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Original Contribution  |   May 2019
Osteopathic Manipulative Medicine Consultations for Hospitalized Patients
Author Notes
  • From the Department of Neuromusculoskeletal Medicine at Stony Brook Southampton Hospital in New York (Dr Levy) and the Department of Family Medicine at Maine Medical Center in Portland (Drs Holt and Haskins). 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Vivian Levy, DO, MPH, 147 Beach Rd, Westhampton Beach, NY 11978-1733. Email: vivian.levy@tu.edu
     
Article Information
Obstetrics and Gynecology / Pain Management/Palliative Care / Pediatrics / Practice Management
Original Contribution   |   May 2019
Osteopathic Manipulative Medicine Consultations for Hospitalized Patients
The Journal of the American Osteopathic Association, May 2019, Vol. 119, 299-306. doi:https://doi.org/10.7556/jaoa.2019.051
The Journal of the American Osteopathic Association, May 2019, Vol. 119, 299-306. doi:https://doi.org/10.7556/jaoa.2019.051
Abstract

Context: Although osteopathic manipulative treatment (OMT) is predominantly known for its benefits in improving musculoskeletal pain, many studies have examined the effects of OMT on hospitalized patients with a variety of conditions, showing improved outcomes in conditions such as pneumonia, postoperative and postpartum recovery, preterm newborn recovery, and newborn feeding dysfunction.

Objective: To determine the reasons osteopathic manipulative medicine (OMM) consultations are being ordered at a tertiary care teaching hospital.

Methods: This descriptive study was conducted at an academic medical center with a well-established electronic health record system. A retrospective review examined data on all OMM consultations between January 1, 2015, and June 30, 2015. Reasons for consultations in a free text field were grouped into categories of “primary reason for consult” by a single reviewer. Demographics and patient location were also assessed.

Results: Of 1310 total consultations included in the study, 620 (47.0%) listed a musculoskeletal complaint as the primary or only reason for a consultation, 231 (18.0%) of which were for back pain, followed by neck pain (69 [5.0%]) and headache (46 [4.0%]). The next most common reason for consultation was for newborn feeding difficulty (352 [27.0%]) or other newborn consultation (66 [5.0%]). A total of 272 consultations (21.0%) were not limited to musculoskeletal complaints and included general nonspecific discomfort (96 [7.0%]) or respiratory complaint (53 [4.0%]). A total of 209 (16.0%) consultations noted patients to be postoperative; 124 (9.5%) to be postpartum; 57 (4.4%) to have cystic fibrosis; and 21 (1.6%) to have constipation.

Conclusion: The majority of inpatient OMM consultations were placed for musculoskeletal complaints, followed by newborn feeding problems. Although it is clear that some physicians think that OMT will help their patients for the aforementioned conditions, the number was still quite low, suggesting that many physicians may be unaware that OMT can help patients with conditions such as respiratory disorder, postoperative recovery, and constipation. There are many opportunities for treatment teams to be ordering OMM consultations as a way to reduce morbidity in their patients.

