Osteopathic Medical Research—2006
http://www.100md.com
《美国整骨期刊》
the Osteopathic Research Center in Fort Worth, Tex, and the University of North Texas Health Science Center at Fort Worth—Texas College of Osteopathic Medicine. Dr Licciardone serves on the Editorial Board of JAOA—The Journal of the American Osteopathic Association and as program chair for the AOA's 50th Annual Research Conference.
Las Vegas, Nev, later this year, will be the setting for the American Osteopathic Association's 111th Annual Convention and Scientific Seminar. At this event, the AOA will sponsor its 50th Annual Research Conference with a theme of "Osteopathic Medicine in the American Health Care System." This theme issue of JAOA—The Journal of the American Osteopathic Association celebrates the AOA's golden anniversary conference by publishing research abstracts for presenters whose work will appear at that event, which runs from October 16 to October 18. In addition, the AOA's editor in chief, Gilbert E. D'Alonzo, Jr, DO, and the JAOA's two associate editors, Michael M. Patterson, PhD, and Felix J. Rogers, DO, have selected the three original contributions that appear in this theme issue. Together, these materials provide a snapshot of osteopathic medical research at the current moment.
Ninety-two research conference abstracts have been accepted by the AOA's Council on Research for this year's conference and poster presentation. Of these 92 abstracts, 12 represent osteopathic manipulative medicine or osteopathic principles and practice; 40, clinical studies; 30, the basic sciences; and 6, medical education. In addition, four osteopathic clinical research fellows have abstracts and posters to present.
Norbert W. Seidler, PhD, working in a laboratory at Kansas City (Mo) University of Medicine and Biosciences College of Osteopathic Medicine.
Although more abstracts will be presented at the AOA's 50th Annual Research Conference than at many past conferences, the overall increase in student participation is perhaps more significant; 47 abstracts represent research conducted by students. I believe that this fact reflects not only student interest and involvement in the research process, but also the fertile ground the profession has laid bare for students at our colleges of osteopathic medicine. It is a credit to our profession that so many of our students have clearly received the encouragement and support of their mentors that then–AOA President, Darryl A. Beehler, DO, envisioned when he launched the Year of the Mentor for 2003–2004.
I encourage attendees of the Annual Convention and Scientific Seminar to show their support for osteopathic medical research by attending the conference's Poster Session between 1:00 pm and 5:00 pm on October 16, 2006, in Exhibit Hall C3 at the Las Vegas Convention Center. All presenters are expected to be at their posters during the Poster Session. Posters will also be exhibited throughout the convention on each day that the exhibit halls are open.
As noted, in addition to publishing research abstracts, this theme issue also includes three original contributions. The first article, by Chao Sun MD, MPH, and coauthors,1 examines trends and factors related to prescribing patterns for osteopathic physicians (DOs) who treated patients for nonspecific upper respiratory tract infections (URTIs). The authors analyze 1997 to 2001 data from the National Ambulatory Medical Care Survey database. Because the dataset contains information on patient visits to physician offices that are selected using a multistage probability sample design, the results of this study can be generalized to DOs nationwide.
Sun and colleagues1 report that antibiotics were prescribed in more than 50% of the 9.6 million patient visits to DOs for the treatment of URTIs. The authors describe the patient and physician characteristics relevant to the prescribing patterns observed. Based on the data available, the authors report that DOs provided "physiotherapy," which the researchers interpreted as including osteopathic manipulative treatment (OMT), for only 1 (0.2%) of every 500 patient visits for this common type of infection.
Extrapolating from their findings, the authors estimate that about 1 million unnecessary antibiotic prescriptions are written annually by DOs for the treatment of URTIs, concluding that there is an urgent need to introduce and sustain continuing medical education programming that will attempt to correct overprescribing of antibiotics among DOs. Although there is little doubt about the data reported or conclusions drawn from them, one wonders how similar data on prescribing practices among allopathic physicians might compare with those presented by Sun and coinvestigators.1
The two remaining original contributions in this theme issue have implications for osteopathic clinical research, particularly with regard to research on osteopathic medicine's unique treatment modality, OMT. My coauthor, David P. Russo, DO, MPH, and I2 explore treatment credibility, expectancy, and related methodologic issues by conducting additional analyses of data originally obtained from 91 subjects enrolled in a randomized controlled trial of OMT for chronic low back pain.3 Dr Russo and I studied the credibility of OMT when compared with sham manipulative treatment among research subjects. Our results show a small, but statistically significant, credibility differential favoring OMT over sham manipulative treatment at evaluations taken at trial baseline (credibility ratio, 1.10; 95% confidence interval, 1.03–1.16) and exit (credibility ratio, 1.15; 95% confidence interval, 1.06–1.23). Nevertheless, there were no significant main effects (ie, no differences in the credibility ratio among treatment groups or over time) or interaction effects (treatment group x time). These factors represent an important aspect of designing clinical trials that involve OMT as a treatment modality.
