Clinical protocols for osteopathic manipulative treatment (OMT) procedures have been used in “technique” studies to examine the effects of specific procedures. Such studies, writes Michael M. Patterson, PhD,
1 are “useful in instances where there may be reason to suspect that a specific manipulative technique would change a particular condition.” I would like to raise a concern regarding whether these technique studies, which are not based on medical histories or physical examinations, are ideal in terms of supporting osteopathic concepts and the practice of distinctive osteopathic medicine. In my opinion, in technique studies based on protocols for OMT procedures, manipulations are not delivered in a manner consistent with osteopathic principles, and there may be unforeseen consequences of such research—whether findings for the procedures are positive or negative.
Dr Patterson
2 has explained that “there are basically two types of studies of osteopathic manipulation: (1)
technique studies... and (2) studies of osteopathic manipulative
treatment.” In a technique study, a specific OM procedure is studied for its effects on a target problem. By contrast, in a study of OMT, the full range of OMT procedures are available, and the application of a specific technique depends on a thorough physical examination of the patient by the osteopathic physician.
Osteopathic manipulative treatment is defined as the “therapeutic application of manually guided forces by an osteopathic physician to improve physiologic function and/or support homeostasis that has been altered by somatic dysfunction.”
3 American Osteopathic Association (AOA) protocols for the use of OMT state that the “diagnosis must be specific.”
4 Once a diagnosis is made, the osteopathic physician “determine(s) the appropriate techniques and treatment.” Furthermore, an evaluation and management service code requires a “history, examination, and medical decision making,” all of which must be documented in the medical record.
4 Thus, by definition, OMT is directed toward removing the somatic dysfunctions that are inhibiting the body's function and self-healing mechanisms. When treatment in a clinical technique study is not based on the findings of a patient's medical history and physical examination, how can we be practicing osteopathic medicine or be studying the effects of a truly
osteopathic manipulative procedure?
In the present letter, I examine each of the tenets of osteopathic medicine
5 as they relate to standardized clinical protocols for OMT procedures.
Clinical protocols for OMT procedures face a challenge in adhering to this tenet. By their very nature, standardized protocols are not able to meet the specific clinical needs of a patient because patients cannot be standardized. Protocols cannot fully address a patient's body unity because they are not based on the patient's physical examination or medical history. Protocols cannot fully address the structure-function tenet because they are not necessarily aimed at the key structural issues involved in each case. Protocols cannot fully assist the patient's self-healing mechanisms and abilities because they do not adequately address the structure and function of the body as a unit.