Special Communication  |   July 2004
George W. Northup, DO, Medical Writing Award Recipients: Lead Authors and Abstracts
Article Information
Neuromusculoskeletal Disorders / Osteopathic Manipulative Treatment
Special Communication   |   July 2004
George W. Northup, DO, Medical Writing Award Recipients: Lead Authors and Abstracts
The Journal of the American Osteopathic Association, July 2004, Vol. 104, 274-278. doi:10.7556/jaoa.2004.104.7.274
The Journal of the American Osteopathic Association, July 2004, Vol. 104, 274-278. doi:10.7556/jaoa.2004.104.7.274
2003—Timothy S. Carey, MD, MPH
Do Osteopathic Physicians Differ in Patient Interaction From Allopathic Physicians? An Empirically Derived Approach
Colleges of osteopathic medicine teach osteopathic principles, which provide a different approach to and interaction with patients than principles taught in allopathic medical schools. The authors examined whether osteopathic primary care physicians' interactions with patients reflect the principles of osteopathic medicine when compared with allopathic physicians' interactions. The principles of osteopathic medicine were adapted to elements that could be measured from an audio recording. This 26-item index was refined with two focus groups of practicing osteopathic physicians. Fifty-four patient visits to 11 osteopathic and 7 allopathic primary care physicians in Maine for screening physicals, headache, low back pain, and hypertension were recorded on audiotape and were dual-abstracted. When the 26-item index of osteopathic principles was summed, the osteopathic physicians had consistently higher scores (11 vs 6.9; P=.01) than allopathic physicians, and visit length was similar (22 minutes vs 20 minutes, respectively). Twenty-three of the 26 items were used more commonly by the osteopathic physicians. Osteopathic physicians were more likely than allopathic physicians to use patients' first names; explain etiologic factors to patients; and discuss social, family, and emotional impact of illnesses. In this study, osteopathic physicians were easily distinguishable from allopathic physicians by their verbal interactions with patients. Future studies should replicate this finding as well as determine whether it correlates with patient outcomes and satisfaction. 
Carey TS, Motyka TM, Garrett JM, Keller RB. J Am Osteopath Assoc. 2003; 103:313-318. Full text pdf available at: 
2002—Russell G. Gamber, DO
Osteopathic Manipulative Treatment in Conjunction With Medication Relieves Pain Associated With Fibromyalgia Syndrome: Results of a Randomized Clinical Pilot Project
Osteopathic physicians caring for patients with fibromyalgia syndrome (FM) often use osteopathic manipulative treatment (OMT) in conjunction with other forms of standard medical care. Despite a growing body of evidence on the efficacy of manual therapy for the treatment of selected acute musculoskeletal conditions, the role of OMT in treating patients with chronic conditions such as FM remains largely unknown. Twenty-four female patients meeting American College of Rheumatology criteria for FM were randomly assigned to one of four treatment groups: (1) manipulation group, (2) manipulation and teaching group, (3) moist heat group, and (4) control group, which received no additional treatment other than current medication. Participants' pain perceptions were assessed by use of pain thresholds measured at each of 10 bilateral tender points using a 9-kg dolorimeter, the Chronic Pain Experience Inventory, and the Present Pain Intensity Rating Scale. Patients' affective response to treatment was assessed using the Self-Evaluation Questionnaire. Activities of daily living were assessed using the Stanford Arthritis Center Disability and Discomfort Scales—Health Assessment Questionnaire. Depression was assessed using the Center for Epidemiological Studies Depression Scale. Significant findings between the four treatment groups on measures of pain threshold, perceived pain, attitude toward treatment, activities of daily living, and perceived functional ability were found. All of these findings favored use of OMT. This study found OMT combined with standard medical care was more efficacious in treating FM than standard care alone. These findings need to be replicated to determine if cost savings are incurred when treatments for FM incorporate nonpharmacologic approaches such as OMT. 
