Epistemological Flexibility in Person-Centered Care: The Cynefin Framework for (Re)Integrating Indigenous Body Representations in Manual Therapy.

BACKGROUND: Chiropractic, osteopathy, and physiotherapy (COP) professionals regulated outside the United States traditionally incorporate hands-on procedures aligned with their historical principles to guide patient care. However, some authors in COP research advocate a pan-professional, evidence-informed, patient-centered approach to musculoskeletal care, emphasizing hands-off management of patients through education and exercise therapy. The extent to which non-Western sociocultural beliefs about body representations in health and disease, including Indigenous beliefs, could influence the patient-practitioner dyad and affect the interpretation of pillars of evidence-informed practice, such as patient-centered care and patient expectations, remains unknown. METHODS: our perspective paper combines the best available evidence with expert insights and unique viewpoints to address gaps in the scientific literature and inform an interdisciplinary readership. RESULTS: A COP pan-professional approach tends to marginalize approaches, such as prevention-oriented clinical scenarios traditionally advocated by osteopathic practitioners for patients with non-Western sociocultural health assumptions. The Cynefin framework was introduced as a decision-making tool to aid clinicians in managing complex clinical scenarios and promoting evidence-informed, patient-centered, and culturally sensitive care. CONCLUSION: Epistemological flexibility is historically rooted in osteopathic care, due to his Indigenous roots. It is imperative to reintroduce conceptual and operative clinical frameworks that better address contemporary health needs, promote inclusion and equality in healthcare, and enhance the quality of manual therapy services beyond COP's Western-centered perspective.

Functional Neuromyofascial Activity: Interprofessional Assessment to Inform Person-Centered Participative Care-An Osteopathic Perspective.

Introduction: Health professionals and bodyworkers may be pivotal in promoting prevention programs, providing tailored advice and guidance to patients' adherence to self-care strategies, such as physical activity. Contemporary evidence encourages manual therapists to involve patients in decision-making and treatment procedures integrating passive and active approaches in treatment planning. This manuscript provides a definition and applications of neuromyofascial movement patterns, discusses the significance of functional assessment, and gives an example of clinical applications in the osteopathic field to highlight how this assessment can promote interdisciplinarity. Methods: The reporting framework used in the current manuscript followed guidelines for writing a commentary. Results: The manuscript highlights the crucial role that the neuromyofascial system plays in human movement and overall well-being and the importance of a functional neuromyofascial activity assessment in the context of person-centered participative care. Conclusions: Understanding individual neuromyofascial patterns could help healthcare practitioners, movement specialists, and bodyworkers in tailoring treatment plans, meeting patients' unique needs, and promoting a more effective personalized approach to care. The current perspective could spark debates within the professional community and provide a research roadmap for developing an evidence-informed interprofessional framework.

Osteopathic structure/function models renovation for a person-centered approach: a narrative review and integrative hypothesis.

OBJECTIVES: The construct of the osteopathic structure-function models is reported as a cornerstone of clinical reasoning and treatment processes. Nevertheless, there are no shared procedures described for their use in clinical practice. The present narrative review aims to analyze a more comprehensive perspective on the phenomenon. METHODS: A structured narrative review was conducted. A database search was conducted using Pubmed, ScienceDirect, and Google Scholar. Peer-reviewed papers without specifying limits on dates and design were included. RESULTS: Twenty-five findings were reported and grouped into two main themes: 1) Debate on models and theoretical frameworks for osteopathic care; 2) Clinical reasoning and decision-making process in the osteopathic field. CONCLUSIONS: An integrated osteopathic care approach based on the structure/function models represents a starting point to establish a shared osteopathic diagnostic and clinical reasoning and an evidence-informed practice promoting health in an interdisciplinary person-centered care process. The present review highlights the limited amount of literature on using osteopathic conceptual models in decision-making and treatment strategies. A research plan is required to develop a common framework for an evidence-based osteopathic practice that promotes well-being in an interdisciplinary person-centered care process.

Patient Active Approaches in Osteopathic Practice: A Scoping Review.

BACKGROUND: In the field of manual therapies there is a growing interest in moving from passive hands-on approaches to patient active approaches. In the osteopathic field there are both active and passive methods described as integrated in the process of care. However, this prospective linkage has not been formally explored and is not well shared in the community of practice. The present review aims to appraise the relevant literature on the functioning and principles of Patient active osteopathic approaches (PAOAs) and explore a prospective model for selecting the different types of PAOA, highlighting their integration into patient management strategies. METHODS: A scoping review was conducted to analyze the relevant literature on the functioning and the different principles of PAOA and to obtain a comprehensive perspective on the phenomenon. RESULTS: The eligible articles provide insights into the mechanisms of functioning and principles of application of active approaches to be integrated with hands-on approaches. These results provide new insights into the relevance of PAOA to clinical practice. CONCLUSIONS: The proposal, emerging from the review, may promote discussions in the community of practice and provide a road map for research towards achieving an evidence-based structure for PAOA.

