Response
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Michael M. Patterson
I very much appreciate the clarification made by John C. Licciardone, DO, MS, MBA, about his study1 that I referenced in my August editorial2 on touch and its effects in manipulative medicine.
As Dr Licciardone states, his 2003 study1 illustrates the pitfalls of using well-intentioned but relatively inexperienced students as providers in studies of osteopathic manipulative treatment (OMT). That study did in fact show the sham OMT protocol to be statistically as effective as the OMT protocol. The reasons for this finding may be many, as Dr Licciardone points out. Of note, at least one other well-designed study3 that used a sham control protocol found true treatment to have superior effects, but the study also demonstrated sham treatment to have an effect when compared with a no-treatment control protocol. These findings seem to show that touch and movements do have a positive effect on how a patient responds to treatment. Thus, a sham treatment must be evaluated carefully as to its effects and cannot be a priori considered a neutral, non–response-producing control.
In addition, the point made in my editorial2 was that touch is an integral and active part of OMT that in itself has real physiologic effects on function. This point was also made in the article4 referred to in my editorial; the article cites several mechanistic studies on the effects of touch on function. Touch must be considered as an active ingredient within the totality of OMT and not relegated to the status of a paraphenomenon, the effects of which are only psychological.
Certainly, studies can be designed to evaluate the effects of various aspects of OMT. However, researchers should evaluate the total treatment before trying to tease apart such factors as touch and physician presence. As Dr Licciardone points out in his letter,5 touch is being used less and less in the patient-physician relationship, which should be of concern to the profession. The possibility remains that touch and physician presence, among other things, reasonably contribute to all manual medicine and that they actively add to the effects of the actual movements administered.
References
1 Licciardone JC Stoll ST Fulda KG et al. . Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial. Spine (Phila Pa 1976). 2003;28(13):1355-1362.10.1097/01.BRS.0000067110.61471.7DSuche in Google Scholar PubMed
2 Patterson MM . Touch: vital to patient-physician relationships [editorial]. J Am Osteopath Assoc.2012;112(8):485.Suche in Google Scholar
3 Noll DR Degenhardt BF Morley TF et al. . Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia: a randomized controlled trial. Osteopath Med Prim Care. 2010;4:2.10.1186/1750-4732-4-2Suche in Google Scholar PubMed PubMed Central
4 Elkiss ML Jerome JA . Touch—more than a basic science. J Am Osteopath Assoc.2012;112(8):514-517.Suche in Google Scholar
5 Licciardone JC . Osteopathic manipulative treatment: much more than simply a “hands-on” phenomenon [letter]. J Am Osteopath Assoc.2012;112(11):704-705.Suche in Google Scholar
© 2012 The American Osteopathic Association
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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Artikel in diesem Heft
- Letters
- Osteopathic Manipulative Treatment: Much More Than Simply a “Hands-on” Phenomenon
- Response
- Evidence-Based Clinical Review
- Management of Primary Knee Osteoarthritis and Indications for Total Knee Arthroplasty for General Practitioners
- Original Contributions
- Bibliometric Measures and National Institutes of Health Funding at Colleges of Osteopathic Medicine, 2006-2010
- Self-Reported Physical Health, Mental Health, and Comorbid Diseases Among Women With Irritable Bowel Syndrome, Fibromyalgia, or Both Compared With Healthy Control Respondents
- Special Communication
- Still Relevant: The Profession's Characteristics of Yesterday and Today
- Case Report
- A Novel Approach to the Diagnosis of Stress-Induced Cardiomyopathy
- Clinical Images
- Erythema Migrans in Early Disseminated Lyme Disease
- In Your Words
- Practicing Medicine Is About More Than Standing on Your Own 2 Feet
- Book Reviews
- Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs
- CME Quiz
- CME Quiz