Although osteopathic manipulative treatment (OMT) is predominantly known for its benefits in improving musculoskeletal pain, such as back pain, neck pain, and headaches,1-3 the osteopathic approach is also meant to restore normal autonomic tone, improve circulation and immune response, and restore physiologic function.4 Many studies have examined the effects of OMT on common conditions in inpatients, with outcomes such as decreased respiratory failure and mortality in pneumonia,5 improved pulmonary function in asthma,6 decreased time to flatus in postoperative ileus,7 faster recovery after cardiac surgery,8-10 decreased need for opiate analgesia after abdominal surgery,11 and decreased postpartum pain.12 Several newer studies suggest that manual medicine can also be helpful in recovering from pancreatitis,13 lysing visceral adhesions,14 treating small bowel obstruction,15 and improving balance disorders and dizziness.16 Among infants, OMT is shown to improve newborns’ ability to breastfeed17 and decrease hospital length of stay in preterm newborns.18,19 
Pomykala et al20 surveyed hospitalized patients who received OMT and found that 98% of respondents had improved overall comfort after OMT, 94% felt that OMT assisted in their recovery, 90% had less stress and anxiety, 74% felt less pain, and 43% felt less need for pain medication. Along with improved outcomes in hospital conditions, the use of OMT in adjunctive care is an excellent opportunity to improve patient comfort and recovery in the hospital using a noninvasive treatment with minimal risk for adverse effects when used appropriately. 
Unfortunately, the potential benefits of OMT are not widely known, as it is not taught in medical education outside of osteopathic medical schools and has become less frequently practiced by DOs over time.21 As of May 2018, 35 hospitals in the United States have osteopathic manipulative medicine (OMM), also known as neuromusculoskeletal medicine (NMM), residencies or combined residencies,22 and it is unclear how many hospitals without an OMM training program have inpatient OMM consultation services. 
Maine Medical Center, a 637-bed teaching hospital in Portland, Maine, is the largest hospital in northern New England. At this hospital, OMM is available as a specialist consultation for the evaluation and treatment of patients using OMT techniques. It is a commonly ordered consultation for inpatients. The OMM department is staffed by attending physicians, fellows, residents, and students. The goal of the current study was to determine for what reasons OMM consultations were most commonly ordered. We hypothesized that the majority of consultations would be for musculoskeletal complaints. But the question remained, how aware were providers of the other potential benefits of OMT? How frequently were OMM consultations being ordered for other problems or to augment standard treatments in general illness? We examined 6 months of OMM consultation requests and the data about the patients and the reasons for consultation to begin to answer these questions. 
Methods
This descriptive study was a retrospective medical record review. We obtained data for all of the primary “inpatient consult to manipulative medicine” orders placed between January 1, 2015, and June 30, 2015, with basic demographics about patients (age, sex, race, insurance type) and hospital stays (length of stay, hospital floor). At this institution, length of stay is 1 day if a patient is admitted and discharged on the same day. The free-text comments that were written as part of the consultation order were also requested. 
Patient and hospital encounter identification numbers and dates of orders and consultation completion were also requested to identify duplicates and clarify information in medical records prior to final analysis. The institutional review board at Maine Medical Center approved this study as exempt from review. 
Primary Reasons for Consultation
A single reviewer (V.L.) manually reviewed the text field “primary reason for consult” and subsequently grouped reasons into distinct categories. A second reviewer (C.H.) spot-checked approximately 10% of the records, and both reviewers came to a consensus about any discrepancies. Three broad categories for consultations were created: (1) musculoskeletal; (2) nonspecific, multiple, or other reason; and (3) newborn. For the 95 consultations with no information written in the text field, medical records were manually checked for the consultation reason note and then grouped into categories. 
First, musculoskeletal consultations included any consultation for pain or related reasons, including decreased mobility, numbness, weakness, and fatigue of an area. If only 1 region was mentioned in the primary complaint, the consultation was further categorized into a regional group: back, neck, head, extremity, shoulder, hip (including groin), chest/rib, or pelvic and/or abdominal pain. If multiple regions were mentioned, the consultation was categorized as multiple regions. This grouping was further categorized into “back +1 or more regions,” for example, which could include the neck, followed by the next most prevalent single region, eg, “neck +1 or more regions,” which was anything associated with the neck but not including the back. 
The second category, “nonspecific, multiple, or other,” included reasons that were either not solely musculoskeletal or did not mention a musculoskeletal region. “General discomfort” included general pain or discomfort without mention of a body region. Other primary categories for consultation not listing a region or a general pain report included postoperative, postpartum, respiratory (including cystic fibrosis), and constipation. “Multiple-reason” consultation orders had multiple reasons listed, such as some of the ones previously described (which may or may not have also included a musculoskeletal region). 
The third category was “newborn” (aged <1 year). Newborn feeding difficulty included any consultations related to feeding. “Other newborn” were single-reason consultations not related to feeding, with subcategories of tone, neck and cranium, preterm, and request (if there was nothing else written in the consultation reason field). “Multiple newborn” included any combination of reasons, which often included breastfeeding and something else, other reasons, such as breathing, hip dysplasia, and foot deformity. 
Binary Yes/No Categories
