The effect of osteopathic manipulative treatment on quality of life in patients with cardiac implantable electronic devices.

CONTEXT: Osteopathic manipulative treatment (OMT) has been demonstrated to have an effect on the autonomic nervous system, which may have antiarrhythmic effects. The effects of OMT in patients with cardiac implantable electronic devices (CIEDs) have not previously been reported. This study investigated the impact of OMT on quality of life (QOL) in this patient population. OBJECTIVES: The purpose of this study is to investigate the effects of OMT on QOL in CIED patients. METHODS: Subjects with CIEDs were recruited into a double-blind randomized controlled institutional review board (IRB)-approved clinical trial (ClinicalTrials.gov ID: NCT04004741) and randomized to OMT or light touch (control) groups. Subjects received a one-time intervention, performed by board-certified neuromusculoskeletal medicine (NMM) and osteopathic manipulative medicine (OMM) physicians. The OMT protocol utilized techniques including myofascial release, rib raising, facilitated positional release (FPR), and osteopathic cranial manipulative medicine. Subjects' QOL was assessed immediately preceding intervention and one-month postintervention utilizing the Research ANd Development (RAND) 36-Item Short Form Health Survey (SF-36, eight parameters). Groups were compared utilizing unpaired t tests; α=0.05. RESULTS: Forty-two subjects were enrolled, with four lost to follow-up, which resulted in 19 OMT and 19 control subjects for analysis. Of the eight QOL parameters, two showed significant improvement with OMT: role limitations due to physical health (p=0.001) and pain (p=0.003). CONCLUSIONS: This study demonstrates the potential for QOL improvement in CIED patients. Specifically, subjects in the OMT group reported an improvement in activities of daily living as well as a decrease in overall pain, including pain interfering with work. Additional research is necessary to further understand the physiologic effects of OMT, including its effects on arrhythmias, in CIED patients.

Abnormal Foot Progression Angle Kinematics in Cervical Dystonia Improved After Osteopathic Manipulative Medicine: A Prospective Case Series.

Introduction Cervical dystonia (CD), a rare disorder, is the most common form of dystonia, a movement disorder. Impairments in activities of daily living and quality of life may result from chronic pain, perceived stigma, difficulty walking, and/or lack of control over movements. Studies of treatments for difficulty walking in CD have been inconclusive. Osteopathic manipulative medicine (OMM) has been used to improve gait biomechanics in other health conditions. Foot progression angle (FPA) while walking indicates functional gait abnormalities that increase the risk of knee injury and osteoarthritis. Objective The aim of this study is to test if five-weekly treatments using an OMM sequence designed for CD improved abnormal gait biomechanics in individuals with CD by identifying and addressing somatic dysfunctions. Methods In this prospective case series, independently ambulating individuals with CD symptom onset before the age of 40 years, not due to traumatic injury, were evaluated utilizing validated scales for severity (Toronto western spasmodic torticollis rating scale [TWSTRsI]) and symptoms affecting quality of life (Cervical Dystonia Impact Profile [CDIP-58]), physical examination, and FPA before and after five-weekly OMM treatments. Lower body joint range of motion and angles were captured in a clinical gait lab by nine cameras collecting three-dimensional Whole-body position data during three trials of one gait cycle at participant-selected walking speed. The FPA waveforms during the gait cycle were quantified by Vicon Nexus and Polygon applications. Pretreatment and posttreatment results were compared to established healthy gait waveforms and tested by repeated measures ANOVA (α=0.05). Results Pretreatment waveforms in CD had a mean 5.13° of excess FPA during gait cycle phases requiring lower-extremity pronation compared to previously published age-gender-matched healthy waveforms. There was 96% improvement in pronation after five treatments, with a mean 0.21° (p=0.041) of excess FPA. Mean TWSTRs and CDIP-58 scores improved. On physical examination, the rotational direction of C2 vertebrae was contralateral to neck muscle hypertonicity. Vertical sphenobasilar synchondrosis strains were present in those with anterotorticollis. Participants had ipsilateral anterolateral neck muscle and anterolateral abdominal wall muscle hypertonicity. All patients had pelvic somatic dysfunctions with left-side superior relative to right-side and restriction from lower-extremity pronation (i.e., supination dysfunctions). Conclusion The FPA was significantly improved after treatment. This OMM sequence was well tolerated and may be useful for improving gait kinematics in individuals with CD. Randomized, controlled, long-term studies are needed to determine effectiveness.

