Empathy and Osteopathic Manipulative Medicine: Is It All in the Hands?

CONTEXT: The osteopathic medical school curriculum is unique because of the inclusion of training in osteopathic manipulative medicine (OMM). Interest in and use of OMM promotes cognitive training in diagnosing conditions, emotional training in the alleviation of pain, and physical training in the application of OMM. Osteopathic manipulative medicine may mitigate a reduction in empathy levels of medical students and explain why osteopathic medical students do not follow the declining pattern of empathy previously reported in allopathic medical students. OBJECTIVE: To examine whether favorable opinions of OMM are positively correlated with overall student empathy as well as the cognitive, emotional, and behavioral subcomponents of empathy. METHODS: Institutional review board approval was obtained to measure empathy in medical students attending the Midwestern University/Chicago College of Osteopathic Medicine for this cross-sectional study. The 20-item Jefferson Scale of Empathy medical student version (JSE-S) was distributed via email to first-year students at the beginning of the 2016-2017 academic year and at the end of the academic year to all students. Items were divided into cognitive, emotional, and behavioral categories. Items related to demographics, interest and use of OMM and the osteopathic philosophy, frequency of touch, and personality were also included in the survey. Data were analyzed using SPSS software and presented as mean (SEM). Statistical significance was set at P<.05. RESULTS: Of the 801 students the survey was sent to at the end of the 2016-2017 academic year, 598 students completed the survey, for a response rate of 75%. When accounting for the effect of gender with a multivariate analysis of covariance, there were no differences in empathy scores across school years. When empathy scores from first- and second-year students were combined and compared with combined third- and fourth-year students' scores to examine the difference between empathy in students during academic and clinical training, a difference in the mean (SEM) JSE-S empathy score was noted (114.6 [0.7] and 112.0 [0.7], respectively; P=.01); however, the effect size was small (partial η2=0.01). Interest in OMM and the osteopathic philosophy were significantly associated with higher empathy scores (P<.05; medium effect; partial η2=0.08). CONCLUSION: Interest in and use of OMM are associated with higher empathy scores and empathy subcomponents. Training and use of OMM should be examined as a mechanism contributing to the durability of empathy in the osteopathic medical profession.

Does Osteopathic Manipulative Treatment Make a Neuropsychological Difference in Adults With Pain? A Rationale for a New Approach.

Cognitive impairment is common in patients with pain. While symptoms of pain are effectively treated with osteopathic manipulative treatment (OMT), the cognitive complaint is vastly ignored. Pain-induced cognitive dysfunction can be severe and is particularly apparent in working memory and attention. There is good reason to expect cognitive responsiveness to OMT. Previous research has reported the effects of OMT on related psychiatric outcomes, including relief from depression and anxiety, suggesting that OMT may produce more cortical benefits than is currently thought. The rationale to link OMT to cognition comes from the tenets of osteopathic medicine: body unity, homeostasis, and the structure-function relationship. The present article provides background evidence to support the hypothetical link between OMT and cognitive benefits and proposes a physiological mechanism of how OMT could exert its effect on cognition. Research strategies are discussed to test the hypotheses that are generated from the proposed theoretical framework.

Cognitive training in the elderly: a randomized trial to evaluate the efficacy of a self-administered cognitive training program.

OBJECTIVES: To evaluate the efficacy of a self-administered cognitive training program for improving cognition in normal elderly persons. METHOD: A multisite, randomized control, double-blind trial was conducted with 28 experimental participants (Mage = 70.7 ± 8.89) and 28 active controls (Mage = 74.4 ± 9.39). Treatment conditions: experimental intervention (EI) consisted of three modules: (1) executive functioning, (2) memory, and (3) emotion training. Active control (AC) consisted of word searches, reading short stories, and answering multiple-choice questions. Treatments were self-administered one hour/five days a week for four weeks. Pre-and post-training neuropsychological outcome measures were utilized as determinants of program success. RESULTS: Compared to the AC group, the EI group displayed significant gains on targeted executive (p = .002) and memory (p < .001) composites, but not the emotion (p = .105) composite. Training-induced benefits were also observed for the EI group on untrained items within global cognition (BCRS, p = .002) and functional abilities (DAD, p < .001; FRS, p = .042). The percentage of participants who showed reliable performance improvements was greater for the EI than AC on executive (55.5% vs. 12.5%), memory (55% vs. 19.5%) and functional (41% vs. 7.5%) ability. Participant recruitment and compliance rates were enhanced by the involvement of a physician. CONCLUSION: Results support the efficacy of self-directed cognitive training in reliably improving cognitive and functional abilities in normal older adults. While physicians are critical in enhancing the delivery of regimented treatment, the present study illustrates the potential for self-directed prophylactic training in deterring the development of cognitive decline.