Gamber RG, Shores JH, Russo DP, Jimenez C, Rubin BR. J Am Osteopath Assoc. 2002;102:321-325. Full text pdf available at: 
2001—Thomas Breithaupt, PhD
Thoracic Lymphatic Pumping and the Efficacy of Influenza Vaccination in Healthy Young and Elderly Populations
The authors investigated whether thoracic lymphatic pumping (TLP) after FluShield vaccination enhanced the production of anti-influenza immunoglobulins in elderly individuals, who are at particular risk for influenza. Osteopathic students and non–TLP-treated elderly subjects served as controls. Serum antibody titers were quantified with enzyme-linked immunosorbent assay, and hemagglutination inhibition assay, both of which generated comparable results. While approximately 70% of the younger controls had increased anti-influenza immunoglobulin production on vaccination, only 30% to 35% of the aged population had increased antibody production. There was no significant enhancement in anti-influenza immunoglobulin production in the TLP-treated subjects. The authors' findings suggest that TLP in conjunction with influenza vaccination does not enhance immunization against influenza in otherwise healthy and active populations. However, such techniques may be of value when applied in conjunction with vaccination to nonambulatory patients or on actual influenza exposure of at-risk individuals. 
Breithaupt T, Harris K, Ellis J, Purcell E, Weir J, Clothier M, Boesler D. J Am Osteopath Assoc. 2001;101:21-25. Full text pdf available at: 
2000—Donald R. Noll, DO
Benefits of Osteopathic Manipulative Treatment for Hospitalized Elderly Patients With Pneumonia
While osteopathic manipulative treatment (OMT) is thought to be beneficial for patients with pneumonia, there have been few clinical trials—especially in the elderly. The authors' pilot study suggested that duration of intravenous antibiotic use and length of hospital stay were promising measures of outcome. Therefore, a larger randomized controlled study was conducted. Elderly patients hospitalized with acute pneumonia were recruited and randomly placed into two groups: 28 in the treatment group and 30 in the control group. The treatment group received a standardized OMT protocol, while the control group received a light touch protocol. There was no statistical difference between groups for age, sex, or simplified acute physiology scores. The treatment group had a significantly shorter duration of intravenous antibiotic treatment and a shorter hospital stay. 
Noll DR, Shores JH, Gamber RG, Herron KM, Swift J Jr. J Am Osteopath Assoc. 2000;100:776-782. Full text pdf available at: 
1999—Michael P. Wells, PhD
Standard Osteopathic Manipulative Treatment Acutely Improves Gait Performance in Patients With Parkinson's Disease
Patients with Parkinson's disease exhibit a variety of motor deficits which can ultimately result in complete disability. The primary objective of this study was to quantitatively evaluate the effect of osteopathic manipulative treatment (OMT) on the gait of patients with Parkinson's disease. Ten patients with idiopathic Parkinson's disease and a group of eight age-matched normal control subjects were subjected to an analysis of gait before and after a single session of an OMT protocol. A separate group of 10 patients with Parkinson's disease was given a sham-control procedure and tested in the same manner. In the treated group of patients with Parkinson's disease, statistically significant increases were observed in stride length, cadence, and the maximum velocities of upper and lower extremities after treatment. There were no significant differences observed in the control groups. The data demonstrate that a single session of an OMT protocol has an immediate impact on parkinsonian gait. Osteopathic manipulation may be an effective physical treatment method in the management of movement deficits in patients with Parkinson's disease. 
Wells MR, Giantinoto S, D'Agate D, Areman RD, Fazzini EA, Dowling D, Bosak A. J Am Osteopath Assoc.. (1999). ;99:92-98.  
