The muscle hypothesis: a model of chronic heart failure appropriate for osteopathic medicine.
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Chronic heart failure is one of the most serious medical problems in the United States, affecting some 4 million persons. In spite of its common occurrence, and comprehensive literature regarding this condition, no unifying hypothesis has been accepted to explain the signs and symptoms of chronic heart failure. The cardiocirculatory and neurohormonal models place an emphasis on left ventricular ejection fraction and cardiac output and do not provide appropriate explanations for the symptoms of breathlessness and fatigue. The muscle hypothesis supplements these conventional models. It proposes that abnormal skeletal muscle in heart failure results in activation of muscle ergoreceptors, leading to an increase in ventilation and sensation of breathlessness, the perception of fatigue, and sympathetic activation. At least one fourth of patients with chronic heart failure are limited by skeletal muscle abnormalities rather than cardiac output. Cardiac rehabilitation exercise can lead to an increase in exercise capacity that is superior to that gained from digitalis or angiotensin-converting enzyme inhibitors. Exercise tends to reverse the skeletal muscle myopathy of chronic heart failure and reduces the abnormal ergoreflex. Other interventions that have been shown to have a favorable outcome include localized muscle group training, respiratory muscle training, and dietary approaches. The possibility that osteopathic manipulative treatment might be of benefit is an attractive, but untested, possibility. (+info)
Patient satisfaction and clinical outcomes associated with osteopathic manipulative treatment.
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A patient survey was used to measure and explain patient satisfaction and clinical outcomes associated with osteopathic manipulative treatment (OMT). Participating in the survey were 459 people who attended an ambulatory OMT specialty clinic from March 1998 through September 1998 and who had received OMT there at least twice previously. Standardized patient satisfaction scores were greatest for overall performance (0.61 +/- 0.29) and interpersonal manner (0.61 +/- 0.24). Satisfaction with finances (0.11 +/- 0.31) was significantly lower than for all other global dimensions of care (P < .001). Subjects perceived OMT to be highly efficacious (0.74 +/- 0.34) and reported significant relief from pain or discomfort (P < .001) and improvement in mobility (P < .001). Of all the respondents, 8.6% attributed an adverse reaction to OMT. Perception of OMT efficacy was significantly associated with all dimensions of patient satisfaction (P values ranged from less than .001 to .003). Relief from pain or discomfort was significantly associated with overall satisfaction (P < .001). Females had greater reduction in pain or discomfort than males (P = .001). Respondents perceived significant community shortages of OMT services through primary care (-0.45 +/- 0.50; P < .001) and specialty (-0.35 +/- 0.54; P < .001) physicians, and reported significant dissatisfaction with insurance coverage for OMT services (-0.09 +/- 0.57; P = .001). These findings suggest the need for greater access to OMT services. (+info)
Evaluation of osteopathic manipulative treatment training by practicing physicians in Ohio.
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The authors mailed a survey designed to evaluate beliefs about osteopathic manipulative treatment (OMT) training to the 2318 osteopathic physicians registered with the Ohio Osteopathic Association. Responses were received from 871 osteopathic physicians (response rate, 38%). Fifty-three percent of the respondents had used OMT with patients at least once during the week before the survey. With regard to OMT training, 60% rated their experience during medical school as acceptable; during postgraduate training the acceptable rating dropped to 9%. Osteopathic manipulative treatment training through continuing medical education programs was rated as acceptable by 26% who had participated in these programs. Forty percent of the respondents reported that they were practicing less OMT now than when they originally entered practice, while 20% reported using OMT procedures more often. No significant correlation was observed between OMT training satisfaction during medical school and current use of OMT. However, a strong negative correlation was observed between satisfaction with postgraduate OMT training and OMT use. This survey did not detect any association between year of graduation and use of OMT. (+info)
Quality of life in referred patients presenting to a specialty clinic for osteopathic manipulative treatment.
