Volume 114, Issue 3

Context: Few studies have assessed the use of osteopathic manipulative treatment (OMT) and subsequent patient-reported outcomes. Objective: To assess the current use of OMT and associated patient-reported outcomes. Design: A retrospective medical record review and a prospective observational study. Setting: Two university-based sites and their clinics associated with the practice-based research network DO-Touch.NET. Participants: Patients aged 18 years or older who received OMT. Main Outcome Measures: Medical records from 2007 were retrospectively reviewed to identify conditions being managed with OMT. From 2008 to 2010, patients were recruited before seeing their physicians. Questionnaires were distributed to patients and physicians, and information including demographics, chief complaints, symptom severity, current and past treatments, interference of symptoms with quality of life, physical examination findings, diagnoses, OMT performed, and immediate patient response to OMT was collected. A subset of patients provided data on symptom severity and frequency and other treatments daily for the 7 days after OMT. On day 7, symptom interference with quality of life was reassessed. Results: Retrospective data were collected from 2569 office visits, and prospective data were collected from 299 office visits (patient age range, 18-93 years). In the medical record review, 17 of the top 25 diagnoses (68%) were related to musculoskeletal conditions. In the prospective study, 18 of the top 24 medical diagnoses (75%) were related to musculoskeletal conditions. Immediately after OMT, patients at 271 of 296 office visits (92%) felt better or much better; those at 5 (<2%) felt worse. After 7 days, patients at 126 of 175 office visits (72%) felt better or much better, and those at 10 (6%) felt worse. Average and worst symptom severity decreased until post-OMT days 4 and 5, respectively, when severity leveled off. There was decreased interference of symptoms with quality of life from before OMT to 7 days after OMT in usual/general activities, sleep, mood, and relationships (all P ⩽.05). Conclusion: These preliminary results suggest that for adults, OMT is predominantly used for managing musculoskeletal pain conditions and is effective for short-term symptom relief. Continued surveillance of DO-Touch.NET member practice outcomes may help identify priorities for osteopathic research and define evidence-based standards for OMT practice and training.

Context: Individuals with vestibular dysfunction are at increased risk for falling. In addition, vestibular dysfunction is associated with chronic pain, which could present a serious public health concern as approximately 43% of US adults have chronic pain. Objective: To assess the incidence of vestibular dysfunction in patients receiving medication for chronic, noncancer pain or other underlying neurologic disorders and to determine associated follow-up therapeutic and diagnostic recommendations. Methods: The authors conducted a retrospective medical record review of consecutive patients who were treated in their private neuroscience practice with medications for chronic pain or underlying neurologic disorders in 2011. All patients underwent a series of tests using videonystagmography for the assessment of vestibular function. Test results and recommendations for therapy and additional testing were obtained. Results: Medical records of 124 patients (78 women, 46 men) were reviewed. Vestibular deficits were detected in 83 patients (66.9%). Patient ages ranged from 29 through 72 years, with a mean age of 50.7 years for women and 52.5 years for men. Physician-recommended therapy and follow-up testing were as follows: 32 patients (38.6%), neurologic examination and possible magnetic resonance (MR) imaging or computed tomography (CT) of the brain; 26 patients (31.3%), vestibular rehabilitation therapy only; 22 patients (26.5%), vestibular and related balance-function rehabilitation therapy, further neurologic examination, and possible MR imaging or CT; 2 patients (2.4%), balance-function rehabilitation therapy and specialized internal auditory canal high-magnification MR imaging or CT to assess for acoustic neuroma; and 1 patient (1.2%), specialized internal auditory canal high-magnification MR imaging or CT to evaluate for possible intracanalicular acoustic neuroma. Conclusion: Patients being treated with medications for chronic, noncancer pain or other underlying neurologic disorders may have a higher-than-average incidence of vestibular dysfunction. Baseline assessment and monitoring of the vestibular apparatus may be indicated for these patients.

Context: Gastroesophageal reflux disease (GERD) is a chronic condition that affects a growing number of people and is currently among the most common disorders seen in clinical practice. Objective: To develop a protocol for the management of GERD with osteopathic manipulative therapy (OMTh) applied to the diaphragm and esophagus, and to evaluate the protocol's effectiveness using the quality of life scale (QS-GERD) for the disease. Methods: In this single-blinded prospective study, an OMTh protocol focusing on the diaphragm and esophagus was applied to a single patient, who had received a diagnosis of GERD 4 years previously. Outcomes were measured using the QS-GERD, which has a total possible score ranging from 0 to 45 (the lower the score, the better the quality of life) and a level of satisfaction from very satisfied to incapacitated. The OMTh protocol was applied at 3 sessions (initial session, second session 1 week after the first, and third session 2 weeks after the second), and the patient completed the QS-GERD 4 times (before the first session, before the third session, and 2 and 4 weeks after the third session). Results: The OMTh protocol was administered without adverse events, and the patient reported positive outcomes after the third session. The QS-GERD showed a score improvement from 13 of 45 to 4 of 45. Conclusion: The results in the present report show that OMTh applied to the diaphragm and esophagus may improve symptoms of GERD and should be added to the somatovisceral approach to the care of patients with this condition.

Ionizing radiation injuries and illnesses are exceedingly rare; therefore, most physicians have never managed such conditions. When confronted with a possible radiation injury or illness, most physicians must seek specialty consultation. Protection of responders, health care workers, and patients is an absolute priority for the delivery of medical care. Management of ionizing radiation injuries and illnesses, as well as radiation protection, requires a basic understanding of physics. Also, to provide a greater measure of safety when working with radioactive materials, instrumentation for detection and identification of radiation is needed. Because any health care professional could face a radiation emergency, it is imperative that all institutions have emergency response plans in place before an incident occurs. The present article is an introduction to basic physics, ionizing radiation, radiation protection, and radiation instrumentation, and it provides a basis for management of the consequences of a radiologic or nuclear incident.

This article—the third in a 6-part series—examines the status of the DO degree in the first 3 decades of the 20th century. This time was an era when osteopathic practitioners established other colleges, developed state and national organizations, upgraded the length and breadth of curricula, and sought to secure licensure laws commensurate with their expanded education. During this period, osteopathic practitioners debated whether the DO degree was the most appropriate degree for their colleges to award or whether the MD degree alone or in conjunction with the DO degree better signified to lawmakers and the public their expanded academic training. At the end of this period it appeared likely that the DO degree would continue to be the sole designation by which osteopathic physicians would identify themselves in continuing their fight to obtain further legal rights and privileges.

Idiopathic intracranial hypertension (IIH)—sometimes called pseudotumor cerebri —is a neurologic condition distinguished by any of the following symptoms: headache, increased cerebrospinal fluid pressure, papilledema, vision loss, diplopia, tinnitus, deafness, nausea and vomiting, or sixth nerve palsy. Medical and surgical management options are available for patients with IIH. The authors report a case of IIH that was successfully resolved with digoxin after standard avenues of therapy were exhausted.