While attempting to categorize the data, it was observed that many patients had a primary complaint but also were noted incidentally in the consultation text to be postoperative, postpartum, or pregnant, or have cystic fibrosis. Separate yes/no fields were made to identify the total numbers of these patients in the final counts. For example, a consultation for a patient who had a primary complaint of back pain but happened to be hospitalized for open-heart surgery was counted in the postoperative field, as was a consultation in which the primary reason for consultation was postoperative. Consultations included in the postoperative yes/no field included surgical procedures and procedures mentioned in the free text field. Yes/no fields were also made for postpartum, respiratory, cystic fibrosis, pregnancy, and constipation-related complaints. If a patient had a cesarean delivery, the consultation would be flagged under both the postoperative and postpartum fields. Of note, consultations flagged in the respiratory yes/no field generally had multiple reasons for order and one was specifically respiratory in nature. However, having cystic fibrosis or requiring mechanical ventilation did not count as one of those reasons. 
Results
For the 6-month time frame requested, 1328 initial consultation orders were identified from the electronic medical record system, with 17 duplicate orders noted, which were similar orders placed within 72 hours of each other but resulted in the patient only being seen once for both orders, and 1 consultation ordered in error. After removing these consultations, 1310 were included in the analysis. We did not include patients’ subsequent OMM visits (consultation follow-up) or subsequent treatment for new or separate symptoms. 
Patient Characteristics
The demographics of patients receiving consultations included slightly more female patients (724 [55%]), predominantly white race (1233 [94.1%]), newborns and infants (425 [32.4%]), and patients older than 65 years (235 [18%]) (Table 1). 
Table 1.
Demographic Characteristics of Inpatients for Whom OMM Consultations Were Ordered in a Large New England Hospital (N=1310)
Characteristic No. (%)
Sex
 Male 586 (44.7)
 Female 724 (55.3)
Age, y
 <1 425 (32.4)
 1-18 62 (4.7)
 19-30 164 (12.5)
 31-65 424 (32.4)
 >65 235 (17.9)
Race
 American Indian and other/unknown 34 (2.7)
 Asian 15 (1.1)
 Black 28 (2.1)
 White 1233 (94.1)
Insurance Type
 Medicaid 287 (21.9)
 Medicare 329 (25.1)
 Commercial insurance 672 (51.3)
 No insurance 22 (1.7)
Hospital Length of Stay
 <48 h 323 (24.7)
 3-7 d 507 (38.7)
 8-14 d 220 (16.8)
 15-30 d 158 (12.1)
 >30 d 102 (7.8)
Pediatric Floors 481 (36.7)
 Newborn nursery 369 (28.2)
 Pediatrics 72 (5.5)
 Neonatal intensive care unit or continuing care nursery 36 (2.7)
 Pediatric intensive care unit 4 (0.3)
Obstetric Floors 177 (13.5)
 Postpartum 108 (8.2)
 Prenatal 49 (3.7)
 Labor 20 (1.5)
Adult Floors 618 (47.2)
 General medical-surgical 455 (34.7)
 Intensive care unit 95 (7.3)
 Intermediate care unit 58 (4.4)
 Psychiatry 10 (0.8)
Adult/Pediatrics 34 (2.6)
 Emergency department 14 (1.1)
 Short stay 14 (1.1)
 Perioperative 6 (0.5)
Table 1.
Demographic Characteristics of Inpatients for Whom OMM Consultations Were Ordered in a Large New England Hospital (N=1310)
Characteristic No. (%)
Sex
 Male 586 (44.7)
 Female 724 (55.3)
Age, y
 <1 425 (32.4)
 1-18 62 (4.7)
 19-30 164 (12.5)
 31-65 424 (32.4)
 >65 235 (17.9)
Race
 American Indian and other/unknown 34 (2.7)
 Asian 15 (1.1)
 Black 28 (2.1)
 White 1233 (94.1)
Insurance Type
 Medicaid 287 (21.9)
 Medicare 329 (25.1)
 Commercial insurance 672 (51.3)
 No insurance 22 (1.7)
Hospital Length of Stay
 <48 h 323 (24.7)
 3-7 d 507 (38.7)
 8-14 d 220 (16.8)
 15-30 d 158 (12.1)
 >30 d 102 (7.8)
Pediatric Floors 481 (36.7)
 Newborn nursery 369 (28.2)
 Pediatrics 72 (5.5)
 Neonatal intensive care unit or continuing care nursery 36 (2.7)
 Pediatric intensive care unit 4 (0.3)
Obstetric Floors 177 (13.5)
 Postpartum 108 (8.2)
 Prenatal 49 (3.7)
 Labor 20 (1.5)
Adult Floors 618 (47.2)
 General medical-surgical 455 (34.7)
 Intensive care unit 95 (7.3)
 Intermediate care unit 58 (4.4)
 Psychiatry 10 (0.8)
Adult/Pediatrics 34 (2.6)
 Emergency department 14 (1.1)
 Short stay 14 (1.1)
 Perioperative 6 (0.5)
×
A total of 672 patients (51.3%) had commercial insurance, 287 (21.9%) had Medicaid, 329 (25.1%) had Medicare, and 22 (1.7%) had no insurance. Roughly one-fourth of hospital stays lasted less than 48 hours, slightly over half lasted 3 to 14 days, and 260 (20%) lasted longer than 2 weeks. The mean hospital length of stay among all consultations was 11.4 days and among nonnewborn patients, 13.4 days (range, 1-247 days). We did not precisely calculate the mean time from order to consultation. 
Approximately half of the consultations (n=618) were on primarily adult floors (Table 1). Among the 481 patients (36.7%) located on pediatric or newborn floors, 369 (28.2%) were healthy newborns, and 36 (2.7%) were in the neonatal intensive care unit or the continuing care nursery (intermediate care unit for newborns). A total of 177 consultations (13.5%) were for pregnant and postpartum women on obstetric floors. 
Reasons for Consultations
Table 2 presents the primary reasons for ordering OMM consultations. Of the 1310 consultations included in the study, 620 (47.3%) listed a musculoskeletal complaint as the primary or only reason for consultation; 490 consultations (37.4%) addressed a single region and 130 (9.9%) addressed multiple regions. Overall, 231 consultations (17.6%) were for single-region back pain, followed by single-region neck pain (69 [5.3%]), headache (46 [3.5%]), shoulder pain (43 [3.3%]), and extremity pain (41 [3.1%]). The next most common reason for consultation was for newborn issues (418 [31.9%]), which included feeding difficulty (352 [26.9%]), nonfeeding reason (34 [2.6%]), or multiple reasons (32 [2.4%]). A total of 272 consultations (20.8%) were not limited to musculoskeletal complaints, with the primary reason for consultations being general nonspecific discomfort (7.3%), respiratory complaint (4.0%), and postoperative (3.9%). 
Table 2.
Primary Reasons for OMM Consultation in Inpatients as Identified in the Order (N=1310)
OMM Consultation Reason No. (%)
MSK Primarily Single Region 490 (37.4)
  Back pain 231 (17.6)
  Neck pain 69 (5.3)
  Headache 46 (3.5)
  Shoulder pain 43 (3.3)
  Extremity pain 41 (3.1)
  Chest and/or rib pain 26 (2.0)
  Hip pain 18 (1.4)
  Pelvic and/or abdominal pain 16 (1.2)
 Multiple Region 130 (9.9)
  Back +1 or more regions 83 (6.3)
  Neck +1 or more regions (not back) 32 (2.4)
  Other combination 15 (1.1)
 Total Consultations With a MSK Complaint as Primary or Only Reason 620 (47.3)
Newborn
 Newborn feeding difficulty 352 (26.9)
 Other newborn 34 (2.6)
  Tone 11 (0.8)
  Neck-related 6 (0.5)
  Breech/Hip Issues 5 (0.4)
  Preterm 4 (0.3)
  Request 8 (0.6)
 Multiple reason newborn 32 (2.4)
  Feeding+1 28 (2.1)
  Other combination 4 (0.3)
 Total Consultations for Newborns 418 (31.9)
Nonspecific, Multiple, or Other
 General discomfort 96 (7.3)
 Respiratory 53 (4.0)
 Postoperative 51 (3.9)
 Multiple reason (could include MSK) 47 (3.6)
 Postpartum 17 (1.3)
 Constipation 8 (0.6)
 Total Consultations With Nonspecific, Multiple, or Other Reason 272 (20.8)