Cognitive, Behavioral and Emotional Empathy in Pharmacy Students: Targeting Programs for Curriculum Modification.

INTRODUCTION: Empathy is an essential trait for pharmacists and is recognized as a core competency that can be developed in the classroom. There is a growing body of data regarding levels of empathy in pharmacy students; however, these studies have not measured differences in behavioral, cognitive, and emotional empathy. The goal of this study was to parse the underlying components of empathy and correlate them to psychosocial attributes, with the overall goal of identifying curriculum modifications to enhance levels of empathy in pharmacy students. METHODS: IRB approval was obtained to measure empathy levels in pharmacy students attending Midwestern University. An online, anonymous survey administered through a secure website (REDCap) was used. This survey utilized the Jefferson Scale of Empathy (Medical Student version) and included questions regarding demographics and personality traits. Empathy questions were sub-divided into behavioral, cognitive, and emotional categories. Data are presented as mean ± SEM with significance set at P ≤ 0.05. RESULTS: Three hundred and four pharmacy students at Midwestern University participated in a fall survey with an overall response rate of 37%. The average empathy score was 110.4 ± 0.8 on a scale of 20-140; which is comparable to empathy scores found by Fjortoft et al. (2011) and Van Winkle et al. (2012b). Validating prior research, females scored significantly higher than males in empathy as well as behavioral, cognitive, and emotional subcomponents. For the entire population, emotional empathy was significantly higher than cognitive and behavioral empathy (P < 0.05). Furthermore, negative correlations to empathy were observed for self-serving behavior (R D 0.490, P < 0.001), medical authoritarianism (R D 0.428, P < 0.001), and experience of coercion (R D 0.344, P < 0.001). CONCLUSION: Overall, empathy levels in pharmacy students are similar to prior studies with females scoring higher than males. Emotional empathy may play a greater role than cognitive and behavioral empathy in this group of students. Targeted programs that promote volunteerism and activities that foster responsiveness to patient needs may attenuate self-serving behavior and medical authoritarianism and, therefore, improve empathy levels in pharmacy students.

Brain training: rationale, methods, and pilot data for a specific visuomotor/visuospatial activity program to change progressive cognitive decline.

INTRODUCTION: Research in the field of the aging brain has evolved to the extent that it is now commonly understood that actively engaging in cognitive tasks provides the potential of being beneficial in affecting the trajectory of age-related cognitive decline. What remains to be examined is the extent, and type, of program required to effect change in aging cognitively impaired individuals. METHODS: To address this issue, a cognitive program focusing on the use of visuospatial (VS)/visuomotor (VM) elements was applied to a group of six older individuals with identified progressive cognitive impairments. It was hypothesized that using tasks with VS and VM components may be beneficial in supporting overall brain performance, and subsequently assist individuals to perform well in various cognitive and behavioral tasks. RESULTS: Results showed that on many evaluative measures individuals remained stable, or improved in performance with medium-to-large effect sizes (e.g., 0.3-1.0). Thus, in a cognitively impaired population sample where decline would be the norm, our participants improved or remained stable. CONCLUSION: The novel application of a VS/VM training program shows promise in addressing global cognitive decline, by targeting a brain area susceptible to early disruptions and providing it with additional and ongoing stimulative tasks in an effort to bolster its functioning and subsequently overall brain functioning.

True functional ability of chronic stroke patients.

BACKGROUND: There is a paucity of information regarding visuospatial (VS) and visuomotor (VM) task performance in patients with chronic right fronto-parietal lobe stroke, as the majority of knowledge to date in this realm has been gleaned from acute stroke patients. The goal of this paper is to determine how VS and VM performance in chronic stroke patients compare to the performance of healthy participants. METHODS: Nine patients with stroke involving the right fronto-parietal region were evaluated against match controls on neuropsychological tests and a computerized visuomotor assessment task. RESULTS: Initial evaluation indicated that performance between participant groups were relatively similar on all measures. However, an in-depth analysis of variability revealed observable differences between participant groups. In addition, large effect sizes were also observed supporting the theory that using only conventional examination (e.g., p-values) measures may result in miss-identifying crucial stroke-related differences. CONCLUSION: Through conventional evaluation methods it would appear that the chronic stroke participants had made significant functional gains relatively to a control group many years post-stroke. It was shown that the type of evaluation used is essential to identifying group differences. Thus, supplementary methods of evaluation are required to unmask the true functional ability of individuals many years post-stroke.