A Content Analysis of Osteopaths' Attitudes for a More Inclusive Clinical Practice towards Transgender People.

OBJECTIVES: The aim of this qualitative study was to explore the attitudes, beliefs, and preferences of Italian osteopaths regarding the management of transgender patients through a content analysis of emergent data from semi-structured interviews. METHODS: This study was a content analysis based on the Standards for Reporting Qualitative Research guidelines. Purposive sampling of 10 Italian osteopaths was applied. Data were collected through semi-structured interviews, from March to April 2021, and subsequently transcribed verbatim with the content analysis carried out as an iterative process. RESULTS: One participant was excluded during the first interview due to them being unsuitable for this study. Data saturation was reached after two interviews with the remaining nine participants. Data analysis revealed four main themes: microaggressions, acceptance and non-judgement, person-centered treatment, and education implementation. CONCLUSIONS: This study presents cisgender Italian osteopaths' attitudes in the care of transgender people, revealing the desire to embrace and apply osteopathic tenets regardless of the patient's gender identity.

Historical Osteopathic Principles and Practices in Contemporary Care: An Anthropological Perspective to Foster Evidence-Informed and Culturally Sensitive Patient-Centered Care: A Commentary.

Historical osteopathic principles and practices (OPP)-considering the patient as a dynamic interaction of the body, mind, and spirit and incorporating the body's self-healing ability into care-are inherited from traditional/complementary and alternative (CAM) principles. Both concepts are familiar to contemporary osteopathic practitioners, but their incorporation into healthcare for evidence-informed, patient-centered care (PCC) remains unclear. Further, a polarity exists in the osteopathic profession between a 'traditional-minded' group following historical OPP despite evidence against those models and an 'evidence-minded' group following the current available evidence for common patient complaints. By shifting professional practices towards evidence-based practices for manual therapy in line with the Western dominant biomedical paradigm, the latter group is challenging the osteopathic professional identity. To alleviate this polarity, we would like to refocus on patient values and expectations, highlighting cultural diversity from an anthropological perspective. Increasing an awareness of diverse sociocultural health assumptions may foster culturally sensitive PCC, especially when including non-Western sociocultural belief systems of health into that person-centered care. Therefore, the current medical anthropological perspective on the legacy of traditional/CAM principles in historical OPP is offered to advance the osteopathic profession by promoting ethical, culturally sensitive, and evidence-informed PCC in a Western secular environment. Such inclusive approaches are likely to meet patients' values and expectations, whether informed by Western or non-Western sociocultural beliefs, and improve their satisfaction and clinical outcomes.

Osteopathic manipulative treatment and the Spanish flu: a historical literature review.

Context: The Spanish flu pandemic of 1918 was approached with a variety of management techniques available at that time, including osteopathic care in addition to standard medical care. Objective: To analyze the osteopathic manipulative treatment (OMT) techniques used for the management of patients affected by the Spanish flu according to four themes: the principles and procedures used, frequency and length of OMT, reported side effects, and advice for patients. Methods: A structured review of the literature was performed by hand-searching texts at the Museum of Osteopathic Medicine International Center for Osteopathic History in Kirksville, Missouri, and online via PubMed (National Library of Medicine), ScienceDirect (Elsevier), and Google Scholar (Google, Inc). The literature search was carried out between February and March 2020. Three keywords were selected from the medical subject headings database of the National Library of Medicine: manipulation, osteopathic; influenza pandemic, 1918-1919; epidemics. Articles were then reviewed for relevance by screening for articles published between 1900 and 1940 that contained at least 1 of the following keywords in their title: Spanish influenza, flu, epidemic, grippe, pneumonia, or osteopathic management/treatment. All articles that provided information about OMT and advice met the inclusion criteria. Articles that did not report descriptions of manipulative intervention were excluded. Results: Our search yielded 63 articles: 23 from the hand-search and 40 from the electronic search. No electronic source was selected for the review because none met inclusion criteria. A total of 16 articles from the hand-searched set met inclusion criteria and were analyzed according to the four main themes stated in the objective. The range of OMT approaches reported to be administered to patients with Spanish flu suggests that early osteopathic physicians treated patients with this disease using OMT in addition to offering advice on healthy lifestyle behaviors. Conclusion: Conclusions from this study are limited by the historical and descriptive nature of the data gathered, which lacked the rigor of modern-day scientific studies. However, this review could lead to future research inquiries on the effectiveness of these approaches. Osteopathic physicians and osteopaths should embrace their historical osteopathic heritage by continuing the work of our predecessors and combining their hands-on experience and osteopathic principles with modern medical treatment and rigorous scientific standards.

