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Osteopathic manipulative treatment of somatic dysfunction as an integral component in the care of patients with chronic medical disease: A thirty-month study in rural Appalachia

Journal: The AAO Journal Date: 2012/09, 22(03):Pages: 26-51, type of study: cohort study

Free full text   (https://www.academyofosteopathy.org/aaoj)

Keywords:

chronic disease [36]
osteopathic manipulative treatment [2973]
OMT [2951]
health, structure [1]
function, [1]
somatic dysfunction [147]
allostatic load [3]
cultural disparity [1]
cohort study [51]

Abstract:

Sixty-one people with both chronic, co-morbid systemic disease(s) and musculoskeletal complaint(s), were followed for a minimum of two years to assess the clinical value and limitations of Osteopathic Manipulative Treatment (OMT) with regard to their overall sense of well-being. Four conditions predominated: cardiovascular disease, connective tissue disease, osteoarthritis and chronic pain syndromes. Predominant neuromusculoskeletal regions treated included somatic dysfunction within the cervical, sacral and ribcage areas, and areas of soft tissue restriction (Counterstrain Points, Chapman’s Points, Diaphragmatic restriction, and “non-compensatory” (Gordon Zink)1 fascial restriction within the torso). Data collected suggested an association between the diagnosis of osteoarthritis and the occurrence of cervical somatic dysfunction. Those with cardiovascular disease(s) were most associated with several areas of somatic dysfunction (cervical, sacrum, ribs and soft tissue restriction). The predominant symptomatic age group was women 50 to 59 years of age, with a range of 28 to 97 years. OMT performed by Neuromusculoskeletal Medicine/ Osteopathic Manipulative Medicine (NMM/OMM)- certified osteopathic physicians and/or undergraduate fellows (under the supervision of the attending physician), had no recorded effect on systemic disease outcomes. However, patients reported the treatments to be of functional value. Functional value was evaluated by four criteria: the subjective analogue pain scale, activities of daily living (ADL) evaluation, energy-level evaluation and psycho-social evaluation. The predominantly used OMT was direct and indirect myofascial release. Stability and improvement of ADLs and marginal pain improvement were observed as gauges of patient success. Depression had no correlation with medical diagnosis or symptom severity, however patient-perceived improvement correlated reciprocally. Allostasis, the body’s neuroendocrine response to any extrinsic or intrinsic stressors, and its prolonged presence, allostatic load, were probable but not measurable outcome influences. Cultural disparity was suggested to be an outcome factor.


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