journal: Journal of Osteopathic Medicine

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Journal of Osteopathic Medicine

Language: English

First published: January 1, 1900

Publication Frequency: 12 issues per year

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The Journal of Osteopathic Medicine, founded in 1901 and known for 119 years as the Journal of the American Osteopathic Association, is the premier scholarly, peer-reviewed publication of the osteopathic medical profession. The mission of JOM is to serve as an international forum for the dissemination of scientific literature that incorporates an integrative, comprehensive, patient-centered approach to clinical care and improving health. JOM conducts double-blind peer review of academic research manuscripts from a wide variety of medical specialties, covering the full spectrum of clinical settings in which osteopathic physicians practice. All submissions are vetted by a distinguished group of Section Editors led by Editor-in-Chief Ross Zafonte, DO, and supported by a full Editorial Board.

JOM publishes original research, narrative and systematic review articles (including meta-analyses), clinical practice descriptions, and a very limited number of case reports, all of which are described fully in our Instructions for Authors. JOM is particularly interested in original scientific research that provides quantitative analysis of and contributes significantly to the evidence base underpinning current practices in osteopathic medicine, including but not limited to neuromusculoskeletal medicine. We also accept research submissions documenting trends and changes in education for osteopathic medical students. The ultimate focus of all material published in JOM is to support, enhance, and advance patient care through evidence.

Open Access
Minimum physical activities protective against Alzheimer’s disease in late life: a systematic review

January 1, 2000

Amy Sakazaki, Austin Lui, Haneef Muhammad, Claire Vu, Aiden le Roux, Patricia Lacayo, Shin Murakami

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Context Previous studies indicate an inverse relationship between physical activity (PA) and the risk of Alzheimer’s disease (AD). Although they highlighted the health benefits of PA, the specific effects of PA in late life remain unclear, and intense PA may be challenging for older adults. Moreover, there is significant variation in how PA is assessed, including the timing and types of activities considered. Objectives This review aimed to evaluate existing literature to determine the effects of PA with an emphasis on late-life PA and the minimum levels of PA for older adults. Methods We conducted a systematic review via the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol utilizing the MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, last assessed in July 2023. Studies that met the inclusion criteria were prospective cohort or interventional studies, that are written in English, and that measured PA in a cohort who did not have dementia, AD, or cognitive decline at baseline. Retrospective cohort, cross-sectional, case reports, and studies not meeting the inclusion criteria were excluded. Each study was evaluated in seven domains of bias utilizing the Risk Of Bias In Non-randomized Studies of Exposures (ROBINS-E) tool. Results Out of 2,322 studies screened, 17 met the inclusion criteria, including six new studies not included in the previous systematic review. This resulted in 206,463 participants from North America (United States and Canada) and Europe (Denmark, Finland, Italy, Sweden, and the United Kingdom). Our method effectively reduced the number of duplicated studies during screenings, resulting in 92 duplications compared to 3,580 in the previous review. The risk of bias assessment in the quality of evidence was “low risk” in 13 studies and “some concerns” in four studies. Four studies assessed PA at midlife (average age, 49 years; average follow-up time, 29.2 years), 11 studies assessed PA in late life (average age, 75.9 years; average follow-up time, 5.9 years), and two assessed PA in adulthood without specification. For studies that assessed PA at midlife, 2 out of 4 (50 %) had statistically significant findings (p<0.05) for studies that assessed PA during late life, 8 out of 11 (75 %) had significant findings (p<0.05), and 2 out of 2 (100 %) of unspecified timing had significant findings (p<0.05). Our review indicated that engaging in PA at least three times per week, for at least 15 min per session, was judged to be the minimum requirement tested for protective effects against AD in late life. Potential biological mechanisms were also discussed. Conclusions Our current review supports existing evidence that PA provides significant protection against the development of AD and found that the requirement of PA may be less than the current guidelines for sufficient and meaningful protection in late life. Excitingly, any form of PA tested can be protective against the development of AD, including household activities, suggesting that a wider variety of PA can be more appropriate for late life. More standardized and detailed studies are needed to update the benefits of PA, particularly in the areas of occupational, household/transportation, and age-group activities. Further research is needed to determine the optimal PA thresholds in these groups.
Open Access
The utility of the implantable loop recorder in patients with Ehlers-Danlos syndrome and hypermobility spectrum disorder

January 1, 2000

Ermin Tale, Grace Robinson, Justin Edward, Riya Kaushal, Bernadette Riley, Todd J. Cohen

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Context Patients with Ehlers-Danlos Syndrome (EDS) and hypermobility spectrum disorder (HSD) often complain of palpitations, presyncope/syncope, attributable to postural orthostatic tachycardia syndrome (POTS). Occasionally, the etiology of these complaints is not positional, unclear, and may require further cardiac evaluation, including cardiac monitoring. To our knowledge, the utility of implantable loop recorders (ILRs) has yet to be explored in this population. Objectives This study aimed to evaluate the utility of the ILRs in diagnosing and/or excluding arrhythmias not attributable to POTS in symptomatic patients with EDS and HSD. Methods Patients with EDS and HSD were referred from the New York Institute of Technology (NYIT) Ehlers-Danlos Syndrome/Hypermobility Treatment Center to the Long Island Heart Rhythm Center (LIHRC) for cardiac evaluation between January 2019 and November 2023. A retrospective analysis of observational de-identified data from the LIHRC was permitted by the NYIT College of Osteopathic Medicine Institutional Review Board (BHS-1465). Patients were monitored monthly, and the utility of the ILRs was assessed based on a correlation of symptoms to an arrhythmia, the ability of the device to monitor therapy efficacy, and/or to rule out an arrhythmia as the explanation of symptoms. Data is reported as percentages and mean ± standard deviation (SD). Results A total of 116 hypermobile patients (81 EDS/35 HSD) were evaluated. Among these patients, 31 (26.7 %) received an ILR (length of follow-up, 27.3 months ± 14.0 months), 29 females/2 males, 28 patients had EDS, 3 patients had HSD, age 34.1 ± 11.4 years. Symptomatic sinus tachycardia (ST) occurred in 16 patients (51.6 %), and ST helped diagnose POTS and/or monitor therapy in 15 (48.4 %). Symptomatic premature ventricular complexes (PVCs) occurred in 8 patients (25.8 %), supraventricular tachycardia (SVT) in 6 (19.4 %), and ventricular tachycardia (VT) in 1 (3.2 %). In 2 patients, ILR findings led to further interventions, including PVC ablation and an implantable cardioverter-defibrillator (ICD) for symptomatic VT. The ILR demonstrated utility in all patients. Conclusions This study demonstrated the utility of the ILR in identifying symptomatic arrhythmias in patients with EDS and HSD. ILR monitoring also aided in solidifying a POTS diagnosis and guiding patient management/treatment efficacy. Further evaluation in a larger cohort is needed to further understand the impact of ILR monitoring in hypermobile patients.
Open Access
Does forward head posture correction improve temporomandibular joint dysfunction? A pilot randomized trial using a cervical extension traction orthotic

January 1, 2000

Shima A. Mohammad Zadeh, Tamer Shousha, Ibrahim M. Moustafa, Iman Khowailed, Deed E. Harrison

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Context This pilot study assessed participants adherence rate and the effect size needed to determine the sample size for a full-scale study evaluating the effectiveness of forward head posture (FHP) correction on temporomandibular disorders (TMDs) and symptoms. Moreover, the potential impact of adding FHP correction to a standard conservative protocol for treatment of TMD severity, pain, and pain-free mouth opening range is explored. Objectives The primary objective was to investigate the additional effect of FHP correction by a cervical extension traction (CET) orthotic on myogenic TMD symptoms of pain and function. Methods A total of 21 participants (19 females) were enrolled and completed the study. The participants’ mean age was 21.99±2.06 years, body mass index (BMI) 22.92±4.27 kg/m 2 . A randomized clinical trial was conducted with participants who were randomly divided into two groups: 1) an experimental group with 10 participants receiving a FHP CET orthotic and a conservative TMD protocol; and 2) a control group with 11 participants receiving the conservative TMD protocol and a placebo CET device utilizing a standard pillow. Outcome assessments included: TMD severity with Fonseca’s questionnaire, numerical rating scale for pain intensity, maximum mouth opening (MMO), and the craniovertebral angle (CVA) to measure FHP. Assessments were performed at three time points (baseline, 3rd week, 6th week), and three treatment sessions per week for six consecutive weeks were administered. Results Both groups achieved a high adherence rate to the study protocol (≥90 %). Within-group analysis for both groups, across the three time points, identified significant differences utilizing Friedman’s test (p<0.001) between measures for orofacial pain, TMD severity, MMO, and CVA. Between-group comparison identified no difference at the follow-up assessments for orofacial pain or MMO measures (p>0.05). The Mann-Whitney U test for between-group comparisons identified a statistically significant difference in CVA at week 3 (p=0.01) and at the 6th week (p<0.001) favoring the experimental group. For the TMD severity score, no difference was found at week 3 (p=0.11) but there was a significant difference between groups at week 6 (p=0.02) favoring the experimental group. Conclusions These preliminary findings suggest that adding FHP correction through the application of a CET orthotic might offer short-term selected benefits for chronic TMD symptoms, which would need to be confirmed in a full-scale trial. High adherence rates were found with a moderate effect size that provided data indicating that at least 38 participants would be required for a full-scale study.
Open Access
Associations in fetal outcomes from cesarean sections with maternal comorbidities: a cross-sectional study of the Pregnancy Risk Assessment Monitoring System

January 1, 2000

Mackenzie Enmeier, Elise Stephenson, Jordyn Prince, Caroline Markey, Binh Phung, Micah Hartwell

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Context Cesarean sections (CSs) can reduce maternal and fetal risk in medically necessary cases. However, studies show that CSs are associated with negative fetal outcomes, including birth defects, low birth weight, delayed fetal resuscitation, neonatal acidosis, and even infant mortality. Maternal comorbidities play a role in determining if a CS is necessary and may contribute to negative fetal outcomes following a CS. Objectives The primary objective of this study was to determine the prevalence of negative fetal outcomes such as low birth weight, birth defects, prolonged hospital stay, and infant mortality in CS deliveries and their increased risk of occurrence among mothers with comorbidities. Methods We conducted a cross-sectional study of the Phase 8 (2016–2019) Pregnancy Risk Assessment Monitoring System (PRAMS) to assess the associations of the aforementioned birth outcomes with pre-existing conditions such as high blood pressure (HBP), depression, and type II diabetes mellitus, as well as demographic factors in the United States (US). Results Our findings showed that mothers who delivered via CS with pre-existing or gestational HBP, or gestational diabetes, were less likely to experience infant mortality (adjusted odds ratio [AOR]: 0.4; confidence interval [CI]: 0.17–0.92, AOR: 0.2; CI: 0.09–0.44, and AOR: 0.09; CI: 0.03–0.33, respectively). However, mothers who delivered via CS with pre-existing or gestational diabetes, pre-existing or gestational HBP, or pre-existing or gestational depression had higher rates of prolonged infant hospital stay (AOR: 1.73; CI: 1.41–2.11, AOR: 1.21; CI: 1.05–1.39, AOR: 1.77; CI: 1.5–2.09, AOR: 2.58; CI: 2.31–2.88, AOR: 1.25; CI: 1.09–1.43 and AOR: 1.33; CI: 1.16–1.52, respectively). Likewise, mothers who delivered via CS with pre-existing or gestational HBP, or pre-existing or gestational depression, were more likely to deliver an infant with low birth weight (AOR: 1.88; CI: 1.62–2.19, AOR: 2.7; CI: 2.45–2.98, AOR: 1.24; CI: 1.09–1.41, and OR: 1.28; CI: 1.14–1.42, respectively). Conclusions Our study revealed a lower incidence of infant mortality following CS deliveries among mothers with pre-existing or gestational HBP, or gestational diabetes. This suggests a potential benefit in antenatal testing in mothers experiencing depression or those with no comorbidities. Additionally, infants born to mothers with these comorbidities experienced longer hospital stays, and infants of mothers with pre-existing or gestational HBP and depression had a higher incidence of low birth weight. Given the increasing rates of diabetes, HBP, and depression in the US, it is crucial to provide healthcare professionals with the necessary guidance to prevent and manage these comorbidities and improve fetal outcomes following CS deliveries.
Open Access
Painful and exophytic tumor on the thigh