Abbreviations: MSK, musculoskeletal; OMM, osteopathic manipulative medicine.

Table 2.
Primary Reasons for OMM Consultation in Inpatients as Identified in the Order (N=1310)
OMM Consultation Reason No. (%)
MSK Primarily Single Region 490 (37.4)
  Back pain 231 (17.6)
  Neck pain 69 (5.3)
  Headache 46 (3.5)
  Shoulder pain 43 (3.3)
  Extremity pain 41 (3.1)
  Chest and/or rib pain 26 (2.0)
  Hip pain 18 (1.4)
  Pelvic and/or abdominal pain 16 (1.2)
 Multiple Region 130 (9.9)
  Back +1 or more regions 83 (6.3)
  Neck +1 or more regions (not back) 32 (2.4)
  Other combination 15 (1.1)
 Total Consultations With a MSK Complaint as Primary or Only Reason 620 (47.3)
Newborn
 Newborn feeding difficulty 352 (26.9)
 Other newborn 34 (2.6)
  Tone 11 (0.8)
  Neck-related 6 (0.5)
  Breech/Hip Issues 5 (0.4)
  Preterm 4 (0.3)
  Request 8 (0.6)
 Multiple reason newborn 32 (2.4)
  Feeding+1 28 (2.1)
  Other combination 4 (0.3)
 Total Consultations for Newborns 418 (31.9)
Nonspecific, Multiple, or Other
 General discomfort 96 (7.3)
 Respiratory 53 (4.0)
 Postoperative 51 (3.9)
 Multiple reason (could include MSK) 47 (3.6)
 Postpartum 17 (1.3)
 Constipation 8 (0.6)
 Total Consultations With Nonspecific, Multiple, or Other Reason 272 (20.8)

Abbreviations: MSK, musculoskeletal; OMM, osteopathic manipulative medicine.

×
When consultations were reviewed for our predetermined binary categories, 209 (16.0%) were found to mention that patients were postoperative, postpartum (124 [9.5%]), had respiratory issues (59 [4.5%]), had cystic fibrosis (57 [4.4%]), were pregnant (57 [4.4%]), or had constipation (21 [1.6%]) (Table 3). Of note, 39 of 209 postoperative consultations (18.7%) were after cesarean delivery and 20 (9.6%) were after coronary artery bypass graft. Twenty-nine of 59 respiratory consultations (49.2%) were for cystic fibrosis. 
Table 3.
Total Number of OMM Consultations by Inpatient Medical Status (N=1310)
Patient Status No. (%)
Postoperative 209 (16.0)
Postpartum 124 (9.5)
Respiratory 59 (4.5)
Cystic fibrosis 57 (4.4)
Pregnant 57 (4.4)
Constipation 21 (1.6)

Abbreviation: OMM, osteopathic manipulative medicine.

