Talk:Osteopathic manipulation

message: Merge it.Donaldal 18:20, 19 May 2006 (UTC)
thread_title: Untitled

message: OMM its its own treatment modality, like "radiation therapy" or "acupuncture."  What would you merge it with? Touro OsteopathicFreak T  03:50, 26 July 2007 (UTC)
thread_title:  Merge it with what? 

message: Traditionally, OMM has stood for "osteopathic manipulative medicine." However, it is becoming more fashionable by some institutions (my own, Des Moines University, being one of them) to begin referring to it as "Osteopathic MANUAL medicine," merely to avoid the connotations associated with the word "manipulative." A simple Google search of the term should demonstrate its prevalence. I would like to propose that this term supplant the old term in this article, if anyone else would agree to its usefulness?  —Preceding unsigned comment added by 71.61.204.168 (talk) 05:59, 25 May 2010 (UTC)
replies: text: Is the new term used in reliable sources? Alexbrn talk|contribs|COI 01:43, 8 February 2014 (UTC)
replies: text: The terms I see most commonly used in the literature (in no specific order) are osteopathic manipulative treatment (OMT), osteopathic manipulative medicine (OMM), osteopathic manual treatment (OMT again). I haven't really seen osteopathic manual medicine in the literature. If someone can find examples, let me know. TylerDurden8823 (talk) 01:52, 8 February 2014 (UTC)
thread_title:  The name for OMM 

message: As an allopathic medical student who is not well-versed in this discipline, I am curious to see how much of OMM is backed up by randomized clinical trials and other solid evidence.  Can anyone provide some content on specifics of therapy and what has been demonstrated to work vs. sham OMM as a control? Bobsagat (talk) 20:07, 30 March 2011 (UTC)
thread_title:  Scientific evidence for usefulness 

message: Myofascial release isn't limited to D.O. practitioners. Hands-on Physiatrist MDs proably utilize the technique and I know for sure that Physical Therapists do. Since it isn't limited to DOs, why is mentioned here with no reference to other, non-DO practitioners? What techniques ARE limited to DOs? Yours, Wordreader (talk) 21:09, 19 November 2011 (UTC)
replies: text: Feel free to reference it. It says in the section heading that many of these techniques are used by other disciplines as well. Kerowyn  Leave a note  00:30, 22 November 2011 (UTC)
thread_title:  myofascial release 

message: There are far more OMM techniques than the ones currently explained on this page. More of them should be added with accurate citations to make this article more complete.  — Preceding unsigned comment added by DoctorK88 (talk • contribs) 06:39, 9 January 2012 (UTC)
thread_title:  More OMM Techniques 

message: A section that briefly explains when OMM/OMT techniques are not indicated would be a useful addition to this article and would make it more complete. TylerDurden8823 (talk) 06:03, 14 March 2012 (UTC)
thread_title:  OMM Contraindications 

message: I would like to hear from others if they think the section heading currently labeled as effectiveness is better that way or if research was a better section heading. Please weigh in, thanks. Alex, I already know where you stand on this issue obviously since it was your edit. It's definitely okay if you want to add your opinion, but I'm curious to hear from others. TylerDurden8823 (talk) 06:19, 7 February 2014 (UTC)
replies: text: MOS:MED suggests we use a "Research" heading for research that is being done. Alexbrn talk|contribs|COI 06:26, 7 February 2014 (UTC)
replies: text: This is an actively researched topic if that's what you mean. TylerDurden8823 (talk) 06:35, 7 February 2014 (UTC)
replies: text: If there's "important work going on" we could mention it in a research section. Is there? Alexbrn talk|contribs|COI 06:36, 7 February 2014 (UTC)
replies: text: I don't know about every single research project on the topic of OMM. All I know is that it is still being actively researched. We do see new reviews and original research emerging about it all the time. If that's not what you mean, then I am unclear on what you are trying to say. What do you mean exactly when you say "important work"? TylerDurden8823 (talk) 01:31, 8 February 2014 (UTC)
replies: text: "Is anything important being done?" is some wording from MOS:MED. I guess it would refer to research that is important enough that it gets coverage in secondary RS: if some major trial was underway which the world was waiting on, maybe? Looking at some GAs and FAs it seems this kind of "Research" section is rare. Alexbrn talk|contribs|COI 01:58, 8 February 2014 (UTC)
replies: text: Seems ill-defined to me. New reviews for OMM will probably be out soon, but I can't quote you when that will happen. I'd still like to hear what other people have to say (if anything) about the change of the titling from research to effectiveness, but it's not a major point. TylerDurden8823 (talk) 02:01, 8 February 2014 (UTC)
thread_title:  Section titling 