Malathi Rao, OMS II, and Darrin J. Spoden, OMS III, working in the laboratory of James M. Woods, PhD, Department of Microbiology and Immunology at Midwestern University/Chicago College of Osteopathic Medicine in Downers Grove, Ill.
Henry C. Tong, MD, and colleagues,4 analyze interobserver reliability, comparing methods of diagnosis for subjects with low back pain to determine sacral base and innominate bone position. The authors conclude that better interobserver reliability, as reflected by (kappa) statistics, is achieved using the results of the one test that has the best interobserver reliability instead of combining the results of several sequential tests to achieve high sensitivity (ie, positive finding if any palpatory examination finding is positive) or high specificity (ie, positive finding only if all palpatory examination findings are positive). Nevertheless, with regard to planning and study design for osteopathic medical research, it is important to note that suboptimal values (range, –0.06 to 0.37; median, 0.15) are reported by Tong and coauthors4 for most of the six types of palpatory examinations studied. This facet of the study should serve to remind researchers that it is essential for the osteopathic medical profession to provide and insist on rigorous research models before implementation of OMT research protocols, particularly when multisite research is conducted.
Footnotes
Editor's note: The American Osteopathic Association's 111th Annual Convention and Scientific Seminar in Las Vegas, Nev, runs from October 16, 2006, to October 20, 2006. The event will be held at the Las Vegas Convention Center. The theme for this year's convention is "DOs: A Family of Medicine Built on the Basics." Please see the DO-Online Web site (http://www.DO-online.org) for more information.
References
1. Sun C, Jew S, Dasta SL. Osteopathic physicians in the United States: antibiotic prescribing practices for patients with nonspecific upper respiratory tract infections. J Am Osteopath Assoc.2006; 106:450 –456.
2. Licciardone JC, Russo DP. Blinding protocols, treatment credibility, and expectancy: methodologic issues in clinical trials of osteopathic manipulative treatment. J Am Osteopath Assoc. 2006;106:457 –463.
3. Licciardone JC, Stoll ST, Fulda KG, Russo DP, Siu J, Winn W, et al. Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial. Spine.2003; 28:1355 –1362.
4. Tong HC, Heyman OG, Lado DA, Isser MM. Interexaminer reliability of three methods of combining test results to determine side of sacral restriction, sacral base position, and innominate bone position. J Am Osteopath Assoc. 2006;106 :464 –469.(John C. Licciardone, DO, )
Las Vegas, Nev, later this year, will be the setting for the American Osteopathic Association's 111th Annual Convention and Scientific Seminar. At this event, the AOA will sponsor its 50th Annual Research Conference with a theme of "Osteopathic Medicine in the American Health Care System." This theme issue of JAOA—The Journal of the American Osteopathic Association celebrates the AOA's golden anniversary conference by publishing research abstracts for presenters whose work will appear at that event, which runs from October 16 to October 18. In addition, the AOA's editor in chief, Gilbert E. D'Alonzo, Jr, DO, and the JAOA's two associate editors, Michael M. Patterson, PhD, and Felix J. Rogers, DO, have selected the three original contributions that appear in this theme issue. Together, these materials provide a snapshot of osteopathic medical research at the current moment.
Ninety-two research conference abstracts have been accepted by the AOA's Council on Research for this year's conference and poster presentation. Of these 92 abstracts, 12 represent osteopathic manipulative medicine or osteopathic principles and practice; 40, clinical studies; 30, the basic sciences; and 6, medical education. In addition, four osteopathic clinical research fellows have abstracts and posters to present.
Norbert W. Seidler, PhD, working in a laboratory at Kansas City (Mo) University of Medicine and Biosciences College of Osteopathic Medicine.
Although more abstracts will be presented at the AOA's 50th Annual Research Conference than at many past conferences, the overall increase in student participation is perhaps more significant; 47 abstracts represent research conducted by students. I believe that this fact reflects not only student interest and involvement in the research process, but also the fertile ground the profession has laid bare for students at our colleges of osteopathic medicine. It is a credit to our profession that so many of our students have clearly received the encouragement and support of their mentors that then–AOA President, Darryl A. Beehler, DO, envisioned when he launched the Year of the Mentor for 2003–2004.
I encourage attendees of the Annual Convention and Scientific Seminar to show their support for osteopathic medical research by attending the conference's Poster Session between 1:00 pm and 5:00 pm on October 16, 2006, in Exhibit Hall C3 at the Las Vegas Convention Center. All presenters are expected to be at their posters during the Poster Session. Posters will also be exhibited throughout the convention on each day that the exhibit halls are open.