Knowledge of osteopathic manipulative medicine and osteopathic physicians in a New York South Asian community.

CONTEXT: Research regarding patient awareness of osteopathic manipulative medicine (OMM) can help identify barriers and factors limiting patient knowledge. Levels of knowledge about OMM and osteopathic physicians have been studied in New York's Chinese and Korean populations, but have not previously been investigated in the South Asian population. OBJECTIVES: To assess the knowledge of OMM and osteopathic physicians within a South Asian community of New York. METHODS: A cross-sectional study was designed in which a culturally appropriate survey, provided in both English and Hindi, was administered to study participants in order to measure knowledge of osteopathic medicine. The study utilized convenience sampling and distributed surveys to individuals who identified themselves of South Asian descent at high traffic sites in Hicksville, New York. The survey contained 10 questions, assessing the individual's knowledge of osteopathic medicine. The Kruskal-Wallis and Chi-Square tests were employed to determine statistical significance of the data obtained from the surveys. RESULTS: The survey was conducted on 100 participants in Hicksville, New York. The respondent demographics included 53 males and 47 females with an average age of 41.2 ± 16.3 years old. There were 34 (34%) participants who had heard of osteopathic manipulative medicine (OMM) and 26 (26%) participants who had knowledge of doctor of osteopathic medicine (DO) physicians. Respondents were found more likely to have knowledge of DOs if they were born in the United States (US) vs. other countries (US, 8 of 14 [57.1%] vs. others, 18 of 86 [20.9%]; p=0.006) or lived longer in the US (11 of 26 [42.3%], p=0.039). Participants who spoke a non-English primary language were also found less likely to have knowledge of DOs as they made up 46 of the 58 respondents who indicated no knowledge (79.3%, p=0.042). CONCLUSIONS: A general lack of knowledge of DOs and OMM exists within the South Asian community of Hicksville, New York and lower levels of awareness were found among participants who were male, born outside the US, had a language other than English as their primary language, and had spent less time in the US. Additional educational resources may be implemented to increase awareness of DOs and OMM among this and similar communities.

Gut Microbiome Changes with Osteopathic Treatment of Constipation in Parkinson's Disease: A Pilot Study.

INTRODUCTION: The gut microbiome appears to be predictive of Parkinson's disease (PD) with constipation. Chronic constipation frequently manifests prior to motor symptoms and impairs quality of life. An osteopathic manipulative medicine (OMM) sequence used physical exam assessment and manual treatment of neuromusculoskeletal dysfunctions pertinent to constipation in PD for this prospective ABA-design study, IRB-NYITBHS1065. The effects of 4 weekly treatments on the gut microbiome among men and women over 40 years old with chronic constipation and PD were investigated. Severity of PD was rated with the Movement Disorders Society-Unified PD rating scale (UPDRS) in six subjects with constipation. Also, the Bristol stool scale and questionnaires validated for constipation were administered for diagnosis, symptom severity, and quality of life during a 4-week control-period (A), 4-weekly OMM-treatments (B), and 2-weeks no-intervention (A). Biweekly stool samples were assessed for normalized microbiota abundance. RESULTS: The mean Bristol rating improved from type 2 (± 1) Pre-OMM to 3 (± 1; p = .167; d = 0.677) Post-OMM. Mean constipation severity significantly decreased (p = .010; d = 1.508) Post-OMM. Mean quality of life significantly improved (p = .041; d = 1.072) Post-OMM. The Pre-OMM mean number of families within the phylum Firmicutes decreased by 3 (p = .043; d = 1.177) Post-OMM. There were significant changes in the normalized abundance of phyla Actinobacteria (p = .040; d = 0.845) and Verrucomicrobia (p = .024; d = 0.675) as well as in genus Roseburia (p = .033; d = 1.109), Intestinimonas (p = .035; d = 0.627) and Anaerotruncus (p = .004) Post-OMM. CONCLUSION: The gut microbiome shifted among individuals with constipation and PD after four weekly treatments with the OMM-sequence. Changes in the gut microbiome Post-OMM were associated with UPDRS results and constipation measures. Clinical trials and studies to develop the gut microbiome into a validated biomarker for PD are necessary to understand the impact of OMM in patients with PD and constipation.

