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1.  Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis 
Background
Nonspecific back pain is common, disabling, and costly. Therefore, we assessed effectiveness of osteopathic manipulative treatment (OMT) in the management of nonspecific low back pain (LBP) regarding pain and functional status.
Methods
A systematic literature search unrestricted by language was performed in October 2013 in electronic and ongoing trials databases. Searches of reference lists and personal communications identified additional studies. Only randomized clinical trials were included; specific back pain or single treatment techniques studies were excluded. Outcomes were pain and functional status. Studies were independently reviewed using a standardized form. The mean difference (MD) or standard mean difference (SMD) with 95% confidence intervals (CIs) and overall effect size were calculated at 3 months posttreatment. GRADE was used to assess quality of evidence.
Results
We identified 307 studies. Thirty-one were evaluated and 16 excluded. Of the 15 studies reviewed, 10 investigated effectiveness of OMT for nonspecific LBP, 3 effect of OMT for LBP in pregnant women, and 2 effect of OMT for LBP in postpartum women. Twelve had a low risk of bias. Moderate-quality evidence suggested OMT had a significant effect on pain relief (MD, -12.91; 95% CI, -20.00 to -5.82) and functional status (SMD, -0.36; 95% CI, -0.58 to -0.14) in acute and chronic nonspecific LBP. In chronic nonspecific LBP, moderate-quality evidence suggested a significant difference in favour of OMT regarding pain (MD, -14.93; 95% CI, -25.18 to -4.68) and functional status (SMD, -0.32; 95% CI, -0.58 to -0.07). For nonspecific LBP in pregnancy, low-quality evidence suggested a significant difference in favour of OMT for pain (MD, -23.01; 95% CI, -44.13 to -1.88) and functional status (SMD, -0.80; 95% CI, -1.36 to -0.23), whereas moderate-quality evidence suggested a significant difference in favour of OMT for pain (MD, -41.85; 95% CI, -49.43 to -34.27) and functional status (SMD, -1.78; 95% CI, -2.21 to -1.35) in nonspecific LBP postpartum.
Conclusion
Clinically relevant effects of OMT were found for reducing pain and improving functional status in patients with acute and chronic nonspecific LBP and for LBP in pregnant and postpartum women at 3 months posttreatment. However, larger, high-quality randomized controlled trials with robust comparison groups are recommended.
doi:10.1186/1471-2474-15-286
PMCID: PMC4159549  PMID: 25175885
Low back pain; Spinal manipulation; Osteopathic manipulative treatment; Systematic review
2.  Assessing fitness-to-practice of overseas-trained health practitioners by Australian registration & accreditation bodies 
BMC Medical Education  2012;12:91.
Background
Assessment of fitness-to-practice of health professionals trained overseas and who wish to practice in Australia is undertaken by a range of organisations. These organisations conduct assessments using a range of methods. However there is very little published about how these organisations conduct their assessments. The purpose of the current paper is to investigate the methods of assessment used by these organisations and the issues associated with conducting these assessments.
Methods
A series of semi-structured interviews was undertaken with a variety of organisations who undertake assessments of overseas-trained health professionals who wish to practice in Australia. Content analysis of the interviews was used to identify themes and patterns.
Results
Four themes were generated from the content analysis of the interviews: (1) assessing; (2) process; (3) examiners; and (4) cost-efficiency. The themes were interconnected and each theme also had a number of sub-themes.
Conclusions
The organisations who participated in the present study used a range of assessment methods to assess overseas trained health professionals. These organisations also highlighted a number of issues, particularly related to examiners and process issues, pre- and post-assessment. Organisations demonstrated an appreciation for ongoing review of their assessment processes and incorporating evidence from the literature to inform their processes and assessment development.
doi:10.1186/1472-6920-12-91
PMCID: PMC3549784  PMID: 23020885
3.  Spinal and sacroiliac assessment and treatment techniques used by osteopathic physicians in the United States 
Background
Osteopathic manipulative medicine texts and educators advocate a range of approaches for physical assessment and treatment, but little is known about their use by osteopathic physicians in the United States.
Methods
A web-based survey using a 5-point Likert scale was developed and e-mailed to 777 practicing osteopathic physician members of the American Academy of Osteopathy. Responses in the "frequently" and "always" categories were combined for reporting purposes. Friedman tests were used to analyze the reported usage of each item. The effect of gender was analyzed using Mann-Whitney tests.