As noted, in addition to publishing research abstracts, this theme issue also includes three original contributions. The first article, by Chao Sun MD, MPH, and coauthors,1 examines trends and factors related to prescribing patterns for osteopathic physicians (DOs) who treated patients for nonspecific upper respiratory tract infections (URTIs). The authors analyze 1997 to 2001 data from the National Ambulatory Medical Care Survey database. Because the dataset contains information on patient visits to physician offices that are selected using a multistage probability sample design, the results of this study can be generalized to DOs nationwide.
Sun and colleagues1 report that antibiotics were prescribed in more than 50% of the 9.6 million patient visits to DOs for the treatment of URTIs. The authors describe the patient and physician characteristics relevant to the prescribing patterns observed. Based on the data available, the authors report that DOs provided "physiotherapy," which the researchers interpreted as including osteopathic manipulative treatment (OMT), for only 1 (0.2%) of every 500 patient visits for this common type of infection.
Extrapolating from their findings, the authors estimate that about 1 million unnecessary antibiotic prescriptions are written annually by DOs for the treatment of URTIs, concluding that there is an urgent need to introduce and sustain continuing medical education programming that will attempt to correct overprescribing of antibiotics among DOs. Although there is little doubt about the data reported or conclusions drawn from them, one wonders how similar data on prescribing practices among allopathic physicians might compare with those presented by Sun and coinvestigators.1
The two remaining original contributions in this theme issue have implications for osteopathic clinical research, particularly with regard to research on osteopathic medicine's unique treatment modality, OMT. My coauthor, David P. Russo, DO, MPH, and I2 explore treatment credibility, expectancy, and related methodologic issues by conducting additional analyses of data originally obtained from 91 subjects enrolled in a randomized controlled trial of OMT for chronic low back pain.3 Dr Russo and I studied the credibility of OMT when compared with sham manipulative treatment among research subjects. Our results show a small, but statistically significant, credibility differential favoring OMT over sham manipulative treatment at evaluations taken at trial baseline (credibility ratio, 1.10; 95% confidence interval, 1.03–1.16) and exit (credibility ratio, 1.15; 95% confidence interval, 1.06–1.23). Nevertheless, there were no significant main effects (ie, no differences in the credibility ratio among treatment groups or over time) or interaction effects (treatment group x time). These factors represent an important aspect of designing clinical trials that involve OMT as a treatment modality.
Malathi Rao, OMS II, and Darrin J. Spoden, OMS III, working in the laboratory of James M. Woods, PhD, Department of Microbiology and Immunology at Midwestern University/Chicago College of Osteopathic Medicine in Downers Grove, Ill.
Henry C. Tong, MD, and colleagues,4 analyze interobserver reliability, comparing methods of diagnosis for subjects with low back pain to determine sacral base and innominate bone position. The authors conclude that better interobserver reliability, as reflected by (kappa) statistics, is achieved using the results of the one test that has the best interobserver reliability instead of combining the results of several sequential tests to achieve high sensitivity (ie, positive finding if any palpatory examination finding is positive) or high specificity (ie, positive finding only if all palpatory examination findings are positive). Nevertheless, with regard to planning and study design for osteopathic medical research, it is important to note that suboptimal values (range, –0.06 to 0.37; median, 0.15) are reported by Tong and coauthors4 for most of the six types of palpatory examinations studied. This facet of the study should serve to remind researchers that it is essential for the osteopathic medical profession to provide and insist on rigorous research models before implementation of OMT research protocols, particularly when multisite research is conducted.
Footnotes
Editor's note: The American Osteopathic Association's 111th Annual Convention and Scientific Seminar in Las Vegas, Nev, runs from October 16, 2006, to October 20, 2006. The event will be held at the Las Vegas Convention Center. The theme for this year's convention is "DOs: A Family of Medicine Built on the Basics." Please see the DO-Online Web site (http://www.DO-online.org) for more information.
References
1. Sun C, Jew S, Dasta SL. Osteopathic physicians in the United States: antibiotic prescribing practices for patients with nonspecific upper respiratory tract infections. J Am Osteopath Assoc.2006; 106:450 –456.
2. Licciardone JC, Russo DP. Blinding protocols, treatment credibility, and expectancy: methodologic issues in clinical trials of osteopathic manipulative treatment. J Am Osteopath Assoc. 2006;106:457 –463.
3. Licciardone JC, Stoll ST, Fulda KG, Russo DP, Siu J, Winn W, et al. Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial. Spine.2003; 28:1355 –1362.
4. Tong HC, Heyman OG, Lado DA, Isser MM. Interexaminer reliability of three methods of combining test results to determine side of sacral restriction, sacral base position, and innominate bone position. J Am Osteopath Assoc. 2006;106 :464 –469.(John C. Licciardone, DO, )