January 1, 2000

Milie M. Fang, Kevin P. White, Alex G. Ortega-Loayza

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Open Access
A quantitative analysis comparing pre-clinical volunteering hours with third-year medical students’ preceptor evaluations

January 1, 2000

Emily K. Ranta, Joshua C. Ranta, David Redden, Alexis M. Stoner

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Context Many studies have suggested that participation in pre-clerkship volunteering opportunities is associated with higher confidence in clinical skills, improved perspectives on social barriers, and greater soft skills and empathy. While these studies have described a positive impact on subjective qualities, few studies have investigated the impact on objective standards such as third-year evaluations. Objectives The aim of this study was to explore the relationship between volunteer hours and third-year evaluations, with the hypothesis being that these previously studied, perceived benefits of volunteerism would translate to better evaluations. Methods This retrospective cohort study stratified a class of 161 medical students by volunteer hours completed during pre-clerkship years and self-recorded into the Translating Osteopathic Understanding into Community Health (TOUCH) reporting system. Preceptor evaluations were gathered utilizing the school’s report system and were analyzed in categories that included communication, problem solving, clinical skills, osteopathic manipulative medicine (OMM), medical knowledge, and professional/ethical standards. The statistical analyses utilized included Pearson and Spearman correlations. Results At the time of data accruement, only 127 of the 161 students had completed all required rotations and had completed evaluations. Therefore, the final sample size analyzed was 127 students and 1,321 evaluations. The average overall score on evaluations was 4.47, and the average number of logged TOUCH hours was 65.63. After Pearson and Spearman correlational analyses, no statically significant results were found (p>0.05). Conclusions Although previous studies suggest the positive impact of volunteering on confidence in clinical abilities, this study suggests no statistically significant correlation between TOUCH hours and preceptor evaluations. Current literature suggests that this may be due to preceptor subjectivity, evaluator and clinical engagement, and grade inflation. Given that evaluations are an important factor in residency interview selection, this study raises the question on how to adapt volunteerism and evaluation standards to better prepare osteopathic medical students for residency and beyond.
Open Access
Evaluating the acute effect of osteopathic manipulative treatment on sprint performance in young adults

January 1, 2000

Garrick Quackenbush, Arielle Navarro, Dresdan Quackenbush, Catherine Arnold, Kalin Sorenson, Kodi Jo McKinlay, Andrew Jacob Roush, Cory Cosgrave

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Context Osteopathic manipulative treatment (OMT) has been shown to improve athletic performance by enhancing shoulder range of motion, flexibility, and balance in various sports. However, its effects on sprint performance, particularly in competitive environments, remain understudied. Sprinting is a high-intensity activity that depends on anaerobic capacity, neuromuscular efficiency, and volume of oxygen (VO2) max. Although OMT has demonstrated potential in enhancing muscle function, its acute impact on 60-m sprint performance has not been established. Objectives This randomized controlled study, approved by the Rocky Vista University Institutional Review Board (IRB), aimed to evaluate whether OMT could improve 60-m sprint times in competitive athletes and explore its potential integration into sideline protocols. Methods Participants were 31 young adults recruited from the community. After providing informed consent, participants completed a standardized 10-min dynamic warm-up, followed by their first timed 60-m sprint trial. Participants were then randomized into two groups: a treatment group receiving a 5-min lower-extremity OMT protocol administered by an osteopathic physician, and a control group receiving 5 min of sham therapeutic ultrasound (STU). A second 60-m sprint was performed under identical conditions to the first trial. Sprint times were measured individually to ensure consistency. Results Statistical analysis revealed modest improvements in sprint times within both groups. The treatment group showed a mean improvement of 0.0693 s, while the control group demonstrated a 0.0275 s improvement. Further paired t -test analyses showed that the results were not significant. Conclusions Although these improvements were not statistically significant, they indicate a slight trend favoring OMT. Between-group analysis did not reveal significant differences (p=0.477), suggesting that the observed changes were comparable across groups. Although OMT produced slight improvements in sprint performance, these changes were not statistically significant. This suggests that OMT may not yield immediate measurable benefits for 60-m sprint times in young adults. However, the observed trend warrants further investigation. Future studies with larger sample sizes, varied athletic populations, and alternative treatment protocols may help clarify the acute effects of OMT on sprint performance. These findings contribute to the growing body of research on OMT and raise new questions regarding its potential role in enhancing performance in athletic activities.
Open Access
Chronic pain outcomes among patients treated by osteopathic vs. allopathic physicians: a 36-month follow-up study

January 1, 2000

John C. Licciardone, Hanna Lewis, Kaylee Dahl, Branden Adams, Subhash Aryal

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Context Osteopathic physicians take a whole-person approach to medical care that may be seen in their relationships with patients and may involve utilizing osteopathic manipulative treatment (OMT) as an alternative to opioid therapy in patients with chronic pain. Objectives This study aimed to compare the outcomes of patients with chronic low back pain (CLBP) treated by osteopathic and allopathic physicians in the United States utilizing a pragmatic design reflecting medical care in real-world settings, including an assessment of potential mediators of osteopathic medical care. Methods A retrospective cohort study was conducted utilizing patients with CLBP selected from the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION) from September 2016 through September 2024. Patients were followed at quarterly encounters for up to 36 months after PRECISION enrollment to determine if they were receiving their CLBP medical care from either osteopathic or allopathic physicians. Outcomes pertaining to pain, function, pain impact, health-related quality of life (HRQOL), and the frequency of chronic widespread pain (CWP) and CLBP recovery were also measured at these encounters utilizing generalized estimating equations. Results were adjusted for sociodemographic and clinical characteristics in multivariable analyses. Regression-based analyses were utilized to determine if OMT, opioid prescribing, or physician empathy mediate the outcomes of osteopathic medical care. Results There were 1,491 patients in the study, including 278 (18.6 %) and 1,213 (81.4 %) treated by osteopathic and allopathic physicians, respectively. A total of 8,854 encounters were completed over 36 months, including 2,107 (23.8 %) and 6,747 (76.2 %) in the osteopathic and allopathic medical care groups, respectively. The adjusted means (95 % confidence intervals [CIs]) for patients treated by osteopathic vs. allopathic physicians were 6.3 (6.0–6.6) vs. 6.5 (6.3–6.7) for low back pain intensity (p=0.05); 14.8 (13.8–15.8) vs. 15.6 (14.8–16.4) for back-related disability (p=0.008); 31.9 (30.6–33.2) vs. 32.7 (31.7–33.7) for pain impact (p=0.07); and 57.8 (56.7–58.8) vs. 58.4 (57.6–59.3) for HRQOL deficits (p=0.04). The frequency of CWP occurrence (risk ratio [RR], 1.00; 95 % CI, 0.87–1.15; p=0.98) and CLBP recovery (RR, 0.65; 95 % CI, 0.38–1.11; p=0.12) did not differ between the osteopathic and allopathic medical care groups after adjusting for potential confounders. The significant results pertaining to pain, function, and HRQOL were consistently and most strongly mediated by physician empathy and, to a lesser extent, by OMT. Conclusions This study found that patients with CLBP treated by osteopathic physicians reported better outcomes for pain, function, and HRQOL than patients treated by allopathic physicians over 36 months of follow-up. These effects of osteopathic medical care were most consistently and strongly mediated by physician empathy and, to a lesser extent, by OMT. Osteopathic medical care was not associated with decreased CWP occurrence or increased CLBP recovery.
Open Access
Why is identification with osteopathy decreasing in medical students?

January 1, 2000

Zachary S. Kauffman, Tony Harper, Robert A. Augustyniak, Chloe Ruff

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Context Across eight classes at Lincoln Memorial University – DeBusk College of Osteopathic Medicine (DCOM), survey data reveal a decrease in students’ identification with osteopathy, which is what distinguishes an osteopathic physician’s values, attitudes, and commitment to the tenets of osteopathy. Without intervention, this trend of decreasing osteopathic identification may produce future generations of osteopaths who devalue the specific tenets of osteopathy. Objectives This study aims to determine factors that influence a student’s identification with osteopathy, as quantified by Likert-style survey response data, and to precisely quantify these factors’ predictive effect on osteopathic identification while simultaneously controlling for other possibly confounding factors. We hypothesize that preparedness and osteopathic manipulative medicine (OMM) skills will be the strongest predictors of osteopathic identification. Methods We utilized retrospective survey data from 1991 past DCOM students. Identifying data were redacted and replaced with research IDs. The survey contained an item that gauged respondents’ identification with osteopathy. To explore our primary objective, we utilized paired samples t tests to determine changes in osteopathic identification from matriculation to graduation within each class, as well as Pearson’s correlation coefficient to determine each item’s correlation with osteopathic identification. To explore objective 2, we utilized multiple regressions and structural equation modeling (SEM) path analyses to quantify these factors’ ability to predict osteopathic identification. Results Osteopathic identification decreased between matriculation and graduation for each class (10–21 % decrease, p<0.001). Feeling highly motivated to serve the community correlated best with osteopathic identification upon matriculation (r=0.2; p<0.001). One’s perception of one’s OMM skills – both in explaining OMM philosophy (r=0.5; p<0.001) and utilizing OMM (r=0.5; p<0.001) – as well as feeling happy to be an osteopath (r=0.6; p<0.001), best correlated with osteopathic identification upon graduation. OMM Skills have the greatest direct predictive effect on osteopathic identification, with an effect size of 0.4 (p<0.001). Commitment to Organization, mediated by both OMM Skills and Preparedness, has the greatest overall predictive effect on osteopathic identification, with an effect size of 0.6 (p<0.001). Conclusions The current study builds on past research by utilizing SEM path analysis to elucidate the predictive value of multiple factors on osteopathic identification. Application of the current study should consider looking at interventions geared toward increasing students’ OMM skills as well as their commitment to their institution, field, and career overall.
Open Access
Why don’t more physicians use osteopathic manipulative medicine? A cross-sectional study of utilization and referral barriers

January 1, 2000

Stephen K. Stacey, Anthony Furlano, Joanne Genewick, Erin Westfall, Bryan Gordon, Jiwan Toor

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Context Evidence supports osteopathic manipulative medicine (OMM) as an effective manual therapy, although it remains underutilized by Doctors of Osteopathic Medicine (DOs). Objectives Understanding barriers preventing the broader adoption of OMM is essential to expanding access to it as a noninvasive treatment option. We set out to survey both DOs and non-DO clinicians to identify perceived barriers to OMM. Methods Survey items were adapted from prior studies utilizing an iterative refinement process that included cycles of pilot testing with revisions. Participants were recruited internally from Mayo Clinic Midwest – a large, multistate, healthcare system in the Midwest region of the United States – utilizing internal email. Participants were given a descriptive survey that was developed with support from the Mayo Clinic Survey Research Center. Results The survey was sent out to a total of 952 individuals, including 184 DOs and 768 non-DO clinicians (MD, Bachelor of Medicine, Bachelor of Surgery [MBBS], nurse practitioners, and physician assistants). Respondents included 76 DOs (41.3 % response rate) and 91 non-DOs (11.8 % response rate). Of the 76 DO respondents, 21 (27.6 %) reported utilizing OMM clinically. Commonly reported barriers include time limitations, poor public perception, and lack of training in residency, and time is allocated to other professional interests. Conclusions Within a large health system that includes primary care and specialty care, few DOs practice OMM, citing time constraints, lack of residency training, and competing professional interests as primary barriers. These challenges might successfully be addressed through targeted osteopathic manipulative treatment (OMT) education in residency programs, enhanced compensation, and improved referral pathways.
Open Access
Ultrasound shear wave elastography to assess neck somatic dysfunction and OMT effects

