA & Aryal, S 2014, 'Somatic dysfunction and use of osteopathic manual treatment techniques during ambulatory medical care visits: A CONCORD-PBRN study', Journal of the American Osteopathic Association, vol. 114, no. 5, pp. 344-355. https://doi.org/10.7556/jaoa.2014.072

Somatic dysfunction and use of osteopathic manual treatment techniques during ambulatory medical care visits : A CONCORD-PBRN study. / Licciardone, John C.; Kearns, Cathleen M.; King, Hollis H.; Seffinger, Michael A.; Crow, W. Thomas; Zajac, Peter; Devine, William H.; Abu-Sbaih, Reem Y.; Miller, Stephen J.; Berkowitz, Murray R.; Dyer, Robin; Heath, Deborah M.; Treffer, Kevin D.; Nevins, Natalie A.; Aryal, Subhash.

In: Journal of the American Osteopathic Association, Vol. 114, No. 5, 05.2014, p. 344-355.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Somatic dysfunction and use of osteopathic manual treatment techniques during ambulatory medical care visits

T2 - A CONCORD-PBRN study

AU - Licciardone, John C.

AU - Kearns, Cathleen M.

AU - King, Hollis H.

AU - Seffinger, Michael A.

AU - Crow, W. Thomas

AU - Zajac, Peter

AU - Devine, William H.

AU - Abu-Sbaih, Reem Y.

AU - Miller, Stephen J.

AU - Berkowitz, Murray R.

AU - Dyer, Robin

AU - Heath, Deborah M.

AU - Treffer, Kevin D.

AU - Nevins, Natalie A.

AU - Aryal, Subhash

PY - 2014/5

Y1 - 2014/5

N2 - Context: Osteopathic manual treatment (OMT) of somatic dysfunction is a unique approach to medical care that may be studied within a practice-based research network. Objective: To measure patient characteristics and osteopathic physician practice patterns within the Consortium for Collaborative Osteopathic Research Development-Practice-Based Research Network (CONCORD-PBRN). Design: Cross-sectional card study. Setting: Eleven member clinics within the CONCORD-PBRN coordinated by The Osteopathic Research Center. Patients: A total of 668 patients seen between January and March 2013. Main Study Measures: Patient age and sex; primary diagnoses; somatic dysfunction as manifested by tenderness, asymmetry, restricted motion, or tissue texture changes; and use of 14 OMT techniques. Results were stratified by anatomical region and adjusted for clustering within member clinics. Clustering was measured by the intracluster correlation coefficient. Results: Patient ages ranged from 7 days to 87 years (adjusted mean age, 49.2 years; 95% confidence interval [CI], 43.3-55.1 years). There were 450 females (67.4%) and 508 patient visits (76.0%) involved a primary diagnosis of disease of the musculoskeletal system and connective tissue. Structural examination was performed during 657 patient visits (98.4%), and 649 visits (97.2%) involved OMT. Restricted motion and tenderness were the most and least common palpatory findings, respectively. Cranial (1070 [14.5%]), myofascial release (1009 [13.7%]), muscle energy (1001 [13.6%]), and counterstrain (980 [13.3%]) techniques were most commonly used, accounting for more than one-half of the OMT provided. Pediatric patients were more likely than adults to receive OMT within the head (adjusted odds ratio [OR], 9.53; 95% CI, 1.28-71.14). Geriatric patients were more likely than adults to receive a structural examination (adjusted OR, 1.83; 95% CI, 1.09-3.07) and OMT (adjusted OR, 1.62; 1.02-2.59) within the lower extremity. Females were more likely than males to receive a structural examination (adjusted OR, 2.44; 95% CI, 1.44-4.16) and OMT (adjusted OR, 2.11; 95% CI, 1.26-3.52) within the sacrum and OMT within the pelvis (adjusted OR, 1.79; 95% CI, 1.12-2.88). Intracluster correlation coefficients for the 4 most commonly used OMT techniques ranged from 0.34 to 0.72. Conclusion: This study provides proof of concept of the feasibility of studying osteopathic medical practice on a national level by developing and growing the CONCORD-PBRN.

AB - Context: Osteopathic manual treatment (OMT) of somatic dysfunction is a unique approach to medical care that may be studied within a practice-based research network. Objective: To measure patient characteristics and osteopathic physician practice patterns within the Consortium for Collaborative Osteopathic Research Development-Practice-Based Research Network (CONCORD-PBRN). Design: Cross-sectional card study. Setting: Eleven member clinics within the CONCORD-PBRN coordinated by The Osteopathic Research Center. Patients: A total of 668 patients seen between January and March 2013. Main Study Measures: Patient age and sex; primary diagnoses; somatic dysfunction as manifested by tenderness, asymmetry, restricted motion, or tissue texture changes; and use of 14 OMT techniques. Results were stratified by anatomical region and adjusted for clustering within member clinics. Clustering was measured by the intracluster correlation coefficient. Results: Patient ages ranged from 7 days to 87 years (adjusted mean age, 49.2 years; 95% confidence interval [CI], 43.3-55.1 years). There were 450 females (67.4%) and 508 patient visits (76.0%) involved a primary diagnosis of disease of the musculoskeletal system and connective tissue. Structural examination was performed during 657 patient visits (98.4%), and 649 visits (97.2%) involved OMT. Restricted motion and tenderness were the most and least common palpatory findings, respectively. Cranial (1070 [14.5%]), myofascial release (1009 [13.7%]), muscle energy (1001 [13.6%]), and counterstrain (980 [13.3%]) techniques were most commonly used, accounting for more than one-half of the OMT provided. Pediatric patients were more likely than adults to receive OMT within the head (adjusted odds ratio [OR], 9.53; 95% CI, 1.28-71.14). Geriatric patients were more likely than adults to receive a structural examination (adjusted OR, 1.83; 95% CI, 1.09-3.07) and OMT (adjusted OR, 1.62; 1.02-2.59) within the lower extremity. Females were more likely than males to receive a structural examination (adjusted OR, 2.44; 95% CI, 1.44-4.16) and OMT (adjusted OR, 2.11; 95% CI, 1.26-3.52) within the sacrum and OMT within the pelvis (adjusted OR, 1.79; 95% CI, 1.12-2.88). Intracluster correlation coefficients for the 4 most commonly used OMT techniques ranged from 0.34 to 0.72. Conclusion: This study provides proof of concept of the feasibility of studying osteopathic medical practice on a national level by developing and growing the CONCORD-PBRN.

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