Table 3.
Total Number of OMM Consultations by Inpatient Medical Status (N=1310)
Patient Status No. (%)
Postoperative 209 (16.0)
Postpartum 124 (9.5)
Respiratory 59 (4.5)
Cystic fibrosis 57 (4.4)
Pregnant 57 (4.4)
Constipation 21 (1.6)

Abbreviation: OMM, osteopathic manipulative medicine.

×
Repeated Consultations
Sixty-four patients (5.4%) received 2 or more consultations in 1 hospitalization. Consultations are sometimes reordered to alert the OMM team that a patient needs to be seen again more urgently. Most of the consultations were for unique patients (1186 [90.5%]) and for unique hospitalizations (1245 [95.0%]). Forty-eight consultations (4.0%) were for patients who had received OMT in a previous hospitalization during this same 6-month period. 
Discussion
In examining the OMM consultations at 1 hospital over 6 months, we found that OMM consultations were used for a broad range of reasons. The total of 1310 OMM consultations analyzed suggests an average of 218 new consultations per month, or roughly 7 new consultations per day. 
The patient characteristics reflected a higher rate of consultations for women, newborns, age group of 31 to 65 years, and whites (similar to Maine's population, which was 94.9% white in 2015). Half of the patients had commercial insurance and half had public insurance. 
As expected, the largest proportion of consultations listed musculoskeletal complaints as the primary or only reason for consultation. In general, OMT is better known for its ability to improve musculoskeletal pain. Considering back pain is one of the most common reasons for outpatient medical visits,23 it is understandable that it is equally if not more prevalent in the inpatient setting, where often patients are confined to uncomfortable hospital beds, causing an increase in stiffness and discomfort. More than 17% of all consultations in the current study were for back pain. 
Newborn feeding complaints made up the next most common reason for consultation. Because OMT has become so widely requested for feeding complaints in this institution, an agreement was made to allow nursing staff to order consultations on behalf of attending physicians. Osteopathic manipulative treatment is also used commonly enough that an OMM consultation order is among the orders that can be selected in the newborn admission order set. This OMM consultation order initiative for newborns might be a model for other institutions. 
The hospital's distribution of consultation reasons may not be generalizable. A similar study by Snider et al24 reviewed inpatient OMM consultations in Kirksville, Missouri. However, Snider et al24 had a total of 1509 consultations over the course of almost 10 years and across several facilities (inpatient acute care, inpatient rehabilitation, and skilled nursing). They found some similarities in the breakdown of reasons for consultations, with musculoskeletal pain, infant feeding disorders, and newborn cranial dysfunction being among the most common. However, their third most common reason was adjunctive treatment for respiratory infection (12%-13% in their study vs 4% in the current study) and fourth most common was bowel ileus (5%-6% vs 1.6% in the current study). This comparison shines a light on an opportunity to increase OMT use, as the present study had a much lower rate of OMM consultations for respiratory and bowel issues despite the prevalence of both these medical conditions in inpatients. A similar percentage of consultations for postoperative patients was found in both studies—18% in the Snider et al24 study and 16% in the current study. 
Of note, patients in some of the “binary yes/no” categories were not flagged because their status, such as “postoperative,” was not mentioned in the consultation order. To truly know how many patients were in each category would require a full medical record review of all patients. However, we are confident that we captured the primary reason for consultation in the free text fields, which was our objective. 
Limitations and Opportunities
Our analysis of the newborn group was limited because age was reported in years, so there may have been more differences in reason for consultation in infants (aged 1 month to 1 year) who were several months old compared with newborns (aged <1 month). Our analysis limited consultations to a 6-month period because of time and resource constraints, but it is possible that there may be a seasonal bias with the types of conditions requiring hospitalization between January and June. 
