Patient Active Approaches in Osteopathic Practice: A Scoping Review
Abstract
:1. Introduction
2. Materials and Methods
- Search strategy,
- Select the studies.
2.1. Identifying the Research Questions
2.2. Identifying the Relevant Studies
2.2.1. Search Strategy
2.2.2. Select Studies
2.3. Collecting, Summarizing, and Reporting Results
3. Results
3.1. Fascia-Oriented Active Approach
3.2. Integrated Mental Imagery and Work-In Exercise
3.3. Mindfulness-Based Exercise
3.4. Gamification and Problem-Solving in the Inter-Enactive Dyadic Approach
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Phases | Explanation |
---|---|
Assessment | The diagnostic process in the osteopathic practice is conducted in a shared decision-making process [41,42,43]. The functional examination of body systems, objective examination tests, and tests of the patient’s responsiveness to provocation can be tools for assessing the impact of somatic dysfunction on the patient’s presentation and for tailoring the treatment to the patient’s needs. The impact of palpatory findings on the patient’s perception (e.g., provocation tests) can act as decision-making drivers, guiding the selection of both osteopathic manipulative techniques and the patient’s active approaches (e.g., exercises) [43]. Pleasant response to touch activates the brain’s interoceptive network, modulating pain and anxiety [42]. Conversely, unpleasant experiences can increase sickness behavior and symptoms [42]. A patient’s responsiveness to slow and light compression types of touch focused on deformation along tangential vectors could be due to tissue changes in the joint capsule’s fibers, affecting, among other things, Ruffini mechanoreceptors [42]. In cases like this, osteopathic techniques such as myofascial release and PAOA with slow movements with myotatic reflex activation and melting stretches are indicated [42]. Conversely, positive responsiveness to slow elongation touch associated with a muscular contraction could be attributable to the internal layer of the joint capsule and the involvement of Golgi mechanoreceptors; in this case, hands-on approaches such as muscle energy technique, associated with Hanna’s pandiculation exercises and active resistant stretches could be selected [42]. In other scenarios, the osteopath is not able to recognize emergent patterns because provocation tests on the clinically relevant area do not evoke improvement in the patient’s responsiveness [42]. This could be a sign of central sensitization with an over-stimulation of fascial mechanoreceptors (mostly free nerve endings) that lead to autonomic nervous system and interoceptive networks firing, also altering the tonus of fascial smooth muscle cells. So-called interoceptive hands-on approaches, such as total body myofascial unwinding, could be administered in a combination of gentle touch, stretching, ideomotor movement, and mindfulness-based strategies in order to improve body awareness [42]. |
Osteopathic care | Osteopathic manipulative techniques are administered according to osteopathic palpatory findings that emerge as clinically relevant in the decision-making process. The above-mentioned hands-on approaches are followed by patient active osteopathic approaches. In osteopathic practice, active assistive exercises, as well as osteopathic manipulative techniques, can be tailored to the functional tissue alterations related to local adaptations, for example, addressing musculoskeletal and visceral dysfunctions [9]. There are also general techniques and exercises for addressing alterations related to general adaptation [9], for improving systems activities (i.e., autonomic nervous system) [23], and for individual energy management [28]. Osteopathic professionals also incorporate the basic principles of fascia-oriented training [18], archetypal postures [44,45], meditation [28,46], stress management [23], and mindfulness-based exercises [28,47] into patient active exercise approaches. The above-mentioned person-centered approaches are integrated with an evidence-informed component of the treatment plan that is mainly focused on symptoms. |
Reassessment | The osteopath evaluates the patient’s responsiveness with respect to their condition’s multidimensional aspects. Both patients and practitioners consider reduced or increased levels of familiar symptoms and comparative signs related to osteopathic palpatory findings in order to evaluate the treatment’s immediate effects. |
Stages | Research Aim | Research Methodology | |
---|---|---|---|
1 | Explore different PAOAs used by osteopathic professionals | Defining practitioners’ attitudes and beliefs toward PAOA | Qualitative research (i.e., thematic analysis) |
2 | Draw up a theoretical construct and shared model of PAOA | Generate an initial outline of the model for PAOA | Qualitative research (i.e., delphi panel and consensus workshop with grounded theory) |
3 | Evaluate potential clinical values of integrating active and PAOA in the treatment plan | Prove the generated model; Evaluate differences in patient-reported outcomes, clinical outcomes and patient satisfaction between subjects who received a passive approach rather than integrative passive and active | Observational studies; Experimental studies (i.e., Case studies, case reports, clinical studies) |
4 | Implement the generated model in clinical practice | Communicate the model to students and practitioners in order to implement it in clinical practice | Mentorship, consensus workshops, continuing professional development |
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Keywords: manipulation, osteopathic; musculoskeletal manipulations; exercise movement techniques; exercise therapy; mind-body therapies; bodyworks; mindfulness; meditation; fascia. | |||
Pubmed search builder: (((((((“Manipulation, Osteopathic” [Mesh]) OR “Musculoskeletal Manipulations” [Mesh]) AND “Exercise Movement Techniques” [Mesh]) OR “Exercise Therapy” [Mesh]) OR “Mind-Body Therapies” [Mesh]) OR “Mindfulness” [Mesh]) OR “Meditation” [Mesh]) OR “Fascia” [Mesh] | |||
Items grouped with respect to theme and subthemes | |||
1.Patient active osteopathic approaches. Principles of application and mechanisms of functioning (total n. = 16). | |||
1.1. Fascia-oriented active approach (n. = 2). | 1.2. Integrated mental imagery and work-in exercise (n. = 5). | 1.3. Mindfulness-based exercise (n. = 7). | 1.4. Gamification and problem-solving in the inter-enactive dyadic approach (n. = 2). |
Lunghi et al., 2016 [9] Schleip and Muller, 2013 [18] | Calsius et al., 2016 [19] Abraham et al., 2020 [20] Minasny, 2009 [21] Dorko 2003 [22] Wallden, 2012 [23] | Casals-Gutiérrez and Abbey, 2020 [24] D’Alessandro et al., 2016 [25] Comeaux, 2005 [26] Nanke and Abbey, 2017 [27] Liem and Neuhuber, 2020 [28] Liem and Lunghi, 2021 [29] Comeaux, 2005 [30] | Liebenson 2018 [31] Esteves et al., 2022 [32] |
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Lunghi, C.; Baroni, F.; Amodio, A.; Consorti, G.; Tramontano, M.; Liem, T. Patient Active Approaches in Osteopathic Practice: A Scoping Review. Healthcare 2022, 10, 524. https://doi.org/10.3390/healthcare10030524
Lunghi C, Baroni F, Amodio A, Consorti G, Tramontano M, Liem T. Patient Active Approaches in Osteopathic Practice: A Scoping Review. Healthcare. 2022; 10(3):524. https://doi.org/10.3390/healthcare10030524
Chicago/Turabian StyleLunghi, Christian, Francesca Baroni, Andrea Amodio, Giacomo Consorti, Marco Tramontano, and Torsten Liem. 2022. "Patient Active Approaches in Osteopathic Practice: A Scoping Review" Healthcare 10, no. 3: 524. https://doi.org/10.3390/healthcare10030524