message: Added Template:dubious to sentence in lede  "(OMM)...is the core technique of osteopathic medicine."  This is certainly not the whole truth, since North American DO's study (in addition to OMM) the exact same things as MD's & have same scope of practice in all 50 states.  We can't just rely on the one source given; that's highly misleading and a bit POINT-y. --Middle 8 (leave me alone • talk to me • COI) 23:00, 20 February 2014 (UTC)
replies: text: I agree that this statement is dubious.  "Osteopathic medicine" usually refers specifically to DO physicians who are trained in the USA.  While DO physicians certainly all learn OMM, the majority do not use it in practice.  OMM is not the core of osteopathic medicine.  Rytyho usa (talk) 03:57, 21 February 2014 (UTC)
replies: text: It does not say it is the core technique used by DOs but that it is the core technique of "osteopathic medicine", and is sourced to an article in NEJM (=topmost journal) which has been praised both by altmed and mainstream commentators. It's true DOs use techniques from mainstream medicine too, but that's beside the point. Alexbrn talk|contribs|COI 08:03, 21 February 2014 (UTC)
replies: text: Alex, don't remove  the tag while there's discussion going on.  Osteopathic medicine in the US = medicine + OMM. --Middle 8 (leave me alone • talk to me • COI) 20:31, 21 February 2014 (UTC)
replies: text: Unsourced, US-centric assertions from an osteopathic POV, contradicting the strong RS we are using. Drive-by tagging at its worst. And now you're edit-warring to boot. Alexbrn talk|contribs|COI 20:35, 21 February 2014 (UTC)
replies: text: No, you were wrong to remove the tag, and what we need to do is keep it and discuss how to proceed.  I'm not arguing US-centrically, I'm saying that speaking too globally and ignoring the US is wrong.  It's a fact that in the US, DO = MD + OMM.  Full stop.  Given that, all we have to do is add sources along those lines and modify the wording of the lede to accomodate all the sources.  What's the big deal? --Middle 8 (leave me alone • talk to me • COI) 21:41, 21 February 2014 (UTC)
replies: text: Hmmm, a bit of a problematic behaviour pattern forming: attacking well-sourced content as POV. Similar to the case currently at WP:AN ... Alexbrn talk|contribs|COI 21:49, 21 February 2014 (UTC)
replies: text: Who said the source was POV?  Per Template:Dubious: "Add  after a specific statement or alleged fact which is sourced but which nevertheless seems dubious or unlikely. Most commonly, this involves uncertainty regarding the veracity or accuracy of the given source, or of an editor's interpretation of that source."  My concern being the latter, and shared by .  Seems like the right template to use under the circumstances.  It doesn't improve the encyclopedia to remove it.  If you have WP:BOOMERANG issues re the QG RfC/U, don't act them out in article and article talkspace.  --Middle 8 (leave me alone • talk to me • COI) 23:33, 21 February 2014 (UTC)

text: Certainly an improvement, thanks.  --Middle 8 (leave me alone • talk to me • COI) 05:41, 22 February 2014 (UTC)
thread_title: Dubious