Some other questions addressed in the Kirksville study24 included hospital diagnoses, regions of somatic dysfunction identified, and OMT techniques used, which could be topics for future studies at our institution. We had decided against examining diagnostic codes in the current study because diagnoses can change throughout a hospital stay and may not have necessarily been related to the reason for the OMM consultation. By knowing the reasons for which consultations were requested, it may be easier to specifically study a certain diagnosis, such as the percentage of patients with constipation who received OMT consultations for constipation and the length of time after starting a bowel regimen that the consultation was ordered. Now that we have identified that a relatively small number of OMM consultations were requested for bowel ileus and respiratory complaints, the next step is to examine ways to increase OMT use in these areas, such as through physician knowledge or creating more order sets that include OMM consultation. Perhaps it would be helpful to give a dropdown list of reasons in the OMM order for physicians to see what complaints can commonly be addressed in the inpatient setting. The impact of inclusion of an OMM consultation option in the order sets also warrants further study, for example, if it affects frequency of use. With a large number of initial consultations, it may be interesting to examine the frequency of follow-up treatments for different conditions as well. 
Knowing that a large volume of consultations are being ordered in a relatively short period may make future studies more approachable. There is certainly room for studies in multiple areas, including examining the effect of OMT on various conditions. 
Conclusion
This study documented that the largest proportion of inpatient OMM consultations were placed for musculoskeletal complaints, followed by newborn feeding. Although it appears that there is some awareness of OMT as an effective adjunct for respiratory complaints, postoperative patients, and constipation, OMT seems to be underused for some of these common inpatient conditions. There are many more opportunities for hospitals to use OMM consultations and OMT to help reduce morbidity in their patients. 
Acknowledgments
We thank Bryan Beck, DO, David Keller, DO, and Michael Conte, DO, from the OMM team at Maine Medical Center for their insights and support. 
References
Nilsson N, Christensen HW, Hartvigsen J. The effect of spinal manipulation in the treatment of cervicogenic headache. J Manipulative Physiol Ther. 1997;20(5):326-330. [PubMed]
Licciardone JC, Gatchel RJ, Aryal S. Targeting patient subgroups with chronic low back pain for osteopathic manipulative treatment: responder analyses from a randomized controlled trial. J Am Osteopath Assoc. 2016;116(3):156-168. [CrossRef] [PubMed]
McReynolds TM, Sheridan BJ. Intramuscular ketorolac versus osteopathic manipulative treatment in the management of acute neck pain in the emergency department: a randomized clinical trial. J Am Osteopath Assoc. 2005;105(2):57-68. [PubMed]
Willard FH, Jerome JA. Introduction: the body in osteopathic medicine—the five models of osteopathic treatment. In: Chila, AG, executive ed. Foundations of Osteopathic Medicine. 3rd ed. Baltimore, MD: Lippincott Williams & Williams; 2011:53-55.
Noll DR, Degenhardt BF, Morley TF, et al.   Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia: a randomized controlled trial. Osteopath Med Prim Care. 2010;4:2. [CrossRef] [PubMed]
Guiney PA, Chou R, Vianna A, Lovenheim J. Effects of osteopathic manipulative treatment on pediatric patients with asthma: a randomized controlled trial. J Am Osteopath Assoc. 2005;105(1):7-12. [PubMed]
Baltazar GA, Betler MP, Akella K, Khatri R, Asaro R, Chendrasekhar A. Effect of osteopathic manipulative treatment on incidence of postoperative ileus and hospital length of stay in general surgical patients. J Am Osteopath Assoc. 2013;113(3):204-209. [PubMed]
O-Yurvati AH, Carnes MS, Clearfield MB, Stoll ST, McConathy WJ. Hemodynamic effects of osteopathic manipulative treatment immediately after coronary artery bypass graft surgery. J Am Osteopath Assoc. 2005;105(10):475-481. [PubMed]
Racca V, Bordoni B, Castiglioni P, Modica M, Ferratini M. Osteopathic manipulative treatment improves heart surgery outcomes: a randomized controlled trial. Ann Thorac Surg. 2017;104(1):145-152. [CrossRef] [PubMed]
Wieting JM, Beal C, Roth GL, et al. The effect of osteopathic manipulative treatment on postoperative medical and functional recovery of coronary artery bypass graft patients. J Am Osteopath Assoc. 2013;113(5):384-393. [PubMed]
Goldstein FJ, Jeck S, Nicholas AS, Berman MJ, Lerario M. Preoperative intravenous morphine sulfate with postoperative osteopathic manipulative treatment reduces patient analgesic use after total abdominal hysterectomy. J Am Osteopath Assoc. 2005;105(6):273-279. [PubMed]
Schwerla F, Rother K, Rother D, Ruetz M, Resch KL. Osteopathic manipulative therapy in women with postpartum low back pain and disability: a pragmatic randomized controlled trial. J Am Osteopath Assoc. 2015;115(7):416-425. [CrossRef] [PubMed]
Radjieski JM, Lumley MA, Cantieri MS. Effect of osteopathic manipulative treatment of length of stay for pancreatitis: a randomized pilot study. J Am Osteopath Assoc. 1998;98(5):264-272. [PubMed]
Bove GM, Chapelle SL. Visceral mobilization can lyse and prevent peritoneal adhesions in a rat model. J Bodyw Mov Ther. 2012;16(1):76-82. [CrossRef] [PubMed]
Rice AD, Patterson K, Reed ED, et al.  . Treating small bowel obstruction with a manual physical therapy: a prospective efficacy study. Biomed Res Int. 2016;2016:7610387.
