Strengthening the evidence base for osteopathic manipulative medicine
John C. Licciardone, DO (right), is the principal investigator of the largest randomized controlled trial ever conducted on the effects of osteopathic manipulative treatment. (Photo courtesy of Dr. Licciardone)
“To know all of a bone in its entirety would close both ends of an eternity.”
—Andrew Taylor Still, MD, DO
In his bold questioning of assumptions and relentless pursuit of knowledge, Andrew Taylor Still, MD, DO, embodied the quest for truth that underlies all scientific research, observes Barbara Ross-Lee, DO, the vice president for health sciences and medical affairs at the New York Institute of Technology in Old Westbury.
“By any measure, A.T. Still was the osteopathic medical profession’s first researcher,” wrote Michael M. Patterson, PhD, in an editorial in the 100th volume of JAOA—The Journal of the American Osteopathic Association, published in April 2000. “His powers of observation and keen clinical insight led to many diagnostic and therapeutic discoveries that are relevant today.”
The second in a series, this article looks at the evidence base for osteopathic manipulative medicine and research currently under way. The first article presents an overview of evidence-based medicine and its application at the point of care.
A passion for inquiry propelled many of the profession’s early pioneers. During the second and third decades of the 20th century, Arthur G. Hildreth, DO, researched the effects of osteopathic manipulative treatment on mentally ill patients at the Still-Hilldreth Sanitorium in Macon, Mo., publishing statistical results on patient recovery rates in a 1929 issue of the American School of Osteopathy’s Journal of Osteopathy. Considered osteopathic medicine’s most renowned investigator of that era, Louisa M. Burns, DO, led the A.T. Still Research Institute in Chicago and then in Los Angeles from 1915 to 1936 and later ran a research laboratory at the former College of Osteopathic Physicians and Surgeons in Los Angeles. Dr. Burns conducted hundreds of studies on the effects of somatic dysfunction on skeletal muscle and visceral functions and wrote dozens of published articles and five books.
Consistently receiving funding from the National Institutes of Health, Irvin M. Korr, PhD, became the profession’s most celebrated researcher of the mid-20th century. Chairing the physiology department at the Kirksville College of Osteopathic Medicine from 1945 to 1975, he investigated the neurophysiological disturbances associated with somatic dysfunction.
Despite dating back more than 100 years, the osteopathic medical profession’s research endeavors failed to gain lasting, professionwide momentum, however. With its long struggle for parity and for public awareness and current focus on reimbursement, the profession as a whole has not consistently made research on osteopathic manipulative medicine a priority, notes Michael A. Seffinger, DO, the president of the American Academy of Osteopathy (AAO) and the vice chairman of the AOA Bureau of Osteopathic Clinical Education and Research.
“We do not have a research culture in our profession,” asserts William Thomas Crow, DO, the director of the integrated residency program in family medicine and neuromusculoskeletal medicine at Florida Hospital East Orlando. While prominent allopathic medical schools emphasize research, osteopathic medical schools for the most part focus on producing well-trained primary care physicians, Dr. Crow says.
But the federal government’s demand for scientific evidence in health care is compelling the profession to shift gears. “The push for evidence-based medicine is forcing us to do what we should have done before,” Dr. Ross-Lee says. “We don’t have enough research.”
In partnership with the Osteopathic Heritage Foundation, the AOA Council on Research provides up to $600,000 of funding annually for research projects. And this year, the annual AOA Research Conference focused entirely on the evidence base for osteopathic manipulative treatment. The AAO, in turn, has established a new foundation that has raised nearly $1 million to fund OMT research and disseminate research findings.
“Building our evidence base is crucial for us in gaining credibility as a profession,” says Hollis H. King, PhD, DO, who chaired the Research Conference that took place Oct. 31 to Nov. 1 during OMED 2011 in Orlando, Fla. “We have made significant progress, but more work needs to be done.”
Certain individuals and entities within the profession have remained committed to research, but they have received insufficient funding over the years, says Dr. Seffinger, an associate editor of the JAOA and the chairman of OMM at the Western University of Health Sciences College of Osteopathic Medicine of the Pacific in Pomona, Calif. Pilot studies, both experimental and observational, on many aspects of OMT have shown promise but have not yet added up to a rich repository of data, except for evidence that OMT alleviates low back pain and improves associated function, he notes. What’s more, today’s higher standards of research methodology have called into question results from the profession’s early forays into scientific investigation.
Fewer than a dozen individuals regularly conduct primary research on OMT, says Dr. King, the osteopathic residency director for a dually accredited program at the University of Wisconsin School of Medicine and Public Health in Madison. With only a small cadre of dedicated researchers, strengthening the evidence base takes considerable time, he notes.