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Previous research has found that patients of osteopathic physicians tend to report poorer general health perceptions than persons in the general population or than patients of allopathic physicians. Quality of life and level of healthcare satisfaction in patients referred to a specialty clinic for osteopathic manipulative treatment (OMT) at a college of osteopathic medicine were measured in 1997. Data from the Medical Outcomes Study 36-Item Short Form (SF-36) were used to compute standardized scores in the following eight health scales: physical functioning, role limitations because of physical problems, bodily pain, general health perceptions, vitality, social functioning, role limitations because of emotional problems, and mental health. There were 185 patients who returned the survey (mean response rate, 90%), including 22 new and 163 established patients. Patients reported poorer health than the general population on all eight scales (P < .001). Patients frequently reported poorer quality of life than referents with hypertension, congestive heart failure, type 2 diabetes mellitus, recent acute myocardial infarction, or clinical depression. More than 97% of established patients were satisfied or very satisfied with the healthcare received at the clinic. This study suggests that referred patients presenting to osteopathic physicians for OMT may have poorer quality of life than is generally recognized when relying only on traditional diagnostic approaches. Early detection and treatment of musculoskeletal conditions may be important factors in preventing chronicity and its impact on quality of life. (+info)
Effects of osteopathic manipulative treatment and concentric and eccentric maximal-effort exercise on women with multiple sclerosis: a pilot study.
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The research objectives of this study were to evaluate the effects of osteopathic manipulative treatment (OMT) combined with maximal-effort exercise (MEE) on strength, coordination, endurance, and fatigue in female patients with multiple sclerosis (MS). Seven female subjects with MS participated in the 12-week study, which included intervention with OMT and MEE twice per week. Standardized tests for progression of MS and fatigue were used. Strength (maximal effort and impulse) was measured with the IsoPump exercise machine (IsoPump USA, Cleveland, Miss) during the three phases of the exercise protocol. Significant changes occurred in all but one measure of strength and on the 25-foot walk (P < .05), but not on the block-and-box test. The change in fatigue scores was not significantly different. Findings indicate that OMT combined with MEE significantly increases strength and ambulatory levels while not increasing fatigue in female patients with MS who have low to medium impairment. Qualitative data show that this intervention also produces beneficial effects in activities of daily living. (+info)
Joint cracking and popping: understanding noises that accompany articular release.
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Articular release is a physiologic event that may or may not be audible. It is seen in patients with healthy joints as well as those with somatic dysfunction. After an articular release, there is a difference in joint spacing-with the release increasing the distance between articular surfaces. Not all noise that emanates from a joint signifies an articular release. A hypothesis about the noise that frequently accompanies this release is offered and includes anatomic, physiologic, and functional models of articular release. Repeated performance of articular release may decrease the occurrence of arthritis. Potential problems from repeated articular release (eg, hypermobility) are also examined. (+info)
Osteopathic manipulative treatment in conjunction with medication relieves pain associated with fibromyalgia syndrome: results of a randomized clinical pilot project.
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Osteopathic physicians caring for patients with fibromyalgia syndrome (FM) often use osteopathic manipulative treatment (OMT) in conjunction with other forms of standard medical care. Despite a growing body of evidence on the efficacy of manual therapy for the treatment of selected acute musculoskeletal conditions, the role of OMT in treating patients with chronic conditions such as FM remains largely unknown. Twenty-four female patients meeting American College of Rheumatology criteria for FM were randomly assigned to one of four treatment groups: (1) manipulation group, (2) manipulation and teaching group, (3) moist heat group, and (4) control group, which received no additional treatment other than current medication. Participants' pain perceptions were assessed by use of pain thresholds measured at each of 10 bilateral tender points using a 9-kg dolorimeter, the Chronic Pain Experience Inventory, and the Present Pain Intensity Rating Scale. Patients' affective response to treatment was assessed using the Self-Evaluation Questionnaire. Activities of daily living were assessed using the Stanford Arthritis Center Disability and Discomfort Scales: Health Assessment Questionnaire. Depression was assessed using the Center for Epidemiological Studies Depression Scale. Significant findings between the four treatment groups on measures of pain threshold, perceived pain, attitude toward treatment, activities of daily living, and perceived functional ability were found. All of these findings favored use of OMT. This study found OMT combined with standard medical care was more efficacious in treating FM than standard care alone. These findings need to be replicated to determine if cost savings are incurred when treatments for FM incorporate nonpharmacologic approaches such as OMT. (+info)
Quantifiable effects of osteopathic manipulative techniques on patients with chronic asthma.
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In this pilot study, the authors evaluated the immediate effects of osteopathic manipulative procedures compared with sham procedures on 10 subjects who were diagnosed with chronic asthma. The research followed a pretest-posttest crossover design wherein each subject served as her own control. Blinded examiners recorded respiratory excursion, peak expiratory flow rates, and subjective measures of asthma symptoms. Measurements of both upper thoracic and lower thoracic forced respiratory excursion statistically increased after osteopathic manipulative procedures compared with sham procedures. Changes in peak expiratory flow rates and asthma symptoms were not statistically significant. (+info)