Fraix M, Gordon A, Graham V, Hurwitz E, Seffinger MA. Use of the SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness. J Am Osteopath Assoc. 2013;113(5):394-403. [PubMed]
Roy J Herzhaft-Le, Xhignesse M, Gaboury I. Efficacy of an osteopathic treatment coupled with lactation consultations for infants’ biomechanical sucking difficulties. J Hum Lact. 2017;33(1):165-172. [CrossRef] [PubMed]
Cerritelli F, Pizzolorusso G, Ciardelli F, et al.   Effect of osteopathic manipulative treatment on length of stay in a population of preterm infants: a randomized controlled trial. BMC Pediatr. 2013;13:65. [CrossRef] [PubMed]
Pizzolorusso G, Cerritelli F, Accorsi A, et al.   The effect of optimally timed osteopathic manipulative treatment on length of hospital stay in moderate and late preterm infants: results from a RCT. Evid Based Complement Alternat Med. 2014;2014:243539.
Pomykala M, McElhinney B, Beck B, Carreiro J. Patient perception of osteopathic manipulative treatment in a hospitalized setting: a survey-based study. J Am Osteopath Assoc. 2008;108(11):4.
Johnson SM, Kurtz ME. Diminished use of osteopathic manipulative treatment and its impact on the uniqueness of the osteopathic profession. Acad Med. 2001;76(8):821-828. [CrossRef] [PubMed]
Opportunities - AOA-approved internships and residencies. American Osteopathic Association website. http://opportunities.osteopathic.org/search/. Accessed May 21, 2018.
Finley CR, Chan DS, Garrison S, et al.   What are the most common conditions in primary care? systematic review. Can Fam Physician. 2018;64(11):832-840. [PubMed]
Snider KT, Snider EJ, DeGooyer BR, Bukowski AM, Fleming RK, Johnson JC. Retrospective medical record review of an osteopathic manipulative medicine hospital consultation service. J Am Osteopath Assoc. 2013;113(10):754-767. [CrossRef] [PubMed]
Table 1.
Demographic Characteristics of Inpatients for Whom OMM Consultations Were Ordered in a Large New England Hospital (N=1310)
Characteristic No. (%)
Sex
 Male 586 (44.7)
 Female 724 (55.3)
Age, y
 <1 425 (32.4)
 1-18 62 (4.7)
 19-30 164 (12.5)
 31-65 424 (32.4)
 >65 235 (17.9)
Race
 American Indian and other/unknown 34 (2.7)
 Asian 15 (1.1)
 Black 28 (2.1)
 White 1233 (94.1)
Insurance Type
 Medicaid 287 (21.9)
 Medicare 329 (25.1)
 Commercial insurance 672 (51.3)
 No insurance 22 (1.7)
Hospital Length of Stay
 <48 h 323 (24.7)
 3-7 d 507 (38.7)
 8-14 d 220 (16.8)
 15-30 d 158 (12.1)
 >30 d 102 (7.8)
Pediatric Floors 481 (36.7)
 Newborn nursery 369 (28.2)
 Pediatrics 72 (5.5)
 Neonatal intensive care unit or continuing care nursery 36 (2.7)
 Pediatric intensive care unit 4 (0.3)
Obstetric Floors 177 (13.5)
 Postpartum 108 (8.2)
 Prenatal 49 (3.7)
 Labor 20 (1.5)
Adult Floors 618 (47.2)
 General medical-surgical 455 (34.7)
 Intensive care unit 95 (7.3)
 Intermediate care unit 58 (4.4)
 Psychiatry 10 (0.8)
Adult/Pediatrics 34 (2.6)
 Emergency department 14 (1.1)
 Short stay 14 (1.1)
 Perioperative 6 (0.5)
Table 1.
Demographic Characteristics of Inpatients for Whom OMM Consultations Were Ordered in a Large New England Hospital (N=1310)
Characteristic No. (%)
Sex
 Male 586 (44.7)
 Female 724 (55.3)
Age, y
 <1 425 (32.4)
 1-18 62 (4.7)
 19-30 164 (12.5)
 31-65 424 (32.4)
 >65 235 (17.9)
Race
 American Indian and other/unknown 34 (2.7)
 Asian 15 (1.1)
 Black 28 (2.1)
 White 1233 (94.1)
Insurance Type
 Medicaid 287 (21.9)
 Medicare 329 (25.1)
 Commercial insurance 672 (51.3)
 No insurance 22 (1.7)
Hospital Length of Stay
 <48 h 323 (24.7)
 3-7 d 507 (38.7)
 8-14 d 220 (16.8)
 15-30 d 158 (12.1)
 >30 d 102 (7.8)
Pediatric Floors 481 (36.7)
 Newborn nursery 369 (28.2)
 Pediatrics 72 (5.5)
 Neonatal intensive care unit or continuing care nursery 36 (2.7)
 Pediatric intensive care unit 4 (0.3)
Obstetric Floors 177 (13.5)
 Postpartum 108 (8.2)
 Prenatal 49 (3.7)
 Labor 20 (1.5)
Adult Floors 618 (47.2)
 General medical-surgical 455 (34.7)
 Intensive care unit 95 (7.3)
 Intermediate care unit 58 (4.4)
 Psychiatry 10 (0.8)
Adult/Pediatrics 34 (2.6)
 Emergency department 14 (1.1)
 Short stay 14 (1.1)
 Perioperative 6 (0.5)
×
Table 2.
Primary Reasons for OMM Consultation in Inpatients as Identified in the Order (N=1310)
OMM Consultation Reason No. (%)
MSK Primarily Single Region 490 (37.4)
  Back pain 231 (17.6)
  Neck pain 69 (5.3)
  Headache 46 (3.5)
  Shoulder pain 43 (3.3)
  Extremity pain 41 (3.1)
  Chest and/or rib pain 26 (2.0)
  Hip pain 18 (1.4)
  Pelvic and/or abdominal pain 16 (1.2)
 Multiple Region 130 (9.9)
  Back +1 or more regions 83 (6.3)
  Neck +1 or more regions (not back) 32 (2.4)
  Other combination 15 (1.1)
 Total Consultations With a MSK Complaint as Primary or Only Reason 620 (47.3)
Newborn
 Newborn feeding difficulty 352 (26.9)
 Other newborn 34 (2.6)
  Tone 11 (0.8)
  Neck-related 6 (0.5)
  Breech/Hip Issues 5 (0.4)
  Preterm 4 (0.3)
  Request 8 (0.6)
 Multiple reason newborn 32 (2.4)
  Feeding+1 28 (2.1)
  Other combination 4 (0.3)
 Total Consultations for Newborns 418 (31.9)
Nonspecific, Multiple, or Other
 General discomfort 96 (7.3)
 Respiratory 53 (4.0)
 Postoperative 51 (3.9)
 Multiple reason (could include MSK) 47 (3.6)
 Postpartum 17 (1.3)
 Constipation 8 (0.6)
 Total Consultations With Nonspecific, Multiple, or Other Reason 272 (20.8)