Results
One hundred seventy-one osteopathic physicians completed the survey (22%). For the assessment of spinal somatic dysfunction, paraspinal tissue texture (98%), transverse process asymmetry (89%), and tenderness (85%) were most commonly reported. Myofascial release (78%), soft tissue technique (77%), and patient self-stretches (71%) were most commonly used for treatment of the spine. For assessment of pelvic landmark asymmetry, the anterior superior iliac spine (ASIS, 87%), sacral base (82%), posterior superior iliac spine (81%), sacral sulci (78%), iliac crests (77%), and inferior lateral angle of the sacrum (74%) were commonly palpated. For assessment of sacroiliac joint motion, ASIS compression (68%) was most commonly used. Sacroiliac pain provocation tests were also employed although their use was less common than asymmetry or motion tests. Muscle energy (70%), myofascial release (67%), patient self-stretches (66%), osteopathy in the cranial field (59%), muscle strengthening exercises (58%), soft tissue technique (58%), and articulatory technique (53%) were most commonly used for treatment of the pelvis and sacroiliac. The effect of gender was significant for many of the treatment procedures, with females using more soft tissue and muscle energy and males more high-velocity techniques. The majority of respondents document the types of osteopathic manipulative techniques used (83%), document somatic dysfunction with Fryette nomenclature (64%), and bill for osteopathic manipulative treatment (92%).
Conclusion
Respondents reported the use of a broad range of assessment and treatment approaches. Results suggest a higher use of myofascial release and cranial technique and lower use of high-velocity techniques in this group of physicians compared to previous studies.
doi:10.1186/1750-4732-3-4
PMCID: PMC2676310  PMID: 19366458
4.  THE EFFECT OF TALO-CRURAL JOINT MANIPULATION ON RANGE OF MOTION AT THE ANKLE JOINT IN SUBJECTS WITH A HISTORY OF ANKLE INJURY 
Introduction: There is little research available on the effects of peripheral joint manipulation. Only a few studies have examined the effect of manipulation on ankle range of motion, with conflicting results. This study aimed to determine whether a single high-velocity, low-amplitude (HVLA) thrust manipulation to the talo-crural joint altered ankle range of motion in subjects with a history of lateral ligament sprain.
Methods: Male and female volunteers (N=52) with a history of lateral ligament sprain were randomly assigned into either an experimental group (n=26) or a control group (n=26). Those in the experimental group received a single HVLA thrust to the talo-crural joint, whilst those in the control group received no treatment intervention. Pre-test and post-test measurements of passive dorsiflexion range of motion were taken.
Results: No significant changes in dorsiflexion range of motion were detected between manipulated ankles and those of control subjects using dependent and independent t-tests. Ankles that cavitated displayed a greater mean DFR and large effect size (d=0.8) compared to those that did not gap and cavitate, but analysis with ANOVA revealed these differences to be not significant.
Conclusion: HVLA manipulation of the ankle did not increase dorsiflexion range of motion in subjects with a history of lateral ligament sprain.
PMCID: PMC2051316  PMID: 17987212
Ankle Joint; manipulation; dorsiflexion; range of motion; osteopathy
5.  THE EFFECT OF CERVICAL SPINE ISOMETRIC CONTRACT-RELAX TECHNIQUE ON HAMSTRING EXTENSIBILITY 
PMCID: PMC2051304  PMID: 17987203
Hamstrings; cervical spine; isometric; contract-relax; passive knee extension; clinical challenge
6.  THE EFFECT OF CERVICAL SPINE ISOMETRIC CONTRACT-RELAX TECHNIQUE ON HAMSTRING EXTENSIBILITY 
Objectives: To re-investigate the effect of a cervical isometric contract-relax technique on hamstring extensibility and examine the duration of any treatment effect.
Methods: Forty asymptomatic participants were randomly assigned equally to either an experimental or control group. Both groups underwent pre and post hamstring extensibility measurements using passive knee extension with the thigh maintained at 90┬░ of hip flexion, with the examiner blinded to treatment allocation of the participants. Torque was measured with a hand held dynamometer to maintain consistent force in pre and post measurements. The experimental group received an upper cervical isometric contract-relax treatment. A digital camera recorded the knee extension angles and the images were computer analysed to determine hamstring extensibility.
Results: A split plot ANOVA (SPANOVA) revealed no significant hamstring extensibility differences between or within the groups, immediately or at 30 minutes.
Conclusion: The cervical isometric contract-relax treatment produced no significant effect to the extensibility of the hamstring. This study does not support the use of cervical techniques to alter hamstring extensibility.
PMCID: PMC2051297  PMID: 17987201
Hamstrings; cervical spine; isometric; contract-relax; passive knee extension

Results 1-6 (6)