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Meaning and Mechanism in Osteopathy
Nanke, L. G. M. [1]

Journal: Unpublished PhD thesis University of Surrey, Date: 2000/01, Pages: 373, type of study: cross sectional study

Free full text   (https://openresearch.surrey.ac.uk/esploro/outputs/doctoral/Meaning-and-Mechanism-in-Osteopathy/99515447302346)

Keywords:

cross sectional study [597]
evidence-based medicine [96]
holism [14]
patients [80]
physician-patient relations [83]
therapeutic process [37]
UK [80]

Abstract:

Osteopathy is a demand-led service, confronting external demands for evidence and internal debate about whether future development should be based on the medical model. Much of the dialogue between osteopathy, complementary and conventional medicine is framed in terms of holism and reductionism. However, research has focused on trials of manipulation and the possibility that the central terms of problem, process and outcome may have a different meaning within holistic and reductionist frames of reference has attracted little research attention. This possibility provided the focus for the current enquiry into pain meaning, management and outcome in osteopathic practice. The semiotic distinction between indexical, iconic and symbolic signs was used to investigate the influence of explanatory frameworks on interpretation and management of chronic pain. It is concluded that in conventional medicine, reductionist definition of objects in terms of properties is reflected in a tendency towards polarisation between physical indexical interpretation of pain; and reciprocally defined psychosocial iconic or symbolic interpretation. In osteopathy, holistic definition of objects in terms of interrelationship is theoretically reflected in symbolic understanding of pain in terms of the unique person/environment context, though there is little evidence that this is reflected in practice. Facet theory and methodology was used to translate the focus on physical and psychosocial relationships in osteopathic pain interpretation, management and outcome evaluation into a series of empirical studies. The relationship between practitioners (n=3) pain explanation, treatment and outcome was evaluated in a questionnaire and interview study of 150 National Health Service (NHS) patients. Explanations were found to map onto the semiotic index (physical); icon (uncertain), symbol (physical and psychosocial) distinction. This was associated with corresponding differences in practitioners' treatment intentions and outcome evaluation; patients' self-reported health status, and, to a much lesser extent, outcome. This distinction was independent of low back pain (LBP), which has provided the focus for trials of manipulation. A questionnaire study of methods used and perception of the ways in which osteopathy helps patients (n=74 osteopaths) showed widespread multi-modal practice.Treatment use was described as an interaction between modality (e. g., physical noninvasive, psychological) and degree of specialisation. Individual differences were associated with number and range of methods used, but not physical or psychosocial modality. Osteopathy was most frequently rated as helping patients to understand their problem, enhancing well-being and symptom relief. Two parallel sentence completion studies of private osteopathic patients were carried out to evaluate expectations (n=267) and experience of the helpful and unhelpful aspects of treatment (n=211). Responses were content-analysed using the mapping sentence. Results showed problem descriptions were primarily body-based, though a minority referred to the whole body or person. Process was described primarily in terms of explanation, which provides the basis for perception of osteopathy as a natural, constructive treatment which treats the cause of the problem, and facilitates self help, in the context of an ongoing therapeutic relationship. Outcome was primarily described in terms of pain relief, mobility, activity, well-being, prevention and health promotion. A subgroup of patients described the most unhelpful aspects of osteopathy in terms of lack of understanding and limited effectiveness, associated with uncertainty about whether to invest in further treatment. In all studies, osteopathic practice was associated with “both physical and psychosocial“ understanding and management. This is consistent with the structural characteristics of the holistic explanatory framework, and does not correspond to definitions of problem, process and outcome definitions in trials of manipulation. In view of the limitations of dualism and advocacy of the biopsychosocial model, meaning and management of complex problems in routine practice would provide a productive and osteopathically valid focus for future research.

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