January 1, 2000

Jing Gao, Eliaz Lynch, Michele Coleman, John Moore, David Park, Benjamin Wilde

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Context Osteopathic assessment and osteopathic manipulative treatment (OMT) have been utilized in managing chronic neck pain (CNP) and neck somatic dysfunction. However, osteopathic assessments lack quantitative measures to detect muscle abnormalities and evaluate the effect of OMT. Objectives This study aims to investigate the feasibility of utilizing ultrasound shear wave velocity (SWV) and shear wave relative anisotropy coefficient (SWRAC) to assess neck somatic dysfunction and the effect of OMT. Methods After receiving Institutional Review Board (IRB) approval and informed consent, we measured upper trapezius muscle (UTM) SWV in both longitudinal and transverse planes. We calculated SWRAC utilizing the formula: (SWV longitudinal – SWV transverse )/SWV transverse . We analyzed differences in muscle SWV and SWRAC between different age groups utilizing one-way analysis of variance (ANOVA). For the comparison in SWV and SWRAC between UTMs with and without neck somatic dysfunction, we utilized an unpaired t -test, although we examined the changes in SWV and SWRAC before and after OMT utilizing a paired t -test. We also evaluated correlations between SWV and muscle somatic dysfunction utilizing Spearman correlation. The diagnostic performance of SWV in identifying neck somatic dysfunction was assessed utilizing the area under receiver operating characteristic curve (AUC). Inter- and intra-observer reliability in measuring muscle SWV was analyzed utilizing intraclass correlation coefficient (ICC). Results From November 2022 to August 2024, we measured muscle SWV in 158 adults (68 men, 90 women, mean age 49 years) without (51) and with (107) neck somatic dysfunction. We observed significant differences in SWV and SWRAC between UTMs with and without somatic dysfunction, and before and after OMT (p<0.01). Longitudinal muscle SWV was high in elderly subjects and those with neck somatic dysfunction. Longitudinal SWV positively correlated to neck somatic dysfunction ( R 2 =0.69). AUC of SWV for determining neck somatic dysfunction was 0.86. ICCs for measuring SWV ranged from 0.80 to 0.99. Conclusions The SWV in longitudinal muscles shows a positive correlation with neck somatic dysfunction, demonstrating moderate diagnostic accuracy and strong observer reliability. Application of OMT significantly decreases muscle stiffness measured by SWV, providing an objective and quantitative method to assess the effectiveness of OMT.
Open Access
Characterizing traumatic brain injury in unsheltered homelessness: prevalence of TBI and cognitive sequelae in individuals utilizing street medicine

January 1, 2000

Graham Atkin, Jessica Reece, Isabel Moran

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Context People experiencing homelessness are at a disproportionately greater risk for developing traumatic brain injury (TBI) than the general population. There has been minimal research to evaluate the prevalence of TBI or the long-term cognitive impacts of TBI among the population experiencing homelessness within the United States. There is minimal literature that examines individuals who are living unsheltered, especially regarding TBI. Objectives This study aimed to assess primarily whether those experiencing unsheltered homelessness had a higher prevalence of TBI than those in shelter. Furthermore, we examined the differences in the prevalence of repeated TBIs, TBI by age of respondent, loss of consciousness (LOC), and cognitive symptoms in people experiencing homelessness across three housing strata (sheltered, low-barrier sheltered, and unsheltered) within a small midwestern city. Methods Participants were recruited utilizing a convenience sampling of patients who utilized street medicine healthcare services. The study enrolled 102 patients during the interval of October 2022 through March 2024 from three housing strata (sheltered, low-barrier sheltered, and unsheltered) in Lansing, Michigan. We employed the Ohio State TBI Identification Method, abbreviated for ease of use. Results were analyzed for associations between TBI and health conditions utilizing chi-squared tests and a single difference-of-proportions test. Results Seventy-five of 102 (73.5 %) of participants reported at least one TBI, with 48 % experiencing their first TBI more than 20 years ago. There was a significant difference in TBI prevalence across housing strata. Ninety percent (90 %) of unsheltered survey respondents reported at least one previous TBI, with 50 % reporting three or more previous TBIs. These rates exceeded those of respondents in shelter (58 % prevalence, 21 % 3+ TBIs) and low-barrier shelter (65.1 % prevalence, 26 % 3+ TBIs), all of which exceeded the reported TBI prevalence for the general population (21.7 %). TBI prevalence did not vary significantly by age. LOC following TBI among participants significantly exceeded that of the general population (48 vs. 12 %). The prevalence of severe TBI was significantly greater than the general population for low-barrier shelter (16 vs. 2.6 %) and unsheltered respondents (23 %), but not for sheltered participants. Many respondents (62.6 %) developed cognitive symptoms as a result of TBI, although no statistical difference emerged between the groups. Cognitive sequalae were most common among those with three or more TBIs. Conclusions Taken together, these results suggest that the likelihood of TBI and the associated risks present a greater threat to those experiencing homelessness. There is a propensity to most strongly affect those living unsheltered.
Open Access
The effectiveness of training student physicians in culturally sensitive patient care using an interprofessional culturally competent curriculum

January 1, 2000

Aida Aminpour, McKenzie Gelvin, Abigail Smurzynski, Frank Gardner, Jeffrey Gardere

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Context As patient populations become increasingly diverse, the need for training and education in providing culturally competent care among student physicians, and Master’s in Interdisciplinary Studies in Biological and Physical Sciences (MS) students, becomes critical. This training is vital for the safety and well-being of patients, as well as for achieving better patient health outcomes. Objectives This study aims to measure and compare the efficacy in improving cultural competency skills among these students after completing cultural competency courses in their respective medical programs: an interprofessional (IPE) cultural competency course for first-year Doctor in Osteopathic Medicine (DO) students and a cultural competency course for MS. Both of the classes took place online. Methods A Qualtrics survey consisting of a modified version of the Cultural Awareness Scale (CAS) was electronically distributed to students before and after completing the Introduction to Cultural Competency course for first-year DOs and a cultural competence course for Master’s students at Touro College of Osteopathic Medicine (TouroCOM). A total of 141 results were analyzed and compared differences in the means of Total CAS score values utilizing paired and independent t -tests. This study was approved by the TouroNY institutional review board (#18532). Results On average, the Master’s mean Total CAS scores were 6.6 points higher on the postclass survey compared to the preclass survey ( t 40 =2.3, p<0.05); however, there was no significant difference between the preclass and postclass mean Total CAS scores of the DO students. Additionally, in the postclass survey, the current Master’s students’ mean Total CAS scores were on average 14.3 points higher than the DO students ( t 39.9 =5.096, p<0.001). This difference was also reflected in analyses conducted on former Master’s students. This finding is compounded by the fact that we found no significant difference between these groups’ mean CAS scores in the preclass surveys (p=0.170). Conclusions Based on the previously mentioned findings, we can deduce that Master’s students showed an improvement in cultural competency skills after attending a cultural competency course for MS, although the first-year DO student physicians did not show any significant change in cultural competency skills after taking an IPE cultural competency curriculum. Based upon the results from both the DO and MS students, the establishment and inclusion of a cultural competency class with a developed curriculum is crucial for reducing bias and addressing medical-based discrimination.
Open Access
Expanding the role of OMT in chronic rhinosinusitis: a welcome step forward

January 1, 2000

James R. Burmeister

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Open Access
Erythromelalgia: a cutaneous manifestation of polycythemia vera

January 1, 2000

Mark Saad, Robert Dazé

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Open Access
Predicting COMLEX-USA Level 2-CE using medical school performance and use for student advising

January 1, 2000

Shiyuan Wang, Pamela Basehore

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Context As Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Level 1 has changed to Pass/Fail scoring, residency programs that required minimum Level 1 scores for applicant consideration may choose to focus on COMLEX-USA Level 2-Cognitive Evaluation (Level 2-CE) target scores for applicant selection. Therefore, finding ways to predict passing and high Level 2-CE performance based on students’ past performance and to guide their study accordingly is essential for helping students succeed in and beyond medical school. Objectives The purpose of this retrospective study is to evaluate the predictive value of major performance measures from pre-admission to clerkship years on Level 2-CE. Then, based on the predictive value of those measures, the objective is to establish a predictive model and optimal cutoff scores with strong predictors to advise students on their preparation of Level 2-CE. Methods School-based performance measures for 948 first-time takers of the Level 2-CE Testing Cycles of 2019/20 to 2023/24 were analyzed. Correlational and multiple regression analyses were utilized to establish a predictive model utilizing: (1) preadmission and preclerkship performance (Medical College Admission Test [MCAT], undergraduate science grade point average [GPA], and preclerkship examination average); (2) national examination performance including the new COMLEX-USA Level 1 pass/fail-only status, individual and average clinical subject Comprehensive Osteopathic Medical Achievement Test (COMAT) scores, and the less studied Comprehensive Osteopathic Medical Self-Assessment Examination (COMSAE) Phase 2; and (3) clinical evaluation scores by preceptors. Then, receiver operating characteristic (ROC) curves were utilized to identify the optimal cutoff scores on the average clinical subject COMATs and COMSAE Phase 2 for student advising. Results A predictive model of COMLEX Level 2-CE was established with average clinical subject COMAT scores, first-time COMSAE Phase 2, preclerkship examination mean, and COMLEX Level 1 Pass/Fail status as the significant predictors. This model explained 73.9 % of the variance in Level 2-CE performance. Optimal cutoffs of the average clinical subject COMAT scores and first-time COMSAE Phase 2 performance were identified for passing Level 2-CE (COMSAE=447, average COMAT score=94.4) as well as having a high performance of Level 2-CE (650 & 700, respectively). Conclusions This study not only added evidence in support of previous studies on the bivariate associations between Level 2-CE and individual major performance measures from the preadmission to clerkship years, but also explored the use of the less-studied COMSAE Phase 2 in predicting Level 2-CE outcomes and provided a better predictive model utilizing the combination of individual performance measures. Most importantly, the current study also demonstrated a way to set optimal cutoff scores on strong predictors during the clerkship years to help the school guide students to better success on COMLEX Level 2-CE and long-term residency goals.
Open Access
An unusual chest lesion with dual pathologies

January 1, 2000

Jessica Colon, Jay Nguyen, Samuel Stahly, Gulsun Erdag, Rajiv Nathoo

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Granuloma faciale (GF) is a rare, benign, chronic inflammatory condition characterized by well-defined reddish-brown papules, nodules, or plaques, often demonstrating follicular accentuation and telangiectasia, which may be termed “peau d’orange.” Typically, GF is localized to the facial area, but extrafacial variants have been reported, particularly on the trunk, scalp, and extremities. We report a 66-year-old male with a history of GF and multiple basal cell carcinomas (BCCs) who presented with a pearly plaque on the chest. Biopsy revealed extrafacial GF with a coincidental BCC, representing a rare case of a collision tumor. GF, typically a facial condition, can present in extrafacial locations, complicating the diagnosis. This case emphasizes the importance of thorough histopathological evaluation to identify concurrent pathologies in atypical skin lesions.
Open Access
Osteopathic manipulative treatment for refractory chronic traumatic pain and mobility restrictions at a level 1 trauma center

January 1, 2000

Gerard A. Baltazar, Michelle Cao, Jared Van Vleet, Sky Hart, Andrea Jakubowski, Nathan Suree, Patrizio Petrone, Shahidul Islam, Francisco Machado, Jerry Rubano

