From needle to knife.

Trauma and Orthopaedic care has been through a rapid evolution over the past few decades. This Editorial discusses some of the advances.

Convergencia en la formación especializada de cirujanos ortopédicos / No disponible

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Variables influencing the use of osteopathic manipulative treatment in family practice.

A questionnaire was mailed to 2000 randomly selected osteopathic physicians to assess use of osteopathic manipulative treatment (OMT). In all, 1055 responses were summarized for the study. The contention is supported that OMT is being used less and less by practicing physicians. Only 6% of the respondents treated more than 50% of their patients with OMT, and nearly one third used OMT on less than 5% of their patients. A progressive de-emphasis of OMT use correlated with more recent graduation from osteopathic medical colleges. Thirty-eight percent of the variance regarding OMT use was attributed to two factors: barriers to use, and OMT protocol used. Perceptions by physicians of insufficient OMT training were not predictive of decreased use of OMT. Significantly more OMT was used in solo practice as opposed to other settings. The results present a wake-up call for the osteopathic medical profession. The profession must strive to remove barriers that preclude OMT use by justifying to policymakers, health professionals, and the public the cost-benefits of OMT in holistic healthcare.

Osteopathic manipulative treatment: student attitudes before and after intensive clinical exposure.

It is widely known that family practice osteopathic physicians actively use osteopathic manipulative treatment (OMT) as a part of their everyday practices, but many DOs in other specialty areas fail to use OMT at all. Physicians who use this modality often limit its use to musculoskeletal complaints. This pattern likely begins during undergraduate training at the time that OMT is taught. To warm student attitudes to OMT and provide a more integrated OMT training background, the University of North Texas Health Science Center at Fort Worth/Texas College of Osteopathic Medicine has added to the clinical curriculum a required 1-month rotation in manipulative medicine. With the rotation in place for a full academic year, it was important to determine the efficacy of the rotation curriculum. This assessment has been accomplished using a specialized protocol designed to gauge student attitudes and opinions regarding OMT, osteopathic medicine, and their own OMT skills.

Preliminary findings on the use of osteopathic manipulative treatment by osteopathic physicians.

The literature suggests that the extent to which osteopathic physicians actually use osteopathic manipulative treatment (OMT) and the factors that predict the use of OMT remain virtually unexplored. A mailed survey of practicing osteopathic physicians was used to query respondents about their use of OMT and about the effects of a number of factors on use of OMT. The survey showed that 71% of 100 practicing physicians used OMT with 5% or more of their patients, and 14% in 50% or more of their patients. Multivariate statistical procedures revealed that a physician's having learned a new OMT format since graduation from medical school was the primary predictor of the use of OMT, followed by interest in OMT during internship. The other predictor was whether the respondent had a family member who was also a DO. Physician's specialty, emphasis on OMT during graduate and postgraduate training, and the era during which DOs received their training were not significant predictors of OMT use. These results indicate a need for further research on OMT use and the variables examined in this study.

Manual therapy: a critical assessment of role in the profession of physical therapy.

Interest in manual therapy appears to continue to grow among physical therapy clinicians and educators throughout the world even though the underlying concepts and techniques have not been justified by a knowledge base. The purposes of this article are to critically assess the role of manual therapy within the physical therapy profession and to provide an introduction to the other articles in this special issue. Eisner's model of explicit, implicit, and null curricula is used as a framework for our analysis and our discussion of manual therapy. The explicit area of manual therapy includes discussions of the definition and the role of manual therapy, the scientific rationale for manual therapy, and manual therapy in education and a comparison of manual therapy evaluative frameworks. The implicit area deals with the role of clinical decision making and critical thinking in manual therapy in education and rehabilitation. In the null (unaddressed) area of manual therapy, we suggest directions for future development and research.