Abbreviations: MSK, musculoskeletal; OMM, osteopathic manipulative medicine.

Table 2.
Primary Reasons for OMM Consultation in Inpatients as Identified in the Order (N=1310)
OMM Consultation Reason No. (%)
MSK Primarily Single Region 490 (37.4)
  Back pain 231 (17.6)
  Neck pain 69 (5.3)
  Headache 46 (3.5)
  Shoulder pain 43 (3.3)
  Extremity pain 41 (3.1)
  Chest and/or rib pain 26 (2.0)
  Hip pain 18 (1.4)
  Pelvic and/or abdominal pain 16 (1.2)
 Multiple Region 130 (9.9)
  Back +1 or more regions 83 (6.3)
  Neck +1 or more regions (not back) 32 (2.4)
  Other combination 15 (1.1)
 Total Consultations With a MSK Complaint as Primary or Only Reason 620 (47.3)
Newborn
 Newborn feeding difficulty 352 (26.9)
 Other newborn 34 (2.6)
  Tone 11 (0.8)
  Neck-related 6 (0.5)
  Breech/Hip Issues 5 (0.4)
  Preterm 4 (0.3)
  Request 8 (0.6)
 Multiple reason newborn 32 (2.4)
  Feeding+1 28 (2.1)
  Other combination 4 (0.3)
 Total Consultations for Newborns 418 (31.9)
Nonspecific, Multiple, or Other
 General discomfort 96 (7.3)
 Respiratory 53 (4.0)
 Postoperative 51 (3.9)
 Multiple reason (could include MSK) 47 (3.6)
 Postpartum 17 (1.3)
 Constipation 8 (0.6)
 Total Consultations With Nonspecific, Multiple, or Other Reason 272 (20.8)

Abbreviations: MSK, musculoskeletal; OMM, osteopathic manipulative medicine.

×
Table 3.
Total Number of OMM Consultations by Inpatient Medical Status (N=1310)
Patient Status No. (%)
Postoperative 209 (16.0)
Postpartum 124 (9.5)
Respiratory 59 (4.5)
Cystic fibrosis 57 (4.4)
Pregnant 57 (4.4)
Constipation 21 (1.6)

Abbreviation: OMM, osteopathic manipulative medicine.

Table 3.
Total Number of OMM Consultations by Inpatient Medical Status (N=1310)
Patient Status No. (%)
Postoperative 209 (16.0)
Postpartum 124 (9.5)
Respiratory 59 (4.5)
Cystic fibrosis 57 (4.4)
Pregnant 57 (4.4)
Constipation 21 (1.6)

Abbreviation: OMM, osteopathic manipulative medicine.

×