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Context Traumatic musculoskeletal injuries may result in chronic pain and mobility limitations, decreasing quality of life, and increasing predisposition to comorbid disorders. Osteopathic manipulative treatment (OMT) utilizes palpatory assessment and application of manual forces as an adjunct intervention for musculoskeletal disease. Multiple studies have demonstrated OMT’s potential benefits for a range of disease states, but data on osteopathic OMT are limited. Objectives The objective of our study was to understand the potential benefits of a novel OMT for trauma outpatient program for the care of injured patients suffering chronic pain and mobility limitations. Methods In 2021, the New York University (NYU) Langone Hospital – Long Island Level 1 Trauma Center established a novel outpatient OMT for Trauma Program (OTP). We performed a retrospective analysis of OTP patients seen from January 1, 2021 to December 31, 2022 with the chief complaint of refractory chronic (persistent ≥3 months since inciting injury) postinjury pain and mobility limitations (inclusion criterion). We excluded patients missing follow-up, then extracted and analyzed patient demographic, injury-specific, and OMT data. Data are presented as frequencies (percentages) or medians (interquartile range [IQR]). Results Forty-three patients (75.4 % of patients treated at the outpatient OTP) reported a mechanism of injury (MOI). Of these, 30 (69.8 %) met the inclusion criteria, and seven met the exclusion criterion, yielding 23 total patients for the analysis (40.3 % of the total OTP population). 73.9 % were female aged 46 (39–59) years old. Patients presented 3.00 (0.58–20) years since etiologic injury. MOIs included 56.5 % motor vehicle collisions (MVC), 21.7 % falls, 8.7 % penetrating, and 13.0 % sports-related or lifting injuries. Patients reported 3 (2–4) treatment modalities tried and 2 (1–3) medications attempted prior to the OTP. After the first OMT session, 95.7 % of patients reported subjective improvement in pain with a decrease in pain score 3 (3–7) out of 10. After OMT, patients also self-reported ease of activities of daily living (ADLs, 82.6 %), improved sleep hygiene (26.1 %), improved anxiety/mood (65.2 %), and decreased use of analgesic medication (13.0 %). Four (17.4 %) reported post-OMT complication of 2–3 days of self-limited, mild musculoskeletal pain. Univariate logistic regression models demonstrate that OMT benefited patients regardless of time since inciting injury. Conclusions OMT may benefit refractory chronic traumatic pain and mobility limitations regardless of the time since inciting the injury. This is the first major publication from the OTP and bolsters proof-of-concept for an organized OMT program at a level 1 trauma center. Further study, including comparative analysis with more formalized pain assessments utilizing validated tools as well as standardized OMT session surveys, is warranted.
Open Access
The impact of adverse childhood experiences on age of diabetes diagnosis and associations with race and ethnicity

January 1, 2000

Allie Rice, Madison Taylor, Amy Hendrix-Dicken, Covenant Elenwo, Julie Croff, Laura J. Chalmers, Sara Coffey, Micah Hartwell

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Context Previous research has linked the manifestation of multiple chronic diseases that are frequently due to health behaviors to adverse childhood experiences (ACEs). Despite this, the link between ACEs and the age of type 2 diabetes mellitus (T2DM) diagnosis is scarce. Objectives As such, our primary objective was to evaluate and describe the impact of ACEs on the age at diagnosis utilizing the data from the 2021 Behavioral Risk Factor Surveillance System (BRFSS). Our secondary objective was to analyze the relationship between various demographic factors and the age of T2DM diagnosis. Methods We conducted a cross-sectional analysis of data from the 2021 cycle of the BRFSS. Applying sampling weights, provided by BRFSS, we assessed the prevalence rates of ACEs across sociodemographic variables and utilized binary and multivariable regressions to determine associations between sociodemographic factors and ACE scores on age of T2DM diagnosis. Results Among the 437,708 respondents, 57,616 (12.6 %) individuals reported having diabetes, with 6901 including responses for age of T2DM diagnosis and ACEs. We found a relationship between ACEs and earlier age of diabetes diagnosis – with individuals experiencing 1–3 ACEs being diagnosed 2.15 years earlier (standard error [SE]=0.48, p<0.001) than those with 0 ACEs, and 6.37 years earlier for individuals experiencing 4+ ACEs (SE=0.61, p<0.001). Significant differences in ACEs and age of diagnosis were also found between ethnoracial groups – compared to White, non-Hispanic individuals with 0 ACEs, the mean age of diagnosis was more than 12 years earlier among those who experienced 4+ ACEs and were either Asian, American Indian/Alaskan Native (AI/AN), or Hispanic. Conclusions This observational analysis of one-year of BRFSS data found earlier diagnosis of T2DM among adults reporting ACEs compared to those without ACEs, but this varied by racial and ethnic identities. Although early diagnosis is critical in long-term T2DM management, appropriate identification of childhood adversity may be a key component to the development of the disease. This may be achieved through comprehensive child and family resources that target mental health and behavioral factors already known to be associated with T2DM.
Open Access
Effects of a myofascial and lymphatic osteopathic manipulative treatment protocol on mood and body connection: a randomized pilot study

January 1, 2000

Erika C. Levy, Min-Kyung Jung

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Context Fascia is a ubiquitous and continuous connective tissue containing receptors involved in nociception, proprioception, and the autonomic nervous system. In conjunction with muscle, the myofascial system plays an important role in body mechanics and connectivity. Beyond structure and function, research implicates the myofascial system in the pathophysiology of depression, anxiety, and stress. As understanding of these multidimensional conditions evolves, there is increasing emphasis on integrated treatment approaches such as osteopathic manipulative treatment (OMT). The myofascial system presents a promising target for standardized treatment that bridges the gap between physical and psychological. Objectives The objective of this study was to investigate the effects of a standardized myofascial and lymphatic OMT protocol on body awareness, dissociation, and mood symptoms related to anxiety, depression, and stress. Methods This was a prospective, randomized, parallel-assignment, open-label, interventional study with 31 volunteer students and staff from an osteopathic medical college. An external party randomly assigned volunteers to one of two groups: OMT intervention or control. Triplanar diagnoses of the occipitoatlantal (OA), cervicothoracic (CT), thoracolumbar (TL), and lumbosacral (LS) regions were obtained and recorded for all subjects for 4 consecutive weeks during a weekly scheduled session. The experimental group was treated with direct myofascial release and a lymphatic pedal pump. Primary outcome measures were scores on the State-Trait Anxiety Inventory (STAI Form Y2), Depression Anxiety Stress Scale (DASS), and Scale of Body Connection (SBC) at baseline (T1), after two treatments (T3), and after four treatments (T4). The effects of OMT on mood and body connection over time were modeled with generalized estimating equations (GEEs). Cohen’s d effect size was also determined for the between-group comparisons. Results A total of 31 participants volunteered for the study. Due to scheduling conflicts, 29 participants (21 females, 72.4 % and 8 males, 27.6 %), with ages ranging from 22 to 54 (M=30.9 years, SD=9.4) were randomly assigned to OMT intervention (n=14) or control (n=15). Medical students comprised 72.4 % (n=21) of the population, whereas the remaining 27.6 % (n=8) were faculty or staff employed by the medical school. The average BMI for female participants was 26.7 (SD=4.9), and 26.4 (SD=4.8) for males. The prevalence of the psychiatric conditions among the participants was high, with 17 (58.6 %) participants reporting a psychiatric diagnosis at some point in their life, with only 3 of the 17 (17.7 %) reporting remission. Significant improvements in trait anxiety (p<0.001), depression (p=0.028), body awareness (p=0.046), and body dissociation (p=0.003) occurred in the experimental group over all time periods. Experimental group improvements in DASS (T1–T4; MD=−9.87; p=0.005; 95 % CI [–16.69, −3.04]) and stress (T1–T4; MD=−3.93; p=0.020; 95 % CI [–7.24, −0.63]) were observed after four treatments. Conclusions A standardized myofascial and lymphatic OMT protocol may have a positive effect on trait anxiety, depression, stress, body awareness, and body dissociation.
Open Access
Erratum to: Longitudinal outcomes among patients with fibromyalgia, chronic widespread pain, or localized chronic low back pain

January 1, 2000

John C. Licciardone, Elizabeth Brownell, Uchechi Nwaichi, Arpan Patel, Khanh Do

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Open Access
Technology use and satisfaction among colleges/schools of osteopathic medical education

January 1, 2000

Machelle Linsenmeyer, Lance Ridpath

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Context In March 2020, as the COVID-19 pandemic became a national concern, quick assessment and rapid changes needed to be made in all areas of osteopathic medical education. The Technology in Medical Education (TIME) adaptive working group was formed by the American Association of Colleges of Osteopathic Medicine (AACOM) to analyze best practices in technology applications used in the schools and colleges of osteopathic medicine (COMs). In January 2023, post-pandemic data was collected to provide comparisons of technology use over time and determine the current landscape of technology. Objectives To determine the technological uses and satisfaction at COMs nationally and offer a comprehensive list of software being used in osteopathic medical education to help inform technology decisions. Methods Survey instruments were used to gather data from 34 COMs (main campuses, branch campuses, and additional locations) during COVID-19 and 49 COMs post-COVID-19. Data was collected during COVID-19 from April 2020 to December 2020 with data analysis through April 2021. Data was collected post-COVID-19 from January 2023 to April 2023 with data analysis through March 2024. Five questions were consistent across both surveys and used for comparisons. Descriptive statistics, Fisher’s exact tests, and thematic analysis were utilized in the data analysis for both surveys. Results Of the 57 COMs surveyed during COVID-19, 34 responses were received for an overall response rate of 59.6 % (34/57). Of the 62 COMs surveyed post-COVID-19, 49 responses were received for a response rate of 79.0 % (49/62). To capture changes across time, thirty-four (34) institutions responded to the five identical questions on both surveys. While software selection was diverse across institutions, overall satisfaction remained high with 75.0 % of COMs being extremely or moderately satisfied with their software selections. Popular software packages across the two survey periods included Canvas (36.4 %, 54.9 %), Panopto (29.0 %, 27.5 %), ExamSoft (81.8 %, 84.0 %), and eValue (44.8 %, 28.6 %). Software shifts saw increased usage of Canvas (36.4–54.9 %), Yuja (3.2–11.8 %), Zoom for remote proctoring (5.2–35.3 %), and internal/custom solutions for clinical education/scheduling (3.4–10.2 %) and decreased usage of Vimeo (9.7–0.0 %), Respondus (9.0–0.0 %) and ExamMonitor (63.2–20.5 %). Comments indicated an interest in the national resources related to topics such as telehealth, public health, health system science, and health informatics. Key takeaways included the need for shared online training material in both preclinical and clinical education; development of new virtual or gaming technologies; and training faculty and staff to support technology integration. Conclusions Technology selection at medical schools is on-going but relatively consistent across time. This was especially true through the COVID-19 pandemic and with the ongoing increase in new osteopathic medical schools. This research offers a comprehensive list of software being used in osteopathic medical education including a snapshot of changes during and post-COVID-19 to help inform technology decisions across osteopathic medical education. In addition, these results are driving the planning process for AACOM initiatives into the future.
Open Access
Nailing the diagnosis

January 1, 2000

Milie M. Fang, Lyudmyla Susla, Phoebe Rich

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Open Access
A proven template for providing streamlined, scalable, cost-effective clinical research opportunities in osteopathic medical schools

January 1, 2000

Jacey N. Greek, Andrew P. Greek, Mari Hopper, Robert Arnce

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Context In an era in which clinical research plays a crucial role in advancing medical knowledge and contributing to the resume of medical students attempting to match into a residency, the creation of sustainable and effective research opportunities within medical education is paramount. Colleges of Osteopathic Medicine (COMs) face unique challenges in creating these opportunities in a scalable and cost-efficient manner. Without these opportunities, osteopathic medical students may find themselves at a disadvantage compared to their allopathic counterparts in residency placements and academic career paths. Objectives We have created a template for providing perpetual, streamlined, scalable, cost-effective clinical research at our institution, and we believe that it can be implemented at other COMs. This abstract describes our research template and its outcomes. Methods Our template for creating clinical research opportunities has been in operation for the past 3 years. All of our studies are structured as retrospective analyses of data obtained from the electronic medical records of patients admitted to the hospital over a specific time frame. Initially, a broad-based research proposal is submitted to the hospital Institutional Review Board (IRB) on a particular topic. From this, multiple initial IRB research projects are generated. First- and second-year medical students go through a standardized application and onboarding process prior to participation in research. Students are then subdivided into research groups of four students each. Each research group is assigned a research topic and a faculty mentor who will help them navigate through the research project. Results Since 2022, a total of 295 medical students have participated in clinical research through this model, supported by 11 faculty research mentors. Across four completed research cycles, 64 projects have been conducted, resulting in 62 poster presentations (97 %), 15 peer-reviewed publications (23 %), and 6 additional manuscripts (9 %) currently under review. Conclusions Clinical research opportunities at COMs are needed now more than ever before. Over the past 3 years, our clinical research template has been proven to provide perpetual, streamlined, scalable, cost-effective clinical research. We believe that our template can be utilized to provide increased clinical research opportunities at other COMs.
Open Access
Cutaneous manifestations of Addison’s disease