1998—Joan M. Radjieski, DO
Effect of Osteopathic Manipulative Treatment on Length of Stay for Pancreatitis: A Randomized Pilot Study
There have been few randomized, controlled studies of the effects of osteopathic manipulative treatment (OMT). In this outcomes research study, the authors randomly assigned patients with pancreatitis to receive standard care plus daily OMT for the duration of their hospitalization (n=6) or to receive only standard care (n=8). Osteopathic manipulative treatment involved 10 to 20 minutes daily of a standardized protocol, using myofascial release, soft tissue, and strain-counterstrain techniques. Attending physicians were blinded as to group assignment. Results indicated that patients who received OMT averaged significantly fewer days in the hospital before discharge (mean reduction, 3.5 days) than control subjects, although there were no significant differences in time to food intake or in use of pain medications. These findings suggest the possible benefit of OMT in reducing length of stay for patients with pancreatitis. 
Radjieski JM, Lumley MA, Cantieri MS. J Am Osteopath Assoc. 1998;98(5):264-272. Erratum in: J Am Osteopath Assoc. 1998;98:408.  
1997—Brian H. Hallas, PhD
Establishment of Behavioral Parameters for the Evaluation of Osteopathic Treatment Principles in a Rat Model of Arthritis
Unilateral arthritis was produced in rats by use of methylated bovine serum albumin in a model of antigen-induced arthritis. The progression of arthritis was measured by computerized motion analysis, bilateral joint circumference, voluntary extension force of the hind legs, and length of ankle extension. Animals with induced arthritis were assigned to treated and untreated groups on the basis of approximately equal deficits by the parameters measured. A third group of rats, which did not have arthritis induced and received no treatment, served to establish mean normal parameters. Modified techniques of muscle energy, passive movement of the ankle and knee, and passive myofascial stretch were applied to the animals, and the animals were exercised in a mechanized exercise wheel. Parameters associated with gait were examined by computerized motion analysis of walking. Animals treated with manipulation and exercise improved significantly relative to untreated animals with antigen-induced arthritis in vertical ankle lift, ankle-based and foot-based stride lengths, knee circumference, and normalized extension of the ankle. The results demonstrate that the parameters identified can be used to detect functional deficits and significant improvement from those deficits can be derived from a nonpharmacologic treatment paradigm that includes osteopathic manipulation and exercise in an animal model of arthritis. These parameters may be useful in the identification of the relative benefits of independent treatment variables including frequency of osteopathic manipulation and exercise and the relative benefits of each in this model. Also, they may elucidate how these treatments produce their beneficial effects clinically. 
Hallas B, Lehman S, Bosak A, Tierney S, Galler R, Jacovina P, Scandalis TA, Wells M. J Am Osteopath Assoc.. (1997). ;97:207-214.  
1996—W. Randolph Purdy, DO
Suboccipital Dermatomyotomic Stimulation and Digital Blood Flow
The effect of gentle, soft tissue manipulation in the suboccipital region on digital blood flow, as a measure of sympathetic nervous system activity, was studied. Digital strain gauge plethysmography was used to measure the changes in pulse contour during (1) a normative test period with the subject in the supine position, (2) after a control interval (placebo) during which the investigator placed his hands under the suboccipital region, and (3) after an interval during which the investigator's fingers applied slow, steady, circular kneading in the suboccipital triangle region. Twenty-five studies were performed in a crossover design with the patient as his or her own control. Total pulse amplitude (Y) and the height from the dicrotic notch to the peak (X) were measured. Examination of the total data of all subjects revealed the occurrence of a significant change in X and Y with simply touching the suboccipital region with the hands. An even more favorable response ensued when suboccipital manipulation was applied. Those subjects reporting comfort or neutral responses had larger significant changes with manipulation when compared with the group reporting the experience as uncomfortable. The response within each group suggests that favorable autonomic changes (sympathetic dampening) occur with specific suboccipital manipulation as well as, indeed, the simple touching of the suboccipital triangle. 
Purdy WR, Frank JJ, Oliver B. J Am Osteopath Assoc. 1996;96:285-289.  
