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CROaM implications

  • There are opportunities for continuing educational development and pre-registration education to be informed by research that describes the characteristics of UK osteopathic practice and the nature of the patients presenting to osteopaths in the UK. For example, there may be opportunities to enhance levels of knowledge with respect to common co- morbidities and pathologies associated with the age range of patients that frequently use osteopathic services.
  • Further debate about the range of osteopaths' scope and style of practice is warranted in terms of both patient expectations and the maintenance of competence with respect to techniques used infrequently. Clinical governance issues, particularly pertaining to private practice and osteopaths who may be isolated in their work, require further exploration. There are opportunities for structured peer review and appraisal.
  • Some risk factors that are necessary or sufficient to produce stroke related to the neck are beyond the scope of clinical detection in osteopathic settings. Until screening procedures are established that are accurate and practical in the context of osteopathic practice, the detection of such rare events remains problematic for osteopaths.
  • Clinical education and professional development should focus on the history and clinical examination of patients to assess suitability for treatment rather than the use of clinical screening tests. Awareness of the function and anatomy of the cervical vascular system, and clinical presentation of cervical vascular pathology is recommended to aid in the identification of patients at risk of stroke when presenting for treatment. Osteopaths should be aware, that whilst serious events are rare, that they do occur.
  • There is a need to develop new guidance and educational materials for osteopaths concerning information giving and consent. These should draw on the results of the current study and related work and include recommendations about consent related processes and indicative risks associated with osteopathic treatment. Further audit or research could evaluate the impact of such materials using the methods and results from the current study as a reference standard.
  • Arguably, our results demonstrate clinically significant levels of improvement for patients that are in accord with other studies. High levels of satisfaction with care have also been demonstrated. These results give some confidence to osteopaths, patients and others that for a large majority of patients, their experience of osteopathic care will be positive in important ways.
  • However, the design of the current study does not enable clear conclusions about the effectiveness of osteopathic treatment. There is a need for further research to evaluate the effectiveness of osteopathic treatment using randomised trial methodology and to explore further the mechanisms underlying the apparent effectiveness of osteopathic treatment.
  • Our study failed to identify technique-related predictors of positive outcomes, but instead supports a mixed package of osteopathic care, which values non-specific aspects of the process of care including the role of communication, explanation and the building of a positive therapeutic alliance.
  • There is an opportunity to build on the results of the current study to establish a reference standard for short-term outcomes against which osteopaths in practice could audit benchmark their own work and provide a focus for continuing professional development.
  • Several management strategies have been identified that appear to be helpful in managing temporary increases in symptoms/pain following treatment. These include pre-warning, explaining the nature of reactions and using practitioners' therapeutic alliance with patients e ffectively. This information should be given to all patients regardless of the site of the main complaint or the nature of the intervention planned by the osteopath. Patients do have specifc frameworks in which they construe their reactions to treatment and these are useful for patients in reducing distress and increasing understanding of their treatment. There is an opportunity for osteopaths to explore these with patients and to agree a mutually consistent explanation to reduce uncertainty. It is anticipated that a wider understanding of the nature and prevalence of adverse events in osteopathy and implementation of common positive management strategies would enable osteopaths to share information about risk with patients more e ffectively. This in turn may increase patients' understanding and recall of risk information given by osteopaths.