January 1, 2000

Christy Lu, Dominique Jacobs, Stacey Blannett, Ranita E. Kuryan, Shane M. Swink

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Open Access
The mechanism of muscle energy for a superiorly subluxed rib one

January 1, 2000

Katherine Teixeira, Nicole Russell, Teodor Huzij

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The muscle energy technique for a superiorly subluxed rib, introduced by Fred Mitchell Sr., DO, and later adapted by Philip Greenman, DO, is an effective treatment for a superior rib one somatic dysfunction. Although muscle energy techniques involve various reflexes, Mitchell and Greenman emphasized the postisometric relaxation variation. However, aligning this technique with general postisometric relaxation principles requires certain assumptions to be made about involved nerve reflexes. By analyzing similarly paired muscles to the anterior and middle scalenes as well as the neurologic mechanisms of muscle energy, the most plausible explanation for this technique involves the crossed-extensor reflex or postisometric relaxation with assumptions. This article examines the reflexes at play and the clinical implications for refining muscle energy applications.
Open Access
Comparative cross-sectional analysis of asthma outcomes and sinus surgery utilization in Appalachian and non-Appalachian counties of Ohio

January 1, 2000

Samuel Borgemenke, Robert Osap, Kirsten Bogunovich, Nicholas Durstock, Elizabeth A. Beverly

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Context Healthcare inequities disproportionately affect underprivileged groups, leading to negative health outcomes. Challenges are compounded in regions like Appalachian Ohio, where rurality and poverty exacerbate issues such as access to care and environmental stressors, significantly impacting conditions like asthma. In severe cases of asthma, sinus surgery is sometimes indicated, because it has been shown to improve asthma-related symptoms. However, the specialists who perform these procedures, such as otolaryngologists, may be less available to certain underprivileged groups. Objectives The purpose of this study was to compare the effects of social determinants of health on the prevalence and treatment of asthma in Appalachian vs. non-Appalachian regions of Ohio, and how those factors affect the rate at which sinus surgery is performed in different populations. Methods This cross-sectional study utilized public data gathered in the year 2021 from the Centers for Disease Control and Prevention (CDC) and the Center for Medicare and Medicaid Services (CMS) to compare asthma prevalence, emergency visit and hospitalization rates, sinus surgery frequencies, and social determinants of health in Appalachian vs. non-Appalachian regions. Results Both the average prevalence rate of asthma (p<0.001) and the number of emergency department visits as a complication of asthma (p<0.01) in Appalachian Ohio counties were significantly higher than non-Appalachian counties. Interestingly, the ratio between sinus surgery prevalence and the number of procedures was not statistically different between Appalachian and non-Appalachian counties. This included balloon sinuplasty (p=0.4), septoplasty (p=0.4), and functional endoscopic sinus surgery (FESS, p=0.4). Additionally, several social determinants of health, specifically the poverty rate ( r =0.9, p<0.001), uninsured rate ( r =0.4, p<0.001), unemployment rate ( r =0.5, p<0.001), and housing burden rate ( r =0.6, p<0.001) were shown to have a significant correlation with the rate of asthma prevalence among adults in Ohio. Conclusions Asthma prevalence and treatment availability differ significantly between Appalachian and non-Appalachian regions of Ohio, highlighting the need to improve access to specialists and address barriers to care in rural populations.
Open Access
Dermatology match disparities: analyzing osteopathic vs. allopathic student outcomes post-ACGME/AOA single accreditation system (2020–2024)

January 1, 2000

Leo Wan, Karandeep Bawa, Aileen Park, Haaris Kadri, Austin Cusick, Shannon C. Trotter

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Context Dermatology remains one of the most competitive medical specialties, with successful candidates often demonstrating outstanding academic performance, extensive research experience, and strong letters of recommendation. The integration of the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) into a single accreditation system in 2020 was intended to streamline residency training, but it has raised concerns about how Doctor of Osteopathic Medicine (DO) applicants will perform in dermatology residency match. Objectives This study examines the differences in DO and MD match rates following the single graduate medical education (GME) accreditation system, focusing on the match performance of DO dermatology applicants. It also analyzes the match rates of DO students into traditional ACGME (formerly allopathic)- and former AOA-accredited programs. Methods A retrospective review of National Residency Matching Program (NRMP) annual reports and the Association of American Medical Colleges (AAMC) Electronic Residency Application Service (ERAS) statistics was conducted for dermatology applicants from 2020 to 2024. Data were analyzed to compare the number of DO and MD applicants and their match rates to traditional ACGME (former allopathic)-accredited and former AOA-accredited programs. Data on the degree types of current residents at all ACGME-accredited residency programs were collected and analyzed. Statistical analyses included chi-square testing and bootstrapping for categorical variables and proportions. Results The study included 137 ACGME-accredited dermatology programs, with 26 (18.98 %) having previously received AOA accreditation. The analysis found that there were substantial discrepancies in postgraduate year 2 (PGY-2) match rates (p<0.05) between 2020 and 2024, with DO applicants matching at a lower rate. Furthermore, more DO applicants consistently matched into former AOA-accredited programs than into ACGME-accredited programs. Matched MD candidates outperformed matched DO applicants in terms of United States Medical Licensing Examination (USMLE) Step 1 scores (p=0.002) and research production (p=0.001). Conclusions In summary, DO applicants continue to have lower match rates in dermatology than MD applicants, with fewer DOs matching into traditional (formerly allopathic) ACGME-accredited programs. There are several reasons for this disparity. Systemic changes and further studies are needed to improve the success rates of DO dermatology applicants in future application cycles.
Open Access
Artificial intelligence and osteopathic medicine: preserving human-centered care in an era of technological advancement

January 1, 2000

Ryan Newhardt, Michalah O’Connell, May S. Lin, Natasha N. Bray

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As artificial intelligence (AI) becomes increasingly integrated into healthcare, osteopathic medicine faces a critical inflection point. This commentary examines how AI integration can augment osteopathic practice while addressing potential challenges to its foundational tenets. The four tenets of osteopathic medicine – unity of body, mind, and spirit; the body’s capacity for self-regulation and self-healing; the interrelationship of structure and function; and rational treatment based on these principles – must guide AI integration to preserve osteopathic medicine’s holistic approach. By reaffirming osteopathy’s mind-body-spirit philosophy and relational approach to care, osteopathic physicians can help shape a future in which AI serves – not supplants – the human connection that is essential to healing. Successful AI implementation requires intentional strategies to preserve therapeutic presence, maintaining the centrality of osteopathic manipulative treatment (OMT), and ensuring that technology enhances rather than replaces the physician–patient relationship. Medical education, research, and governance must evolve to prepare osteopathic physicians to work ethically alongside AI while maintaining fidelity to osteopathic principles.
Open Access
Research gaps in the correlation of anxiety and depression prevalence in former college athletes: a systematic review

January 1, 2000

Madison L. Reese, Blakelee A. Eggleston, Alexandra M. Smith, Austin J. Young, Anna Mazur, Micah Hartwell

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Context There is not much current literature looking at anxiety and depression in athletes transitioning out of college sports into the real world. This study identified gaps in the current mental health literature for former college athletes and what interventions are currently being offered to help them. By utilizing the gaps identified in the current literature, we provided recommendations for educational programs that are modeled on the programs that professional sports leagues offer while utilizing the existing college infrastructure. We also encourage future research to perform longitudinal studies following these athletes as they transition from sports. Objectives Collegiate sports participation is integral to culture and identity. Transitioning from athletics to regular life often leads to significant mental health concerns. Abrupt lifestyle and identity changes can result in dietary, career, and health consequences that impact athletes’ mental well-being. While some data addresses this transition, research focused on developing best practices to support athletes during this period remains limited. This study aims to conduct a systematic review to identify the existing research and gaps concerning the described supports in mental health, particularly depression and anxiety, in retired athletes. Methods A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review (PRISMA-ScR) guidelines. We analyzed original research, literature reviews, systematic reviews, meta-analyses, clinical trials, and case studies. Articles were sourced from PubMed (MEDLINE), Embase, Scopus, Cochrane, and Web of Science. Results A total of 169 articles were identified, with 61 selected for full-text screening and nine included in the study. These nine articles comprised four cross-sectional studies analyzing survey data, four systematic or scoping reviews, and one qualitative analysis. While all articles addressed depression or anxiety, most focused on individuals returning to exercise post-injury and quality of life. Conclusions Current research highlights the needs of collegiate, professional, and retired athletes. Limited literature exists on former collegiate athletes, with available studies emphasizing university programs to ease transitions and help athletes apply their skills in retirement. Research gaps include examining programs across divisions and sports, minimizing self-reporting surveys, and conducting longitudinal studies. Future efforts should focus on addressing these gaps to better support athletes transitioning to life beyond sports.
Open Access
Osteopathic manipulative treatment in the management of headaches associated with musculoskeletal dysfunction: systematic review and meta-analysis

January 1, 2000

Yasir Rehman, Jonathon Kirsch, Mary Ying-Fang Wang, Robert Johnston, Meadow Will, Emily Gibson, David Spencer, Claudio Garcia, Karen T. Snider

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Context Osteopathic manipulative treatment (OMT) can be utilized as a primary or adjunctive treatment for headaches associated with musculoskeletal disorders. Although previous systematic reviews investigated the effectiveness of manual therapies for treating headaches, they did not focus specifically on OMT or perform a pooled meta-analysis to evaluate the effectiveness of outcomes. Objectives The aim of this study is to systematically evaluate the effectiveness of OMT for managing headaches associated with musculoskeletal dysfunction and to assess the associated harm outcomes. Methods In September 2023, the following databases were searched for randomized controlled trials (RCTs) of adult patients with headaches associated with musculoskeletal dysfunction who were treated with OMT: Allied and Complementary Medicine Database, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica (EMBASE), Osteopathic Medicine Digital Library (OSTMED), Ovid Emcare, Ovid MEDLINE, Physiotherapy Evidence Database (PEDro), PsycINFO, and PubMed. The search terms included osteopathic manipulative medicine, manual therapy, osteopath, headache, concussion, and head injury. The studies had to compare OMT techniques (e.g., articulatory [ART]; high-velocity, low-amplitude [HVLA]; soft tissues [ST]) to another form of treatment or a different type of OMT technique. Our primary outcomes included headache severity, headache frequency, disability associated with headaches, quality of life, and return to work (RTW); harm outcomes included all-cause dropout (ACD) rates, dropouts due to inefficacy, and adverse effects. The Cochrane Risk of Bias (ROB) tool was utilized to assess the ROB in the reviewed studies, and the quality of evidence was assessed utilizing the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Outcomes data were pooled for analysis and reported as standardized mean difference (SMD) and 95 % confidence interval (CI). Results Our search identified 11,657 RCTs. After removing duplicates and screening titles and abstracts, 167 underwent full-text review, and 18 were included in our review. None of the reviewed RCTs met all of the Cochrane ROB criteria. Moderate-quality evidence indicated that combined ART-HVLA (SMD=−0.61, 95 % CI=−1.0 to −0.23) and ST HVLA-ART (SMD=−0.48, 95 % CI=−0.83 to −0.13) effectively reduced the severity of headache. Moderate-quality evidence also indicated that the combined techniques of ART-HVLA (SMD=−0.43, 95 % CI=−0.74 to −0.13) and ST-ART-HVLA (SMD=−0.62, 95 % CI=−0.89 to −0.35) effectively reduced the frequency of headaches. Moderate-quality evidence indicated that quality of life was improved with combined ART-HVLA (SMD=0.57, 95 % CI=0.14 to 0.99). Low-quality evidence indicated no significant associations of OMT with disability or harm outcomes (all p>0.26). Conclusions Results of our systematic review and meta-analysis suggested that a combination of multiple types of OMT techniques effectively reduced the frequency and severity of headaches and improved quality of life. However, high-quality RCTs with large sample sizes utilizing a variety of technique modalities and combinations of technique modalities are necessary to better evaluate the effectiveness of OMT for managing headaches.
Open Access
The role of osteopathic manipulative medicine in cerebral palsy: bridging treatment gaps and enhancing care