1995—William L. Johnston, DO
Changes in Presence of a Segmental Dysfunction Pattern Associated With Hypertension
The short-term portion of this study (part 1) showed an association between somatic dysfunction and the regulation of blood pressure. To study long-term relationships, follow-up examinations were made of 61 subjects studied 3 to 10 years earlier. They were heterogeneous Family Practice Clinic patients with a mean age of 45 years. By methods used in part 1 and in our previous studies of systemic interactions, palpatory examination was done to support presence or absence of a C6T2T6 pattern of segmental motion dysfunctions, and blood pressure status was established by the medical history. The C6T2T6 pattern persisted in 16 of 16 subjects with grade 2 or greater hypertension and 4 of 9 normotensive subjects who had shown the pattern initially. At follow-up, the pattern first appeared in 7 subjects who had hypertension previously diagnosed and who remained hypertensive; the pattern disappeared in 5 normotensive subjects who remained normotensive. The C6T2T6 pattern's long-term persistence in hypertensive subjects and changes in its presence corresponding to the subjects' hypertensive status indicate an important relationship between this pattern of segmental motion dysfunctions and disturbances in regulation of blood pressure. 
Johnston WL, Kelso AF. J Am Osteopath Assoc. 1995;95(5):315-318.  
1994—Benjamin M. Sucher, DO
Palpatory Diagnosis and Manipulative Management of Carpal Tunnel Syndrome
Carpal tunnel syndrome was studied by use of supplemental palpatory diagnosis in 20 abnormal wrists. Restriction in motion at the carpal tunnel was quantified with a rating system. All wrists with carpal tunnel syndrome revealed at least moderate restriction to motion, as compared with only mild or no restriction in 20 wrists in normal, symptom-free subjects. Several participants (16 abnormal wrists) underwent osteopathic manipulative treatment, including a new “opponens roll” maneuver, and self-stretching, or a similar treatment accomplished by use of a self-treatment accomplished by use of a self-treatment appliance. In those treated, palpatory restriction decreased into the normal range, often before symptoms decreased. Improvement in nerve conduction studies usually followed within 1 to 3 months. Palpatory diagnosis is a useful adjunctive method of assessing patient status in carpal tunnel syndrome and helpful in prognosticating outcome. The modified manipulative technique described for the treatment of mild to moderate carpal tunnel syndrome may be effective in more severe cases. 
Sucher BM. J Am Osteopath Assoc.. (1994). ;94(8):647-663.  
1993—Christopher T. Meyer, DO
Osteopathic Medicine: A Call for Reform
During the past 40 years, the osteopathic medical profession has undergone a transformation from “osteopathy” to “osteopathic medicine.” The former was characterized by manipulative treatment; the latter, by full-service healthcare. During this transformation, the profession has won acceptance from the government, the military, and MDs. These changes in status have resulted in new problems for the profession because DO graduates are increasingly turning toward allopathic programs for residency training. Thus, osteopathic medicine's primary care orientation is being replaced by an emphasis on specialty training. The authors propose that osteopathic medicine return to its original mission of primary care, abandon or restrict specialty training to those who have completed primary care residencies, and rethink its separate-but-equal posture. They also propose that osteopathic medicine establish lines of communication with allopathic medicine, the American Medical Association, and the government to facilitate the development of a rational national policy for primary care that considers the potential osteopathic medicine has to offer in meeting the nation's primary care needs. 
Meyer CT, Price A. J Am Osteopath Assoc. 1993;93(4):473-485.  