message: INTRO
_________
"Research into OMM has generally not found it to be an effective therapy.[3][4][5] Some critics have characterized it as pseudoscience.[6][7][8]"
?Research into OMM has generally not been able to prove with certainty whether or not it is an effective therapy since it is very difficult to study manual therapies. Some research studies have found OMM to be effective while others have not. Some critics have characterized it as pseudoscience but OMM has many advocates in the medical community"
The old text is very misleading. Research hasn't generally found it to be an effective therapy but it also has not proved it to be an ineffective therapy. This is a technicality in the way scientific reviews are written and the wording of the original text will lead visitors to believe that OMM is ineffective. The new text is a much more accurate way of descriving the current state of the research. This can be verified at http://www.med.nyu.edu/content?ChunkIID=37409#evidence.
EFFECTIVENESS
____________
Added this additional research information on OMM. The original text includes only studies that are outdated and only one view of a topic with two sides.
"In a study of 183 people with neck pain, use of osteopathic methods provided greater benefits than standard physical therapy or general medical care. Participants receiving OMT showed faster recovery and experienced fewer days off work. OMT appeared to be less expensive overall than the other two approaches; however, researchers strictly limited the allowed OMT sessions, making direct cost comparisons questionable. Another study evaluated a rather ambitious combined therapy for the treatment of chronic pain resulting from whiplash injury (craniosacral therapy along with Rosen Bodywork and Gestalt psychotherapy). The results failed to find this assembly of treatments more effective than no treatment. Korthals-de Bos IB, Hoving JL, van Tulder MW, et al. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial [electronic version]. BMJ . 2003;326:911.Ventegodt S, Merrick J, Andersen NJ, et al. A Combination of Gestalt Therapy, Rosen Body Work, and Cranio Sacral Therapy did not help in Chronic Whiplash-Associated Disorders (WAD) - Results of a Randomized Clinical Trial. ScientificWorldJournal . 2005;4:1055-1068. 
In a 14-week, single-blind study of 29 elderly people with shoulder pain, real OMT proved more effective than placebo OMT. Although participants in both groups improved, those in the treated group showed relatively greater increase in range of motion in the shoulder. And, in a larger study of 150 adults with shoulder complaints, researchers found that adding manipulative therapy to usual care improved shoulder and neck pain at 12 weeks. Bergman GJ, Winters JC, Groenier KH, et al. Manipulative therapy in addition to usual care for patients with shoulder complaints: results of physical examination outcomes in a randomized controlled trial. J Manipulative Physiol Ther. 2010 Feb;33(2):96. 
In a small randomized, placebo-controlled trial researchers used oscillating-energy manual therapy, an osteopathic technique based on the principle of craniosacral therapy, to treat 23 subjects with chronic tendonitis of the elbow (tennis elbow or lateral epicondylitis). Subjects in the treatment group showed significant improvement in grip strength, pain intensity, function, and activity limitation due to pain. These results however, are limited by the small size of the study and the fact that the therapist delivering the treatment could not be blinded.Nourbakhsh MR, Fearon FJ. The effect of oscillating-energy manual therapy on lateral epicondylitis: a randomized, placebo-control, double-blinded study. J Hand Ther. 2008;21:4-14. 
Twenty-four women with fibromyalgia were divided into five groups: standard care, standard care plus OMT, standard care plus an educational approach, standard care plus moist heat, and standard care plus moist heat and OMT. The results indicate that OMT plus standard care is better than standard care alone, and that OMT is more effective than less specific treatments, such as moist heat or general education. However, because this was not a blinded study (participants knew which group they were in), the results can’t be taken as reliable. In another study, 93 women (average age 53) with fibromyalgia were randomized to receive sham treatment or craniosacral therapy (one-hour sessions twice a week for 20 weeks). The women in the craniosacral therapy group experienced a decrease in pain at 20 weeks, which persisted for at least one year. In another randomized trial, 94 people with fibromyalgia received either myofascial release or sham therapy for 40 sessions (20 weeks). 21 At the 6-month follow-up, the people in the treatment group reported less pain and more physical ability. But, only some of these results lasted until the 1-year follow-up. Castro-Sánchez AM, Matarán-Peñarrocha GA, Sánchez-Labraca N, et al. A randomized controlled trial investigating the effects of craniosacral therapy on pain and heart rate variability in fibromyalgia patients. Clin Rehabil. 2011;25(1):25-35.