January 1, 2000

Ambrose Loc Ngo, Niki Gharavi Alkhansari, Rachana Tadakamalla, Mercede Hess, Uyen Tam Nguyen, John Yazji, Robert S. Rogers

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Osteopathic manipulative medicine (OMM) is a hands-on approach utilized by physicians to diagnose, treat, and prevent various conditions through the application of muscle manipulation techniques. It has been applied in managing chronic musculoskeletal (MSK) pain, headaches, migraines, Parkinsonian gait, and psychological conditions such as stress, anxiety, and depression. In our narrative review, we aim to integrate both direct clinical studies of OMM in cerebral palsy (CP) and supportive literature on mechanisms and related conditions. A comprehensive literature search was conducted utilizing PubMed and Google Scholar to identify relevant studies on OMM in CP management. Search strategies were intentionally broad to capture mechanistic, supportive, and clinical evidence. Representative terms included “osteopathic manipulative medicine and cerebral palsy,” “osteopathic treatment and neurological disorders,” and “manual therapy and cerebral palsy.” Additionally, reference lists of relevant articles were manually reviewed to identify additional studies. Overall, we found that integrating OMM into CP management may offer a noninvasive approach to improving MSK function and neuromuscular control while alleviating the emotional and physical challenges, as well as increasing movement to reduce joint contractures associated with the condition. OMM techniques may also help reduce stress, anxiety, and constipation, which are prevalent among CP patients due to the psychological and physiological burdens of the disorder. OMM’s holistic approach has the potential to enhance outcomes for individuals with CP by addressing their multifaceted needs. While further research and advocacy are necessary to fully integrate OMM into mainstream CP management, existing evidence suggests that OMM may improve patient outcomes and quality of life. However, the current evidence has remained somewhat limited.
Open Access
Do patients with renal calculi exhibit viscerosomatic reflexes as evident on CT imaging?

January 1, 2000

Dillon R. Haughton, Akhil K. Gupta, Bader R. Nasir, Adrienne M. Kania

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Context Experimental evidence supporting the existence of the viscerosomatic reflex highlights an involvement of multiple vertebral levels when renal pathology is present. Further exploration of this reflex, particularly in the context of nephrolithiasis, could offer valuable insights for osteopathic treatments related to this pathology. Open-sourced machine learning datasets provide a valuable source of imaging data for investigating osteopathic phenomena including the viscerosomatic reflex. Objectives This study aimed to compare the rotation of vertebrae at levels associated with the viscerosomatic reflex in renal pathology in patients with nephrolithiasis vs. those without kidney stones. Methods A total of 210 unenhanced computed tomography (CT) scans were examined from an open-sourced dataset designed for kidney and kidney stone segmentation. Among these, 166 scans were excluded due to pathologies that could affect analysis (osteophytes, renal masses, etc.). The 44 scans included in the analysis encompassed 292 relevant vertebrae. Of those, 15 scans were of patients with kidney stones in the right kidney, 13 in the left kidney, 7 bilaterally, and 11 without kidney stones. These scans included vertebral levels from T5-L5, with the majority falling within T10-L5. An open-sourced algorithm was employed to segment individual vertebrae, generating models that maintained their orientation in three-dimensional (3D) space. A self-coded 3D slicer module utilizing vertebral symmetry for rotation detection was then applied. Two-way analysis of variance (ANOVA) testing was conducted to assess differences in vertebral rotation between the four possible combinations of kidney stone location (left-sided, right-sided, bilateral, or none) and vertebral levels (T10-L4). Subsequently, the two-way ANOVA analysis was narrowed down to include various combinations of three vertebral levels (T10-L4) to identify the most significant levels. Results We observed a statistically significant difference in average vertebral rotation (p=0.0038) dependent on kidney stone location. Post-hoc analysis showed an average difference in rotation of −1.38° leftward between scans that contained left kidney stones compared to no kidney stones (p=0.027), as well as an average difference of −1.72° leftward in the scans containing right kidney stones compared to no kidney stone (p=0.0037). The average differences in rotation between the remaining stone location combinations were not statistically significant. Narrowed analysis of three vertebral level combinations showed a single statistically significant combination (T10, T12, and L4) out of a total of 35 combinations (p=0.028). A subsequent post-hoc procedure showed that angular rotation at these levels had the only statistically significant contribution to the difference between scans containing right kidney stones and no kidney stones (p=0.046). Conclusions This study observed a statistically significant difference in the rotation of vertebrae at the levels associated with the viscerosomatic reflex between patients with unilateral kidney stones and those without kidney stones. The vertebral levels with the highest significance of association with this finding, particularly in right kidney stones, were T10, T12, and L4.
Open Access
Effect of positional asymmetry palpatory models on improvement and retention of accuracy during pelvic asymmetry assessments

January 1, 2000

Justin M. Hajicek, Madelyn B. Huhn, Ashley Thurgood, Edelheide N. Isemann, Chase B. Barnwell, Zane Starks, Mary Ying-Fang Wang, Brian F. Degenhardt

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Context Asymmetry of bony landmarks, such as the anterior superior iliac spine (ASIS) or posterior superior iliac spine (PSIS), is often utilized to identify somatic dysfunction in the pelvis. However, establishing good accuracy for these assessments can be challenging, so objective training models have been developed to enhance learning and accuracy. Objectives The objective of this study was to determine the effect of training with positional asymmetry models with objective feedback on the improvement and retention of pelvic asymmetry assessment accuracy. Methods First-year osteopathic medical students and undergraduate interns were recruited for model training. After a basic technique demonstration, they completed a 72-question baseline assessment on the ASIS and PSIS models. Subsequent training was conducted for 5 h per week (1 h/day) for two consecutive weeks. Model accuracy was assessed four times at baseline, midpoint, final, and retention. Assessments were scored as a percent of the correctly identified asymmetries, and change scores were calculated by comparison with the previous assessment score (i.e., baseline to midpoint, midpoint to final, final to retention) and overall (baseline to retention). Results Twelve students (age range, 20.3–29.2 years) participated. At baseline, overall scores were 57.6 % for ASIS and 72.9 % for PSIS models. For ASIS models, the change scores improved from baseline to midpoint (+18.9 %, p<0.001) and from midpoint to final (+6.6 %, p=0.01) but decreased from final to retention (−7.2 %, p=0.01). The overall retention scores were higher than baseline (+18.3 %, p<0.001). For PSIS models, the change scores improved from baseline to midpoint (+13.0 %, p<0.001), and the overall retention scores were higher than baseline (+15.0 %, p<0.001). Conclusions Training with positional asymmetry models with objective feedback resulted in significant sustained improvements in ASIS and PSIS positional asymmetry assessment accuracy. Integration of these models into the standard medical curriculum should be considered.
Open Access
The impact of a summer research internship program on research engagement of osteopathic medical students

January 1, 2000

Anupam Bishayee, Michael A. Wallace, Adam K. Bobak, Tianna L. Sasher, Luis A. Alvarez, Tania S. Flink

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Context Research plays a critical role in the medical field, driving progress and shaping clinical guidelines. It has become particularly significant in the residency application process due to the advent of “pass or fail” scoring for Step 1. Unfortunately, there is a marked discrepancy between the quantity of research conducted by osteopathic and allopathic students, disadvantaging many osteopathic residency applicants. Objectives Lake Erie College of Osteopathic Medicine (LECOM)-Bradenton established the Summer Research Internship Program in 2023 to improve research self-efficacy, facilitate research participation, and encourage lifelong research engagement in Doctor of Osteopathic Medicine (DO) students. The purpose of this study was to evaluate participant research experience and self-efficacy through pre- and postprogram surveys. Methods This study consisted of an experimental group of 18 students who participated in this program. A control group consisted of 20 students not enrolled in the program who had minimal research experience and no plans to conduct research throughout the study’s duration. Participants completed pre- and postprogram surveys, assessing research experience and self-efficacy across four domains: knowledge of research foundations, ability to identify scholarly literature, motivation to conduct research, and likelihood of future engagement. Data were analyzed via a quantitative Likert scale. Results The experimental group reported significantly greater (p<0.05) research experience pre- and postprogram including poster creation, LECOM Research Day participation, and publication history. The experimental group also had significantly (p<0.05) more experience with manuscript preparation postprogram compared to the controls. For the self-efficacy survey, the experimental group had higher (p<0.05) motivation to perform research prior to the start of the program compared to the controls. Moreover, this group gained greater (p<0.05) experience in research foundations and identification of the literature postprogram compared with controls. Conclusions The LECOM Summer Research Internship Program significantly enhanced research experience and self-efficacy among participants when compared to controls. This program study may serve as a model for other institutions seeking to expand student research engagement and build a culture of scholarly activity. Expanding successful structured research programs may also help address the disparity in research output between osteopathic and allopathic medical students.
Open Access
Race, ethnicity, and gender discrepancies between allopathic and osteopathic otolaryngology trainees from 2015 to 2023

January 1, 2000

Katrina M. Minutello, Savannah L. Nicks, Benjamin T. Gillette, Md Sakibur Hasan, Carl B. Shermetaro

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Context Existing studies have analyzed gender and race representation among otolaryngology - head and neck surgery (OHNS) applicants and residents in the United States. Further analysis by graduate medical degree type does not currently exist. Objectives The objective of this study was to identify and compare gender and racial disparities in osteopathic (Doctor of Osteopathic Medicine [DO]) and allopathic (Doctor of Medicine [MD]) OHNS applicants and residents. Methods Cross-sectional analysis of sex and racial characteristics of DO and MD OHNS applicants and residents from 2015 to 2023 obtained from the American Association of Medical Colleges (AAMC) and Electronic Residency Application Service (ERAS) data were performed. Differences between the aggregate proportions of applicants and corresponding residents at Accreditation Council of Graduate Medical Education (ACGME)-accredited OHNS programs by graduate medical degree were evaluated utilizing chi-square tests with Yates’ continuity correction. Results The proportion of White MD, Asian MD, and White DO residents increased compared to their corresponding applicant pools (ACGME 0.535, ERAS 0.615; Δ + 0.080; 95 % confidence interval [CI], 0.059–0.101; p<0.001), (ACGME 0.212, ERAS 0.236; Δ + 0.024; 95 % CI, 0.006–0.042; p<0.001), and (American Osteopathic Association [AOA] 0.661, ERAS 0.809; Δ + 0.148; 95 % CI, 0.032–0.159; p<0.01), respectively. Compared to MD residents, there were increased proportions of White (ERAS 0.615, ERAS 0.809; Δ −0.193; 95 % CI, −0.129 to −0.060; p<0.001) and male (ERAS 0.593, ERAS 0.685; Δ −0.092; 95 % CI, −0.080 to −0.013; p=0.01) DO residents. Conclusions Findings suggest that gender and racial discrepancies exist between DO and MD representation in OHNS. Further research is encouraged to examine the explanation for these differences and improve representation of the DO surgeon in otolaryngology.
Open Access
Retrospective analysis of patients with cardiopulmonary symptoms in the setting of Long COVID syndrome: investigating risk factors

January 1, 2000

Jenna Mahoney, Genti Shatri, Patricia E. Simmer, Daniel Doherty, Vamsi Matta, Dominic J. Valentino

