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Perception of Osteopathic Medicine in a Rural Clinic in Peru
Hovetter, K. [1]
Henke, C. [1]
Lopes, K. [1]
Berger, M. [2]
Boswell, K. [1]
Kandil, F. [1]
Ridpath, L. [9]
Waddell, M. [1]
Schmidt, D. [24]

Journal: Journal of Osteopathic Medicine Date: 2024/12, 124(12):Pages: A100-A102. doi: Subito , type of study: cross sectional study

Full text    (https://www.degruyter.com/document/doi/10.1515/jom-2024-2000/html)

Keywords:

cross sectional study [820]
knowledge [60]
OMT [3741]
osteopathic manipulative treatment [3761]
patients [145]
perception [131]
Peru [8]

Abstract:

Context: Iquitos, Peru is the capital of one of the poorest regions in the country, with some of the worst health indicators.1 Many patients struggle to afford medications and other treatments accessible to them. Referrals for specialized treatment are often not a realistic option because of the remoteness and geographical isolation from the country’s capital. Osteopathic Medical Treatment (OMT) has been shown to benefit patient outcomes and reduce pain in a variety of conditions.2-4 OMT can be especially useful in remote and underserved settings where there are limited resources for treatment. There are no Doctor of Osteopathic Medicine training programs in Peru and there is little literature regarding OMT in Peru. There have been efforts to introduce OMT to healthcare professionals5 and medical students,6 but few studies have focused on the patient experience. An osteopathic medical school chapter of DOCARE International charters an annual global health outreach trip to the underserved community of Iquitos, Peru. We sought to survey patients during this trip and learn more about how those patients perceived OMT. Objective: The goal of this study was to assess the level of knowledge and the perceptions of OMT in Iquitos, Peru. We aimed to identify existing knowledge of OMT in Iquitos and how this field of medicine was perceived by patients presenting to the OMT clinic. Additionally, we aimed to identify knowledge gaps related to this topic with the goal of addressing newfound gaps during future medical aid trips. We hypothesized that there would be a lack of knowledge about OMT in the remote, economically depressed region of Iquitos, Peru. We also hypothesized that when OMT was introduced to the population as a treatment modality for pain, that it would be well-received. Methods: This study consisted of a survey of 51 patients presenting with musculoskeletal complaints seeking care at a free community clinic during a one-week period in the spring of 2024. Any patient over the age of 18 presenting to the OMT clinic was given the opportunity to participate in the survey. No randomization or blinding procedures were implemented. The study was classified as exempt from Institutional Review Board approval. No identifying information was collected. We developed a pre- and post-survey with input from native Spanish speakers. The survey collected information about the participants’ demographics (age, gender, and occupation), knowledge and impression of OMT before and after receiving patient specific OMT for their complaint, and region and intensity of pain. Approval was obtained for use of the EQ-5D health questionnaire, which assesses mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.7 The EQ-5D was analyzed to provide additional demographic information about the participants’ quality of life. The EQ-5D and pre- and -post surveys were self-completed on paper and were available in United States English and Peruvian Spanish. Participants completed the pre-survey and EQ-5D before their appointment and the post-survey afterward. All participants were seen by the same physician for their complaint and their standard of care was not affected by their participation in the survey or lack thereof. Surveys were administered in Spanish by 6 WVSOM students who had received prior training and were given a script to follow. There was a local interpreter present to assist with communication as needed. A data log was used to ensure all parts of each survey were completed and to track which participants received OMT. Prior to beginning data analysis, pain location was categorized based on the ICD-10 codes defining somatic dysfunction regions including head, cervical spine, thoracic spine, lumbar spine, sacrum, pelvis, ribs, viscera/abdomen, upper extremity, and lower extremity. A diagram with region cut-offs was created to ensure that all categorization was uniform. Any discrepancies were discussed by multiple members of the research team to reach a consensus. SAS v9.4 was used to analyze the data. Due to normality issues in the data, nonparametric tests (Wilcoxon 2-sample test and the Wilcoxon Signed-Rank Test) were used to analyze outcomes. Of the 51 participants, there were 13 who inappropriately filled out a post-treatment portion of the survey which did not apply to them. Their post-treatment survey results were disregarded for the analysis. For those who received OMT, their post-treatment responses were coded into a Likert scale, with responses such as “Strongly Agree,” “Favorable,” and “Definitely Would” being given a score of five. Responses such as “Strongly Disagree,” “Unfavorable,” and “Definitely Would Not” were given a score of one, while any “Neutral” responses were given a value of three. For these items, a Wilcoxon Signed-Rank test was performed to determine if the overall score was significantly greater than 3 (neutral). Results: Of the 51 participants, 33 received OMT while 18 did not. The 33 participants who received OMT were statistically likely to agree that their pain improved (S = 254.5, p). Conclusion: Survey results showed that most patients had not heard of OMT before their appointment and had a favorable opinion of OMT after their appointment. As a secondary finding, the results showed a significant reduction in pain for a small sample following OMT application. We observed a general lack of understanding of OMT, i.e., patients may think they received it when they did not. Another barrier may have been differences in health literacy levels or cultural nuances. Future efforts should aim to address these limitations and introduce an educational component to increase patient understanding. Future research may also collect more comprehensive data on the patient’s complaint to analyze pain reduction by region or type of treatment.

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