A study of 28 people with tension headaches compared one session of OMT against two forms of sham treatment and found evidence that real treatment provided a greater improvement in headache pain. A small randomized controlled trial with 63 patients compared two myofascial release techniques to a control group. Myofascial release treatments resulted in fewer headaches for the 4-week trial period compared to the control group.Hoyt WH, Shaffer F, Bard DA, et al. Osteopathic manipulation in the treatment of muscle-contraction headache. J Am Osteopath Assoc . 1979;78:322-325. Ajimsha MS. Effectiveness of direct vs indirect technique myofascial release in the management of tension-type headache. J Bodyw Mov Ther 2011 Oct;15(4):431. 
OMT has shown some promise for the treatment of back pain, including a randomized trial of 455 patients. The trial assessed the effects of 6 OMT sessions over 8 weeks compared to sham treatments. At 12 weeks, OMT was associated with moderate or substantial pain reduction compared to sham OMT. OMT also reduced the use of prescription pain medications. However, one of the best-designed trials failed to find it a superior alternative to conventional medical care. In this 12-week study of 178 people, OMT proved no more effective than standard treatment for back pain.6 Another study, this one enrolling 199 people and following them for 6 months, failed to find OMT more effective than fake OMT. This study also included a no-treatment group; both real and fake OMT were more effective than no treatment. A much smaller study reportedly found that muscle energy technique enhances recovery from back pain, but this study does not appear to have used a meaningful placebo treatment.Andersson GBJ, Lucente T, Davis AM, et al. A comparison of osteopathic spinal manipulation with standard care for patients with low back pain. N Engl J Med . 1999;341:1426-1431. Ramos-González E, Moreno-Lorenzo C, et al. Comparative study on the effectiveness of myofascial release manual therapy and physical therapy for venous insufficiency in postmenopausal women. Complement Ther Med. 2012 Oct;20(5):291-298.Licciardone JC, Stoll ST, Fulda KG, et al. Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial. Spine . 2003;28:1355-1362. 
Researchers analyzed 4 studies investigating the benefits of manual therapy (including massage therapy, joint mobilization, and manipulation) for osteoarthritis of the hip or knee. The results were inconclusive. Although one of the studies (involving 68 people) did find that massage therapy helped to improve pain and function, it was compared to no intervention rather than another treatment or a placebo. French HP, Brennan A, White B, Cusack T. Manual therapy for osteoarthritis of the hip or knee - a systematic review. Man Ther. 2011;16(2):109-17
Some studies have evaluated the potential benefits of OMT for speeding healing in people recovering from surgery or serious illness. The best of these studies compared OMT against light touch in 58 elderly people hospitalized for pneumonia. The results indicate that use of osteopathy aided recovery.  Noll DR, Shores JH, Gamber RG, et al. Benefits of osteopathic manipulative treatment for hospitalized elderly patients with pneumonia. J Am Osteopath Assoc . 2000;100:776-782. 
OMT showed improvement in 6-minute walk test distance in a small randomized trial of 20 patients with stable chronic obstructive pulmonary disease. Distance in patients in the OMT group improved on average by 72.5 meters compared to 23.7 meters for patients in the sham OMT group.Zanotti E, Berardinelli P, Bizzarri C. Osteopathic manipulative treatment effectiveness in severe chronic obstructive pulmonary disease: a pilot study. Complement Ther Med. 2012;20(1-2):16-22.
In 2013, a Cochrane Review reviewed six randomized controlled trials which investigated the effect of four types of chest physiotherapy (including OMT) as adjunctive treatments for pneumonia in adults and concluded that "based on current limited evidence, chest physiotherapy might not be recommended as routine additional treatment for pneumonia in adults." A 2013 systematic review of the use of OMT for treating pediatric conditions concluded that its effectiveness was unproven.
		 	