Effects of Clinical Exposure to Osteopathic Manipulative Medicine on Confidence Levels of Medical Students.

CONTEXT: Training in osteopathic manipulative medicine (OMM) is a unique component of the osteopathic medical school curriculum. Indicators of successful OMM programming include student comfort in explaining and performing OMM as well as confidence in using OMM on future patients. Research on the amount of clinical exposure sufficient to achieve this goal is limited. OBJECTIVES: To gauge the impact of clinical OMM exposure on medical students' self-assessed understanding of OMM, their ability to discuss, explain, and perform OMM, and their plan to use OMM in their future practice. METHODS: Fourth-year osteopathic medical students were e-mailed surveys before (baseline), during, and after 4 weeks (postrotation) of an elective OMM rotation. Answers were scaled from 0 to 10, with 0 being not at all comfortable/confident and 10 being the most comfortable/confident. RESULTS: Thirty-five students participated in the survey. A significant mean (SD) increase was found between the baseline and postrotation scores for students' understanding of OMM principles (1.43 [0.51]; P<.001), comfort discussing OMM principles with patients (1.27 [0.88]; P<.001), comfort with explaining OMM to someone unfamiliar with it (1.32 [0.82]; P<.001), comfort with performing an osteopathic structural examination (2.23 [1.44]; P<.001), and confidence incorporating OMM into future practice (1.86 [0.47]; P<.001). CONCLUSION: Increased clinical exposure to OMM increased the confidence of osteopathic medical students in all dimensions surveyed. This observation can help guide the development of undergraduate osteopathic clinical programming as well as standards for entry of allopathic residents into ACGME programs with osteopathic designation.

Effects of rib raising on the autonomic nervous system: a pilot study using noninvasive biomarkers.

CONTEXT: Rib raising is an osteopathic manipulative treatment technique used to address restricted excursion of the rib cage and modulate sympathetic nervous system (SNS) activity. However, the physiologic effects of this technique have not been well documented. OBJECTIVE: To investigate the effects of rib raising on the autonomic nervous system and the hypothalamic-pituitary-adrenal axis using noninvasive biomarkers. METHODS: Changes in salivary biomarkers after rib raising were investigated using a pretest-posttest, placebo-controlled design. Healthy adult participants were recruited and randomly assigned to rib raising or placebo (light touch) groups. All participants provided baseline saliva samples and samples immediately and 10 minutes after receiving the rib raising or placebo procedure. Salivary flow rate, alpha-amylase activity, and cortisol levels were measured for each sample. RESULTS: Twenty-three participants were recruited, of whom 14 completed the study (7 in each group). Subjects who received rib raising had a statistically significant decrease in alpha-amylase activity both immediately after (P=.014) and 10 minutes after (P=.008) the procedure. A statistically significant change in alpha-amylase activity was not seen in the placebo group at either time point. Changes in salivary cortisol levels and flow rate were not statistically significant in either group. CONCLUSIONS: The results of the present pilot study suggest that SNS activity may decrease immediately after rib raising, but the hypothalamic-pituitary-adrenal axis and parasympathetic activity are not altered by this technique. Salivary alpha-amylase may be a useful biomarker for investigating manipulative treatments targeting the SNS. Additional studies with a greater number of subjects are needed to expand on these results.