The Journal of the American Osteopathic Association

Context: Strain-directed therapy such as vacuum compression and manual manipulative therapies are clinically effective, but their cellular and molecular mechanisms are not well understood.

Objective: To determine the effects of modeled myofascial release (MFR) on fibroblast wound healing and to investigate the potential role of nitric oxide (NO) in mediating these responses.

Methods: Using an in vitro scratch wound strain model, the authors investigated human fibroblast wound healing characteristics in response to injurious repetitive motion strain (RMS) and MFR. Secretion of NO was induced with interleukin-1β and sodium nitroprusside and inhibited with NO synthase inhibitor L-N^G-monomethyl arginine citrate (L-NMMA) to determine the effects of NO on wound healing. Protein microarray was also performed to evaluate the expression of intracellular protein and activation of protein kinase G (PKG), extracellular signal-regulated kinase (ERK1/2), protein kinase C (PKC), and phosphoinositide 3-kinase (PI3K), the downstream effectors in the NO pathway.

Results: Fibroblasts that received RMS resulted in reduced wound closure rates (vs nonstrain, P<.05), which are partially attenuated by a single dose of MFR. Interleukin-1β and exogenous NO did not appear to have an effect on nonstrained fibroblast wound healing. However, strained fibroblasts appeared to express increased sensitivity to NO. The authors also observed a 12.2% increase in NO secretion, an increase in PKG activation, and a downregulation of PKC and PI3K inhibitory domain in the combined strain group.

Conclusion: If clinically translatable, these data suggest that mechanical strain such as vacuum compression therapy and manual manipulative therapy may modify PKC and PI3K to sensitize fibroblasts to NO and improve wound healing by promoting cell proliferation and migration by means of PKC and PKG signaling

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International Journal of Osteopathic Medicine

Objective

The objective of this study is to assess the effect of a single session of a general osteopathic treatment (OG) on several psychological features.

Methods

Thirty-four asymptomatic female volunteers (age) completed baseline auto-questionnaires about anxiety, body satisfaction and global self-perception. Then, they were randomly assigned to OG or to control group (restful state). Each intervention was performed during 30 min. After the session, psychological data were collected using the same auto-questionnaires. To test the effect of treatment we used ANOVA for repeated measures and compared changes over time between OG and control groups.

Results

At baseline, characteristics were comparable between groups. Following the intervention, we observed improvements in psychological state in both OG and control groups. Nevertheless, OG had a significant larger effect over restful state for anxiety and global self-perception (p < 0.02).

Conclusions

The present study suggests that an osteopathic approach using articular and soft tissue mobilisations has an effect, at least in the short term, on anxiety and global body perception. Further investigation is needed to confirm the relevance and broaden the scope of the present study.

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International Journal of Osteopathic Medicine

Background: The clinical reasoning processes which result in the formation of a diagnosis, are fundamental for safe, effective and efficient clinical practice and are central to professional autonomy and accountability. While research has identified the diagnostic reasoning approaches taken by a range of healthcare professions, there is limited understanding of how osteopaths formulate diagnoses in clinical practice.

Objectives: The aim of this research was to explore the diagnostic reasoning of experienced osteopaths in the UK.

Methods: A qualitative constructivist grounded theory approach was taken in this study, which was situated in the interpretive research paradigm. A total of seventeen face-to-face semi-structured interviews were conducted with twelve experienced osteopaths. Participants were purposefully and theoretically sampled to take part in this study. Data collection methods involved semi-structured interviews with participants and observation and video-recording of clinical appointments, which were followed by video-prompted reflective interviews. The constant comparative method of analysis was used to code and analyse data.

Results: The findings suggest that when formulating a diagnosis practitioners adopted two diagnostic reasoning approaches, namely hypothetico-deductive reasoning and pattern recognition. In this study, there was interplay of these reasoning approaches as a result of the perceived level of complexity and degree of familiarity of the patient presentation.

Conclusions: Experienced osteopaths adopted diagnostic reasoning approaches which are akin to other healthcare professions including medicine and physiotherapy. Metacognitive and reflexivity skills were central for safe and effective diagnostic reasoning. Further work is required to explore the transferability of these findings with practitioners of different levels of clinical experience and who work in different clinical settings.

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PLoS ONE

Background

Cervical artery dissection (CAD) and stroke are serious harms that are sometimes associated with cervical spinal manipulation therapy (cSMT). Because of the relative rarity of these adverse events, studying them prospectively is challenging. As a result, systematic review of reports describing these events offers an important opportunity to better understand the relation between adverse events and cSMT. Of note, the quality of the case report literature in this area has not yet been assessed.

Purpose

1) To systematically collect and synthesize available reports of CAD that have been associated with cSMT in the literature and 2) assess the quality of these reports.

Methods

A systematic review of the literature was conducted using several databases. All clinical study designs involving CADs associated with cSMT were eligible for inclusion. Included studies were screened by two independent reviewers for the presence/absence of 11 factors considered to be important in understanding the relation between CAD and cSMT.

Results

Overall, 43 articles reported 901 cases of CAD and 707 incidents of stroke reported to be associated with cSMT. The most common type of stroke reported was ischemic stroke (92%). Time-to-onset of symptoms was reported most frequently (95%). No single case included all 11 factors.

Conclusions

This study has demonstrated that the literature infrequently reports useful data toward understanding the association between cSMT, CADs and stroke. Improving the quality, completeness, and consistency of reporting adverse events may improve our understanding of this important relation.

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