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Context Long COVID, a debilitating condition characterized by persistent symptoms following acute Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection, continues to pose a significant public health burden. Currently, research is ongoing regarding risk factors for developing Long COVID. Identifying patients susceptible to symptoms of Long COVID can assist with identifying those at risk, and developing preventative strategies for these individuals. Objectives The objectives of this study are to evaluate a cohort of patients who followed up in the Long COVID clinic who were experiencing cardiopulmonary symptoms 8–12 weeks from initial inoculation, and to retrospectively identify any statistically significant risk factors or clinical features present. Methods This retrospective cohort study examined patients identified between April 2021 and September 2022. Patients who were diagnosed with COVID-19 and developed persistent symptoms were subsequently referred to the post–COVID-19 pulmonary clinic. For the cohort of patients seen in post COVID-19 pulmonary clinic, pre-existing pulmonary and systemic disease, severity of COVID-19 illness, and treatments received were examined. Analysis was performed on these data utilizing Cox regression analysis. Results Two hundred forty-six (246) adult patients who had Long COVID symptoms 8–12 weeks post–COVID-19 infection were identified and included in this analysis. Cox regression analysis indicated that in this population, patients who had required oxygen support (supplemental oxygen, noninvasive ventilation, or intubation) during their initial COVID-19 hospitalization and who also had prior history of either obstructive sleep apnea (OSA) or chronic obstructive pulmonary disease (COPD) and were more likely to develop Long COVID symptoms. Patients with pre-existing OSA had an odds ratio (OR) of 3.6 and a 95 % confidence interval (CI) of 1.70–7.65 (p=0.0012). Patients with pre-existing COPD had an OR of 12.19 and a 95 % CI of 2.38–62.33 (p=0.0015). Conclusions Patients who required oxygen support during their initial COVID-19 hospitalization who also had previous history of either OSA or COPD were more likely to develop cardiopulmonary Long COVID symptoms. This suggests that pre-existing respiratory conditions and the severity of the initial COVID-19 illness may influence the development of these symptoms of Long COVID.
Open Access
Exploring the impact of methylenetetrahydrofolate reductase (MTHFR) gene variations on autism spectrum disorder severity

January 1, 2000

Christian C. Iannuzzelli, Andrea L. Iannuzzelli, Brandon Cunha, Venkateswar Venkataraman, Wendy Aita

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Context Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by challenges in social communication and repetitive behaviors. Its etiology is influenced by a combination of genetic and environmental factors. Variations in the methylenetetrahydrofolate reductase (MTHFR) gene, which is implicated in folate metabolism and neurodevelopment, are widespread in the autism population. Understanding the relationship between MTHFR gene variations and ASD may be critical for early diagnosis and intervention. Objectives This study aims to investigate the association between MTHFR gene variations and the severity of ASD symptoms in a clinical cohort. The goal is to determine whether reduced MTHFR activity correlates with increased symptom severity, thus offering insights into potential mechanisms and intervention strategies. Methods A cohort of 78 patients diagnosed with ASD who had previously undergone genetic testing to measure MTHFR activity levels were recruited. ASD severity was assessed utilizing DSM-5 criteria. Statistical analyses were performed to evaluate the relationship between MTHFR activity and ASD symptom severity. Results The analysis identified a significant negative correlation between MTHFR activity levels and ASD severity (p<0.05). Patients with lower MTHFR activity exhibited more severe ASD symptoms, as measured by DSM-5 classifications. These findings emphasize the potential link between MTHFR gene variations and neurodevelopmental outcomes in ASD. Conclusions This study highlights the role of MTHFR gene variations in modulating ASD severity. The results support the potential for utilizing MTHFR activity as a biomarker for early screening and tailoring targeted interventions for individuals with MTHFR deficiencies. Due to a small sample size, any conclusions drawn from this study are limited and may be misleading in future studies. Further research is warranted to explore the underlying mechanisms and to develop clinical strategies that mitigate the impact of these genetic variations on ASD progression.
Open Access
Predictability of cranial base strains as related to birth presentation: a review of literature

January 1, 2000

Summer K. McElwain, Deborah Schmidt

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Context The etiology of cranial base strains (CBS) in newborns is poorly elucidated in historical and current literature. There have only been a handful of studies examining the prevalence of CBS in newborns or vaginal birth presentation prevalence individually, let alone their relationship. Defining this link could help to further the applications of osteopathic manipulative medicine in neonates. Objectives The objective of this review was to consolidate all historical and current research on the potential link between vaginal birth presentation and CBS in infants. Methods A review of historical and current literature was completed in October 2023 by all authors utilizing the PubMed database and Google Scholar with the following search terms: cranial strain, osteopathy, fetal, molding, pediatric, birth presentation, delivery, and labor. These terms were utilized in various combinations and individually. Inclusion criteria included description of infant skull morphology, CBS patterns, and vaginal birth presentation. Exclusion criteria included studies with noninfant populations that did not address cranial morphology and/or discussed plagiocephaly unrelated to birth. There was no date range in the exclusion criteria due to the scarcity of research. Texts that included an evaluation and treatment of children at various ages were selected for partial reviews, only including the sections relevant to infancy. The best judgment of the authors was utilized to recognize reliable articles and texts. Extensive research returned very few recorded associations of CBS caused by vaginal birth and their accompanying mechanisms; thus, a review of citations in articles sought for retrieval was also completed. Most of the information procured was found in academic and historical texts rather than research articles. Results The results of this review are inconclusive and can only align with the theory that physiological CBS are the most common and that pathological CBS are uncommon; no relationship to vaginal birth presentation can be concluded with the available research. However, the literature reviewed illustrates a statistically significant increase in somatic dysfunction/cranial asymmetry in infants after prolonged labor, an increase in the rates of plagiocephaly in infants born to nulliparous women and/or the use of assistive devices, improvement of symmetry with the administration of osteopathic manipulative treatment (OMT), and the improvement of symptomatology after OMT. Conclusions More research needs to be completed on this topic to increase knowledge in the field of infantile CBS. A better understanding of the effect of vaginal birth presentation on infant CBS and occipital flattening could optimize infant development and the prevention of common diagnoses such as plagiocephaly, developmental delay, torticollis, colic, and feeding difficulties.
Open Access
Identifying somatic and social concerns that may suggest an underlying mental health condition in pediatric primary care

January 1, 2000

Casey Shubrook, Kimberly Breneisen, Maxine Pottenger

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Most adult mental health conditions begin in early childhood and adolescence, the most common being anxiety and behavioral disorders. Early intervention can improve outcomes and may reduce the risk of developing a clinical disorder in the future. However, children may not have the communication or understanding to share their symptoms with those around them, leaving pediatric primary care providers responsible for identifying concerning signs. This paper reviews both general symptoms that suggest possible mental health conditions as well as specific correlations between symptoms and psychiatric diagnoses. A literature search utilizing PubMed identified nine relevant articles that were supplemented with additional sources. The findings found that impaired coordination or balance, weakness, paralysis or loss of sensation, seizure-like activity, blindness, double vision, deafness, or one severe symptom, typically pain, were general signs that may indicate a psychiatric illness. More specific associations were also identified. For instance, children who report somatic complaints and school refusal have been linked to anxiety; in addition, reported stress, anger, and worries about family alcohol and drug use have been linked to depression, among many others. Awareness of the somatic and social concerns presented by children to primary care can reduce the delay from the onset of symptoms to diagnosis, leading to earlier identification, treatment, and improved outcomes. Early intervention may delay or prevent symptoms from developing into a diagnosable psychiatric disorder and/or may reduce the severity of symptoms in a child who already has a psychiatric condition.
Open Access
Geographical distribution and match trends of osteopathic residents in otolaryngology residency programs: a cross-sectional analysis

January 1, 2000

Luke Reardon, Brenton Stucki, Deepthi Akella, Michele M. Carr

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Context Following the implementation of the Single Accreditation System (SAS) in 2020, the integration of osteopathic and allopathic residency programs has reshaped access to surgical specialties. Despite these efforts, osteopathic medical graduates remain underrepresented in otolaryngology residencies, with historical concentration in a few Midwestern states and limited access to home residency programs. Objectives The objective of this study was to assess the geographical distribution, training site characteristics, and match patterns of osteopathic otolaryngology residents from 2020 to 2024, including relationships with medical school location and program history (historically AOA-accredited vs. historically allopathic-only). Methods A retrospective cross-sectional analysis was conducted utilizing data on 109 osteopathic otolaryngology residents matched from 2020 to 2024. Data were gathered from National Resident Matching Program (NRMP) results, residency websites, and public sources. Variables included residency location, hospital size, urban/rural status, and medical school affiliation. Statistical methods included descriptive statistics, chi-square tests for trend, Pearson correlation, regression analysis, and a two-sample t test for geographic mobility. Results Michigan, Pennsylvania, and Ohio accounted for 74.3 % of residents. Geographic distribution trends over the 5-year period (2020–2024) showed no significant year-to-year change (p=0.54). A positive correlation (p=0.014) existed between osteopathic school locations and resident distribution. All residents trained in urban programs; 80.7 % trained in large hospitals (≥400 beds). A two-sample t test showed that residents who relocated for residency moved significantly farther than those who remained in-state (p=0.014). More osteopathic residents matched into historically AOA-accredited programs than into formerly allopathic-only programs. Conclusions Five years after the SAS merger, osteopathic otolaryngology residents continue to cluster geographically near osteopathic medical schools and train predominantly in large, urban hospitals. Historically AOA-accredited programs remain a primary entry point for osteopathic graduates. Further efforts are needed to expand access and representation across the broader otolaryngology training landscape.
Open Access
Private equity in healthcare: implications and policy recommendations

January 1, 2000

Maxim Jestin

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Private equity (PE) involvement in healthcare has generated considerable debate regarding its implications for patient care, healthcare quality, and system sustainability. While PE can inject much-needed capital into struggling healthcare facilities, its profit-driven motives and focus on short-term financial gains can lead to cost-cutting measures and business closures that jeopardize patient access and the quality of care. To maximize profits, PE firms may exploit legal and regulatory loopholes, engage in aggressive billing practices, and acquire healthcare providers to reduce competition through consolidation, driving up prices. Evidence suggests that there are both risks and benefits to PE involvement in healthcare, with some studies reporting increased costs and quality concerns, whereas others highlight improved operational efficiency and stabilization of at-risk providers. This commentary provides an overview of both sides and offers policy recommendations addressing some of the detrimental effects of PE practices on the healthcare sector, to ensure that patient well-being remains the priority.
Open Access
Necrobiosis lipoidica arising in a port wine stain treated with topical ruxolitinib

January 1, 2000

Neena Edupuganti, Jay Nguyen, Fahad Siddiqui, Victoria Dukharan, Rajiv Nathoo

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We present a unique case of necrobiosis lipoidica (NL) arising within a port-wine stain (PWS), which, to our knowledge, has not been previously reported. NL is a rare granulomatous disorder often associated with diabetes mellitus, characterized by chronic inflammation and microvascular dysfunction. PWS, a congenital vascular malformation, results from defective endothelial differentiation and capillary malformation. The coexistence of these conditions suggests a potential link in their pathophysiological mechanisms, including inflammation, endothelial dysfunction, and shared signaling pathways such as mitogen-activated protein kinase (MAPK), phosphoinositide 3-kinase (PI3K), and tumor necrosis factor (TNF)-alpha. Our patient’s NL lesions demonstrated improvement with topical ruxolitinib, a Janus kinase (JAK) inhibitor, after failing conventional therapies, including clobetasol, tacrolimus, and pulsed dye laser. To our knowledge, this is the first reported case of NL successfully treated with topical ruxolitinib monotherapy. This case highlights the emerging role of JAK inhibitors in managing granulomatous disorders and raises intriguing questions about the shared pathophysiologic mechanisms between inflammatory and vascular processes. Further investigation into cytokine dysregulation, immune responses, and targeted therapies for these overlapping pathologies could inform more effective treatment strategies and improve patient outcomes.
Open Access
The hospitalist’s paradox: on pay, perception, and the true value of a healer in the valley of the sun

January 1, 2000

Gary P. MacDonald

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This article examines the sentiments of a Phoenix-area hospitalist who feels underpaid despite earning an objectively high salary. While physician compensation in the United States, including that of hospitalists (around $365,000 in Phoenix), ranks among the highest globally and places them in the top income percentiles domestically, the perception of being “underpaid” persists. The piece argues this feeling is a complex value judgment, influenced by the immense effort, sacrifice, and societal contribution inherent in the profession, often perceived as inadequately reflected by market-driven compensation. Cognitive biases, such as the Intrinsic Worth Fallacy and Social Comparison Bias, further shape this perception. Systemic healthcare issues, including administrative burdens and professional disempowerment, also contribute, leading to dissatisfaction where salary becomes a primary, yet seemingly insufficient, metric of worth. The article concludes that true professional value transcends monetary figures, calling for systemic changes to better acknowledge and support physicians, ensuring their profound contributions are recognized beyond financial metrics.
Open Access
Interactive module’s effectiveness on empathy and attitudes of healthcare students