A small study found some evidence that OMT might be helpful for childhood asthma.Guiney PA, Chou R, Vianna A, et al. Effects of osteopathic manipulative treatment on pediatric patients with asthma: a randomized controlled trial. J Am Osteopath Assoc . 2005;105:7-12. ?
201.229.95.34 (talk) 03:00, 22 June 2014 (UTC)
replies: text: While some of your additions were definitely acceptable, other such as the last mention of a small study are primary sources, and do not abide by the policy on medical sourcing WP:MEDRS. Please look at that before you try to add new content again. -- CFCF (talk · contribs · email) 11:11, 22 June 2014 (UTC)
thread_title:  Changes to OMM 

message: Alexbrn, please explain the grounds for your revert. Your objection to the rewrite seems to be nothing more than stylistic and I don't think that's adequate cause for the revert (especially without a constructive counterproposal and just a simple revert). I left a very clear edit summary explaining the reason for the change: "More accurate-should not generalize and instead specifically state that some/certain practitioners use it for conditions such as asthma or PD." The point of this edit was to clarify that not all practitioners of OMT use it in this manner and that the application of OMT in this manner is likely done by a small minority. 
Your objection to this initial edit per your edit summary (here ) was about tense. I responded by correcting the tense in my original edit while maintaining the wording correction. Therefore, I see no grounds for your reversion unless you're changing your tune about why you objected. This feels extremely nitpicky and like you are unable to collaborate with me on the simplest/most minor of changes and that's rather disheartening. The meaning has not been changed at all except to be more specific in saying that only certain practitioners apply OMT in this way. Can you seriously say that's not a fair statement? If so, please explain how so with specific quantitative evidence to support your position. Additionally, the claim of "clunky" seems rather absurd since it's only a few words. It's really more helpful to suggest alternate wording instead of what's already there (I think it can be improved upon though perhaps you don't think so). As written, this sentence can be interpreted to mean that all OMT practitioners "sometimes" use these techniques in this way and that is an inaccurate statement. Only certain practitioners use it in this way (in reality this is likely a rather small minority). Do you have suggestions for alternate wording to avoid this issue? If so, I am open to a dialogue and I hope you are open to a collaborative dialogue as well. TylerDurden8823 (talk) 06:26, 18 December 2014 (UTC)
replies: text: The sentence can be interpreted that way, or maybe not; it's fine. As you say, it's nitpicky but I'd prefer changes at least to be reasonable English. You now changed it again which is okay except we're now refering to "a minority of OMT practitioners". What's your source for "minority"? Do I recall you have a COI for this topic? Alexbrn talk|contribs|COI 06:34, 18 December 2014 (UTC)
replies: text: I have no qualms with reasonable English, but wholesale reverts are unnecessary to accomplish this feat. As for the issue of COI, your recollection is incorrect. In the past you have asserted that I have such a COI, but I have never assented. Therefore, it is merely speculation on your part. You are certainly welcome to your opinion of course, but I think my editing history on this page speaks for itself as I have strived to achieve a neutral page (e.g., see my edits from earlier today prior to this word choice disagreement). As for minority, I don't think there is any specific source that comments quantitatively as to the exact number of practitioners that use it in any specific way. However, we clearly state in this article that back pain is the most common use for it, so it seems like a logical inference. I will look around for specific quantitative data to see if there are any such reports. If you do not agree with the phrase "minority of practitioners" (though there is absolutely nothing to suggest otherwise), what would you propose (since this is pretty clearly the reality)? Do you have any evidence to the contrary suggesting more than a minority (and what would be our cutoff for minority?) utilize OMT in this way? TylerDurden8823 (talk) 06:43, 18 December 2014 (UTC)
replies: text: Though this paper does not specifically address the use of OMT for the exact examples mentioned in this article (asthma & PD as examples of systemic conditions), the 1998 Guglielmo paper indicates rather strongly that only a minority of DOs persist in using treatments for more "dubious" indications (per Stephen Barrett's quote in that article). Do you require another example? TylerDurden8823 (talk) 06:50, 18 December 2014 (UTC)