Thematic Analysis of Attitudes Held by a Group of Italian Osteopaths Toward Osteopathic Evaluation, Treatment, and Management in the Neonatal and Pediatric Field: A Qualitative Study.

OBJECTIVE: The purpose of this study was to investigate the attitudes held by a group of Italian osteopaths toward osteopathic evaluation, treatment, and management in the neonatal and pediatric field. METHODS: A thematic analysis with elements of grounded-theory approaches was used. Purposive sampling was used to recruit expert osteopaths in the neonatal and pediatric field. Data were gathered from July 2017 to January 2018 by individual semistructured interviews and transcribed verbatim. A thematic analysis of the data was then performed. The Consolidated Criteria for Reporting Qualitative Research checklist was used to structure the design of this qualitative study. RESULTS: Eight osteopaths participated. Data analysis generated 3 main themes: the role of the osteopath in the collaborative process of care, osteopathic diagnostic-clinical reasoning in the neonatal and pediatric field, and osteopathic treatment in the neonatal and pediatric field. CONCLUSION: The present study highlights that Italian osteopaths may prefer interprofessional and integrative activities aimed at supporting adaptive capacity and resilience for pediatric patients.

The role of touch in osteopathic practice: A narrative review and integrative hypothesis.

INTRODUCTION: Osteopathy relies on a touch-based approach to promote health. This narrative review aims to analyze the role of touch in clinical osteopathic practice. METHODS: A database search was conducted using MEDLINE, EMBASE, PEDro and Google Scholar. Peer-reviewed papers without specifying limits on dates and design were included. RESULTS: 47 articles met the inclusion criteria and were used to elucidate two main themes: Biological and psychological effects of touch; Touch in the context of osteopathic clinical reasoning. DISCUSSION: Touch is one of the tools to achieve a collaborative interaction with the patient, to substantiate clinical information, and to detect somatic dysfunctions: neuro-myofascial active areas that might act as an osteopath-patient interface to transmit the biological and physiological effects of touch. CONCLUSION: The findings of the review support a shared decision-making process, in which touch is one of the osteopath-patient dyad 's leading communication tools to develop a tailor-made osteopathic approach.

Cynefin Framework for Evidence-Informed Clinical Reasoning and Decision-Making.

Osteopathy (manipulative care provided by foreign-trained osteopaths) emphasizes manual techniques as the cornerstone of patient care. Although osteopathic medicine has been well integrated into traditional health care systems in the United States, little is known about the role of osteopathy in traditional health care systems outside the United States. Therefore, it is incumbent on the osteopathy community to gather evidence in order to practice scientifically informed effective methods. This narrative review outlines the Cynefin framework for clinical reasoning and decision-making and encourages a broadening of the evidence base among osteopaths to promote health in an interdisciplinary care setting. This review also presents the concept of an osteopath's mindline, in which the osteopath combines information from a range of sources into internalized and collectively reinforced tacit guidelines.

[Ankle-brachial index: which clinical use?]. / Indice caviglia-braccio: quale utilizzo clinico?

The ankle-brachial index (ABI) obtained by the ankle/brachial blood pressure ratio is the gold standard for the diagnosis of peripheral arterial disease (PAD): ≤0.9 is the cut-off value for PAD diagnosis and ≤0.4 for the diagnosis of acute or chronic critical limb ischemia. Recently, the ABI has been proposed as an independent marker of cardiovascular (CV) risk, but its role remains debated. According to some authors, ABI improves CV risk scoring when added to traditional scores, such as the Framingham risk score, in both primary and secondary prevention: an ABI of ≤0.9 or ≥1.4 can allow for the selection of a subset of patients at high CV risk even if asymptomatic. On the contrary, others reported that ABI does not always improve CV risk scoring and, most importantly, optimization of therapy does not result in reduced rates of CV events. Side effects due to aggressive therapy were found to be more clinically relevant than the advantages deriving from a better control of CV risk. This review was aimed at defining the role of ABI as the gold standard for PAD screening and diagnosis, and as an independent early marker of CV risk, namely of coronary risk, taking into account the pros and cons reported in the literature.