Volume 104, Issue 5

Context: Preliminary study results suggest that osteopathic manipulative treatment (OMT) may reduce pain, improve ambulation, and increase rehabilitation efficiency in patients undergoing knee or hip arthroplasty. Objective: To determine the efficacy of OMT in patients who recently underwent surgery for knee or hip osteoarthritis or for a hip fracture. Design: Randomized controlled trial involving hospital and postdischarge phases. Setting: Hospital-based acute rehabilitation unit. Patients: A total of 42 women and 18 men who were hospitalized between October 1998 and August 1999. Intervention: Patients were randomly assigned to groups that received either OMT or sham treatment in addition to standard care. Manipulation was individualized and performed according to study guidelines regarding frequency, duration, and technique. Main Outcome Measures: Changes in Functional Independence Measure (FIM) scores and in daily analgesic use during the rehabilitation unit stay; length of stay; rehabilitation efficiency—defined as the FIM total score change per rehabilitation unit day; and changes in Medical Outcomes Study Short Form-36 scores from rehabilitation unit admission to 4 weeks after discharge. Results: Of 19 primary outcome measures, the only significant difference between groups was decreased rehabilitation efficiency with OMT (2.0 vs 2.6 FIM total score points per day; P = .01). Stratified analyses demonstrated that poorer OMT outcomes were confined to patients with osteoarthritis who underwent total knee arthroplasty (length of stay, 15.0 vs 8.3 days; P = .004; rehabilitation efficiency, 2.1 vs 3.4 FIM total score points per day; P = .001). Conclusion: The OMT protocol used does not appear to be efficacious in this hospital rehabilitation population.

While osteopathic and allopathic medicine share many commonalities, there are key practice-based differences that uniquely characterize the two professions. For osteopathic medicine, one such defining feature is the use of osteopathic manipulative treatment (OMT). Unfortunately, while various treatment modalities are taught in osteopathic medical schools, there has been relatively little work done to establish standardized evaluation protocols. The purpose of this investigation was to explore the use of OMT assessment in the context of a multistation standardized patient examination. Analysis of performance data from 121 fourth-year osteopathic medical students indicated that the ability to do OMT can be reliably and validly assessed using a combination of simulated patient encounters, trained osteopathic physician raters, and an objective rating tool. Additional studies that incorporate a larger sample of students and focus on modifications to the assessment tool and rating protocols are warranted.

Although combined osteopathic and allopathic medical programs are well established for graduate medical education and continuing medical education, little has been published in the literature about such integration at the undergraduate level. The authors describe the preliminary efforts of a joint clinical clerkship program with students from regional osteopathic and allopathic medical schools at a major community teaching hospital in New England. Osteopathic principles and practice are consistently reinforced, exposing students from both medical backgrounds to them. It is hoped that this pilot program serves as a model for developing similar combined programs throughout the United States.

Pleural effusions after coronary artery bypass grafting (CABG) occur in up to 89% of patients undergoing the procedure. Effusions present days to months after surgery, and fluid characteristics relate to timing factors. Most of the effusions are left-sided and resolve spontaneously. Pleural effusions requiring treatment occur in a small percentage of patients who have undergone CABG. Post-CABG pleural effusions in temporal relation to malignant effusions are not widely reported. This report describes a 50-year-old man presenting with a malignant left-sided pleural effusion 3 months after CABG, with characteristics resembling a late post-CABG effusion.