replies: text: Apologies about my false COI memory: I must have mis-remembered. As you know it's considered especially important for medical topics that editors are squeaky clean so I'm happy to accept that you have no connnection to the world of osteo* (if that's what you mean). You "minority" claim is unfortunate however as it goes against the source we use which states "many" osteopaths will treat chronic conditions. Would be grateful if you would correct this WP:V error. Alexbrn talk|contribs|COI 06:52, 18 December 2014 (UTC)
replies: text: Your apology is accepted. As for your mention of a source stating many osteopaths will treat chronic conditions, which source are you referring to exactly? As I stated earlier, I will look around and see if I find additional evidence supporting the "minority" claim. Perhaps the numbers are different for non-physician osteopaths and osteopathic physicians and perhaps this is mentioned in a qualitative or quantitative way somewhere. I'm looking... TylerDurden8823 (talk) 06:55, 18 December 2014 (UTC)
replies: text: The Wiley book we cite right there (also used for the claim back pain is most commonly treated). Alexbrn talk|contribs|COI 06:58, 18 December 2014 (UTC)
replies: text: Yes, the 1997 source, I see it now. I will see if newer sources can offer any clarification since this source simply says "many osteopaths" without quantifying (and as mentioned earlier this may be a point of difference between non-physician osteopaths and osteopathic physicians which would be worth mentioning). TylerDurden8823 (talk) 07:01, 18 December 2014 (UTC)
replies: text: This 1999 paper from BMJ does not offer specific quantitative data, but also seems to clearly indicate that OMT is mainly used for musculoskeletal issues and less so for systemic problems though the precise wording of "a minority of practitioners" is not found (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1116959/). In the meanwhile, I'm still searching to see if there are any papers discussing this specific issue. This link from NYU Langone supports the idea that the majority of OMT practitioners are not using it for systemic conditions (but this idea is not presented quantitatively): http://www.med.nyu.edu/content?ChunkIID=37409 TylerDurden8823 (talk) 07:54, 18 December 2014 (UTC)
replies: text: It's not normal editorial practice to put content in the lede (which runs against the source cited), and then hunt for other sources in support. Are you aware this article is subject to discretionary sanctions? Alexbrn talk|contribs|COI 08:11, 18 December 2014 (UTC)
replies: text: Overall, I cannot find specific quantitative data to support or refute the minority of practitioners claim. I wouldn't be surprised if the data is out there, but if it is, it seems fairly well hidden. How do you wish to proceed? Do you have a proposal for alternate wording? Perhaps emphasis should be placed more on the fact that the most commonly treated issues are MSK in nature and the issue of the number of practitioners using these techniques for a given issue (MSK vs. systemic) should be deemphasized since we do not have specific supportive data discussing how many OMT practitioners regularly use these techniques for systemic conditions and how many do not. TylerDurden8823 (talk) 08:23, 18 December 2014 (UTC)
replies: text: WP:STICKTOSOURCE and just say "many" practitioners use it for chronic conditions? Alexbrn talk|contribs|COI 08:33, 18 December 2014 (UTC)
replies: text: Your memory isn't false Alexbrn, TD is just in denial. -Roxy the dog™ (resonate) 08:38, 18 December 2014 (UTC)
replies: text: Chronic conditions are not necessarily the same as "systemic conditions" as stated verbatim in the source if you're going to tell me to stick to the source. Certainly, asthma and PD are both chronic and systemic conditions, but chronic nonspecific low back pain is also a chronic condition but I doubt most would argue it's a systemic condition. If you want to change the phrasing to say chronic conditions and cite the 1997 source for support and explicitly state that osteopaths (referring to non-physician osteopaths do this), then I have no objection and we would be sticking to the source as you suggest, Alex. Roxy, this is inappropriate behavior on your part implying a COI for which you have zero evidence. Very disappointing behavior from a veteran Wikipedia editor. Maybe it would be more productive to focus on content instead, hmm? TylerDurden8823 (talk) 15:12, 18 December 2014 (UTC)
thread_title:  Recent revert