January 1, 2000

Jacob Linomaz, Desmond Chee, Jana Wardian, Elizabeth Beverly, Shelene Thomas

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Context As the prevalence of social determinants of health (SDH) continues to have an impact on the management of chronic conditions, it is imperative to expose health professional students to these encounters. Objectives This study investigates the role that virtual interactive modules play on osteopathic medical students and physician assistant (PA) students’ empathy and attitudes toward individuals with diabetes mellitus who are also affected by an array of SDHs. Methods Students from both health professional programs were asked to complete a pre-survey and post-survey that encompassed the Diabetes Attitude Scale, the Jefferson Empathy Scale, and the Assessing Student Competence and Knowledge of Social Determinants of Health (ASCK-SDH) Instrument. Students engaged with virtual interactive modules to follow the life of a patient, Lula Mae, who lives in the Appalachian area with Type 2 diabetes. Results Results from 151 osteopathic medical students concluded significant findings for the Diabetes Attitudes Scale (p<0.001), Jefferson Empathy Scale (p<0.02), and ASCK-SDH (p=0.02). While the matched data pairs for the PA students were too small in number to be significant, the data showed a positive trend pre-module to post-module. Conclusions This interactive module improved health professionals’ awareness, empathy, and attitudes toward SDH affecting those with chronic conditions. This implementation can be a valuable and insightful medical educational tool that can be adapted for other scenarios like various clinical rotations and sensitive healthcare topics to enhance the development of health professional students’ cultural competency and health equity awareness by exposure to various cultural, socioeconomic, and social identities in their future medical decision-making.
Open Access
Equity reporting in systematic reviews and meta-analysis for geographic atrophy: a PROGRESS-Plus assessment

January 1, 2000

Ryan Emmert, Tyler McKenzie, Dawsyn Smith, Hanna Russell, Gracie Schultheis, Micah Hartwell

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Context As systematic reviews and meta-analyses (SRMAs) are crucial for treatment development, they must provide guidelines that represent diverse patient demographics to promote equitable health care. As new research and treatment modalities are being developed for geographic atrophy (GA), establishing an equitable research foundation is becoming vitally important to physicians as they personalize their treatment plans. Objectives This analysis aims to determine whether SRMAs pertaining to GA are reporting equity-related items utilizing the PROGRESS-Plus framework. Methods We conducted a cross-sectional analysis by searching databases for systematic reviews and meta-analyses concerning GA from the year 2000 to November 2023. From this search, 176 articles returned, but only 57 of them met all the inclusion criteria. After screening the articles for inclusion, data pertaining to PROGRESS-Plus items were extracted. All analyses were conducted in a masked and duplicative fashion. χ 2 tests were employed to determine whether associations existed between the variables. Results From the initial search, 176 articles returned, of which 119 were excluded due to duplication, data unrelated to GA, or because it was animal-based research. Of the remaining 57 studies, 26 (45.6 %) included zero PROGRESS-Plus items. Fewer articles from the US-reported equity items (31.3 %, 5/16) compared to other countries (63.4 %, 26/41), which held statistical significance (p=0.028). Conclusions The American Academy of Ophthalmology has created initiatives to increase diversity, equity, and inclusion within the subspecialty. By using the PROGRESS-Plus framework, this study concluded that the majority of the articles pertaining to GA do not meet equity item objectives. As these documents aid physicians in developing treatment plans, these findings are concerning as physicians may find it more difficult to individually tailor treatment plans according to each patient’s holistic needs. Limitations in this study included unintentional omission or misclassification of research documents despite the comprehensive search string and double-blinded analysis. Furthermore, the results of this study cannot be generalized to other areas of research.
Open Access
Corrigendum to: Exploring the impact of methylenetetrahydrofolate reductase (MTHFR) gene variations on autism spectrum disorder severity

January 1, 2000

Christian C. Iannuzzelli, Andrea L. Iannuzzelli, Brandon Cunha, Venkateswar Venkataraman, Wendy Aita, Jennifer LeComte

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Journal Impact Factor	1.1	2024, Journal Citation Reports (Clarivate, 2025)
5-year Journal Impact Factor	1.4	2024, Journal Citation Reports (Clarivate, 2025)
Journal Citation Indicator	0.37	2024, Journal Citation Reports (Clarivate, 2025)
CiteScore	2.6	2024, Scopus (Elsevier B.V., 2025)
SCImago Journal Rank	0.445	2024, SJR (Scimago Lab, 2025; Data Source: Scopus)
Source Normalized Impact per Paper	0.667	2024, CWTS Journal Indicators (CWTS B.V., 2025; Data Source: Scopus)

More information about journal rankings

The JOM is the official scientific publication of the American Osteopathic Association (AOA) and the premier peer-reviewed, indexed, scholarly publication of the osteopathic medical profession.

The JOM's mission is to serve as an international forum for the dissemination of scientific literature that incorporates an integrative, comprehensive, patient-centered approach to clinical care and improving health.

Article Types and Subject/Domain Areas

The JOM accepts the following article types for peer review:

Original Article
Review Article
Brief Report
Case Report
Clinical Practice
Clinical Image
Commentary
Letter to the Editor

The JOM gives priority to original research, systematic reviews, and meta-analyses. Authors may select from the following topic/domain categories when submitting an article to the JOM:

Behavioral Health
Cardiopulmonary Medicine
General
Innovations
Medical Education
Musculoskeletal Medicine
Neuromusculoskeletal Medicine/Osteopathic Manipulative Treatment (OMT)
Obstetrics/Gynecology
Pediatrics
Public Health and Primary Care

Submission and Peer Review Process

To submit a manuscript to us, visit our manuscript tracking system on ScholarOne https://mc04.manuscriptcentral.com/jomed.

You may upload manuscripts and accompanying materials to the ScholarOne site referenced above, and you will receive all correspondence regarding their submissions through the site. You may use this site to check the status of your manuscript at any time.

Failure to follow these Instructions for Authors and include all required components will result in your manuscript being returned to you before peer review. The JOM will consider the manuscript after all items are formatted properly.

Generally speaking, first decisions are returned within 30 days of submission. If you feel your publication warrants rapid review, please email us at editorial@osteopathic.org.

The JOM employs a single-blinded peer review process. Submissions are assigned directly to a Section Editor familiar with your particular area of study, who may issue an immediate decision or decide to forward your manuscript for full peer review. During peer review, your work will be reviewed by experts in a relevant specialty.

Authors who are considering submitting multiple manuscripts that will convey the progression of a study or that are part of a series of articles intended to be published at the same time are strongly encouraged to contact JOM staff before submitting such articles.

AOA EDITOR IN CHIEF

Ross D. Zafonte, DO
Spaulding Rehabilitation Hospital Harvard Medical School
Boston, Massachusetts

EDITORIAL BOARD

BEHAVIORAL HEALTH
Section Editor:
Eileen Ryan, DO
The Ohio State University Wexner Medical Center
Columbus, Ohio

Associate Editors:
Justin Faden, DO (Philadelphia, Pennsylvania)
R. Gregory Lande, DO (Silver Spring, Maryland)
Jed Magen, DO, MS (East Lansing, Michigan)
Stephen M. Scheinthal, DO, CS (Mount Laurel, New Jersey)

CARDIOPULMONARY MEDICINE
Section Editor:
Kenneth J. Steier, DO, MBA, MPH
Touro College of Osteopathic Medicine
Middletown, New York

Associate Editors:
Olalekan Ogunsakin, MD, PhD, MBA, MPH (New York, New York)
Tanchun Wang, PhD (Middletown, New York)

MEDICAL EDUCATION
Section Editor:
Nadege Dady, EdD
Touro College of Osteopathic Medicine
New York, New York

Associate Editor:
Albert H. O-Yurvati, DO, PhD (Fort Worth, Texas)

MUSCULOSKELETAL MEDICINE AND PAIN
Associate Editors:
Mary E. Caldwell, DO (Henrico, Virginia)
Jonathan W. Lowery, PhD (Indianapolis, Indiana)
R. Dallin Thomas, DO, MPH, CAQSM (Bethesda, Maryland)

NEUROMUSCULOSKELETAL MEDICINE/OMT
Section Editor:
Kimberly Wolf, DO
Touro University California College of Osteopathic Medicine
Vallejo, California

Associate Editor:
Sheldon C. Yao, DO (Old Westbury, New York)

OBSTETRICS AND GYNECOLOGY
Section Editor:
Meaghan Nelsen, DO
The University of North Texas Health Science Center
Fort Worth, Texas

Associate Editors:
Kiran Kavipurapu, DO, JD, MPH (San Francisco, California)
Daniel J.S. Martingano, DO, PhD (Rockaway, New York)
DeEtte Vasques, DO (Fort Worth, Texas)

PEDIATRICS
Section Editor:
Amanda Foster, DO
Oklahoma State University
Tulsa, Oklahoma

Associate Editors:
Michael A. Baxter, DO (Tulsa, Oklahoma)
Alissa Craft, DO, MBA (Scottsdale, Arizona)
Colony S. Fugate, DO (Tulsa, Oklahoma)
Tami Hendriksz, DO (Vallejo, California)
Muhammad Waseem, MD, MS, CHSE-A (Bronx, New York)

PRIMARY CARE AND PUBLIC HEALTH
Section Editor:
Elizabeth A. Beverly, PhD
Ohio University Heritage College of Osteopathic Medicine Athens, Ohio

Section Editor:
Kevin M. Pantalone, DO, ECNU
Cleveland Clinic
Twinsburg, Ohio

Associate Editors:
John Ashurst, DO, MSc (Scottsdale, Arizona)
Craig S. Boisvert, DO (Lewisburg, West Virginia)
John J. Dougherty, DO (Provo, UT)
Lisa M. Hodge, PhD (Fort Worth, Texas)
Kim Pfotenhauer, DO (Vallejo, California)

CME EDITOR
Alissa Craft, DO, MBA (Scottsdale, Arizona)

INTERNATIONAL ADVISORY BOARD

Yasir Rehman, MD, MsC, PhD (Ontario, Canada)
Cleofás Rodríguez Blanco, PhD, DO (Madrid, Spain)
Loic Treffel, DO, PhD (Toulouse, France)

STUDENT, RESIDENT AND FELLOW ADVISORY BOARD

Emily Chin, OMS IV, MBA, MHA (Auburn, Alabama)
Jantzen J. Faulkner, OMS II (Tulsa, Oklahoma)
Divakara Gouda, OMS I (Stratford, New Jersey)
Matthew Mayeda, OMS IV, MPH (East Lansing, Michigan)

REPRESENTATIVE FROM THE AOA BOARD OF TRUSTEES
Geraldine T. O'Shea, DO (Jackson, California)

AOA LEADERSHIP

President:
Teresa Hubka, DO

President-elect:
Robert Piccinini, DO

Chief Executive Officer:
Kathleen S. Creason, MBA

EDITORS IN CHIEF EMERITUS
Robert Orenstein, DO
Mayo Clinic
Phoenix, Arizona

Thomas Wesley Allen, DO, MPH
Oklahoma State University Center for Health Sciences College of Osteopathic Medicine
Tulsa, Oklahoma
University of Oklahoma College of Medicine
Oklahoma City, Oklahoma

Gilbert E. D'Alonzo Jr, DO
Temple University School of Medicine
Philadelphia, Pennsylvania

EDITORIAL STAFF

Director:
Hunter Alexander

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Journal information

Additional information

eISSN:

2702-3648

Language:

English

Publisher:

De Gruyter

Additional information

First published:

January 1, 1900

Publication Frequency:

12 issues per year

eISSN: 2702-3648

Creative Commons

BY 4.0

Journal of Osteopathic Medicine

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