1992—Thomas Adams, PhD
Parietal Bone Mobility in the Anesthetized Cat
To quantify parietal bone motion in reference to the medial sagittal suture, a newly developed instrument was attached to the surgically exposed skull of anesthetized adult cats. The instrument differentiated between lateral and rotational parietal bone movements around the fulcrum of the suture. Bone movement was produced by external forces applied to the skull and by changes in intracranial pressure associated with induced hypercapnia, intravenous injections of norepinephrine, and controlled injections of artificial cerebrospinal fluid into the lateral cerebral ventricle. Responses varied considerably among test animals. Generally, lateral head compression caused sagittal suture closure, small inward rotation of the parietal bones, increased intraventricular pressure, transient apnea, and unstable systemic arterial blood pressure. Graded increases in intracranial volume produced stepped increases in pressure, lateral expansion at the sagittal suture, and outward rotation of the parietal bones. We attribute variations in animal response largely to differences in intracranial and suture compliance among them. Cranial suture compliance may be an important factor in defining total cranial compliance. 
Adams T, Heisey RS, Smith MC, Briner BJ. J Am Osteopath Assoc. 1992;92:599-600, 603-610, 615-622.  
1991—Irvin M. Korr, PhD
Osteopathic Research: The Needed Paradigm Shift
The purposes of this article are twofold: (1) To assist scientists on the faculties of colleges of osteopathic medicine in the design of research projects relevant to osteopathic medical theory and practice; and (2) to assist clinical investigators in the development of research protocols that are best suited to the assessment of clinical outcomes of osteopathic medical practice. Toward this end, the central osteopathic medical principles are heuristically interpreted and elaborated, with the intention of facilitating the formulation of fundamental questions by researchers in the various biomedical disciplines and the design of clinical research projects by osteopathic physicians. A few of the questions evoked by such elaboration of the osteopathic medical principles and awaiting study are suggested for consideration by researchers. Such research questions require and, in part, compose a research paradigm that differs basically from, yet complements and “completes,” the prevailing and highly productive reductionist paradigm. It is, in the original sense of the word, a “holistic” paradigm that places emphasis on the organismic context in which the biological mechanisms exist and operate. 
Conventional clinical research protocols for the assessment of efficacy of most chemical and physical therapeutic agents are ill-suited for the assessment of osteopathic medical care, of manipulative treatment in particular. It is emphasized that osteopathic medical care must be evaluated as it is practiced and not as a contrived, unreal version; and that it must be tested as a derivative of, and in the context of, that philosophy by criteria consonant with that philosophy. Arguments are presented that conventional correction for the socalled placebo effect would render invalid the testing of osteopathic medicine as it is practiced. 
Alternative designs and models are suggested. Most of them have been tested and reported in the clinical literature; others await careful trial and development under osteopathic auspices. 
Korr IM. J Am Osteopath Assoc.. (1991). ;91: 156, 161-168, 170-171.  
1990—Richard Van Buskirk, DO
Nociceptive Reflexes and the Somatic Dysfunction: A Model
A model of somatic dysfunction is developed in which restriction in mobility and autonomic, visceral, and immunologic changes are produced by pain-related sensory neurons and their reflexes. Nociceptors are known to produce muscular guarding reactions, as well as autonomic activation, when musculoskeletal or visceral tissue is stressed or damaged. This guarding causes abnormal musculoskeletal position and range of motion. Local inflammatory responses and autonomic reflexes further reinforce nociceptor activity, maintaining restriction. Nociceptive autonomic reflexes also evoke changes in visceral and immunologic function. Finally, maintenance of muscles, joints, and related tissues in an abnormal guarding position causes changes in the connective tissues, solidifying the abnormal position. Stretching these tissues into a normal range of motion will restimulate the nociceptor, reflexly reinforcing the somatic dysfunction. This model has evolved from Korr's neurologic model but emphasizes the nociceptor and its reflexes as a source of the connective tissue, circulatory, visceral, and immunologic changes seen in the somatic dysfunction. 
Van Buskirk RL. J Am Osteopath Assoc. 1990;90:792-794, 797-809.  
  Awards are presented in the year following publication at the AOA Annual Convention and Scientific Seminar. So the 2002 award, for example, was presented at the 2003 convention, and the 2003 award will be presented at the 2004 convention.