Osteopathy Research
Research into the effectiveness of osteopathy has not been as prolific as the profession would have liked. The profession is a small profession and does not have the manpower or the financial clout needed to man and fund research necessary for the modern medical fraternity.
Physiological research as with acupuncture is much easier to undertake and there is much research that ba cks up the positive physiological responses to active and passive articulation, stretching of the musculoskeletal system.
Clinical studies are far more difficult and expensive to perform. However the research that has been done has given results which are positive as far as the osteopathic manipulation is concerned. (BEAM UK BMJ 2004;329 (11 December), doi:10.1136/bmj.329.7479.0-c ). The following pages give an insight to where osteopathy is as far as official research is concerned.
UK Beam Trail 2004 - SUMMARY
Positive news for sufferers of lower back pain – UK BEAM trial Friday, 19 November 2004 - A Medical Research Council (MRC) trial to assess 'best care' in general practice for patients with lower back pain has found that spinal manipulation, as practised by osteopaths, followed by a programme of exercise, provides significant relief of symptoms and improvements in general health
The UK Back pain Exercise And Manipulation (UK BEAM) trial is the first of it's kind to examine the effectiveness of two treatments, spinal manipulation and exercise, alone and in combination, for the routine management of low back pain in primary care. The results of the study, published online in the British Medical Journal (19 November), found that added to GP ‘best care', spinal manipulation is both beneficial to the patient and the economy, with only modest costs to the NHS.
MRC FINDS ADDING SPINAL MANIPULATION AND EXERCISE TO GP CARE PROVIDES RELIEF FOR BACK PAIN - Friday, 19 November 2004
A Medical Research Council (MRC) trial to assess 'best care' in general practice for patients with lower back pain has found that spinal manipulation, as practised by osteopaths, followed by a programme of exercise, provides significant relief of symptoms and improvements in general health. The results of the trial are published online today, in the British Medical Journal
Back pain is one of the most common ailments confronting general practitioners (GPs), affecting 80% of the population in the UK and costing the nation £6 million a year in lost working days and health care.The UK Back pain Exercise And Manipulation (UK BEAM) trial is the first of it's kind to examine the effectiveness of two treatments, spinal manipulation and exercise, alone and in combination, for the routine management of low back pain in primary care.
The national trial also compared outcomes between participants receiving manipulation in NHS premises and private premises.Commenting on the outcomes of the study, Ian Russell, Professor of Public Health & Director of the Institute of Medical and Social Care Research at the University of Wales Bangor, and a lead researcher in the trial team said:"Though the average benefit to patients was only moderate in size, back pain is so widespread and so costly to society that these benefits add up to substantial economic benefits across the UK. Our analysis also showed that the cost to the NHS was modest.
Added to GP 'best care', spinal manipulation gives the best value for money."
The General Osteopathic Council (GOsC) welcomed the findings of the UK BEAM Trial and its contribution to the management of back pain within the UK and internationally, and its potential influence on both practice and health care commissioning.The National Council for Osteopathic Research (NCOR) today was encouraged by the positive effects the spinal manipulation and exercise treatment package had on a patient group that continues to grow in size.
"The immense cost to society and to the individual that back pain can inflict is well documented; it is encouraging to identify an adjunct to GP care that is both beneficial to the patient and modest in terms of economic outlay. The reasons behind the positive effect of spinal manipulation and exercise treatment had on the general health of the trial participants merits further research in itself," commented Carol Fawkes, Research Development Officer at NCOR. "The research focus of the osteopathic profession is concerned with examining the practice, building an evidence base for osteopathic treatment and seeking ways in which that treatment can be enhanced for the greater benefit of the patients who consult osteopaths in growing numbers."
About the UK BEAM trial
The UK Back pain Exercise And Manipulation (UK BEAM) trail is a randomised controlled trial involving 1350 participants with simple low back pain, selected from 14 locations across the UK - Belfast, Edinburgh & Tayside, Exeter, Harrow, Northampton, Norwich, Nottingham, Plymouth, Reading, Sheffield, Stockport, Teesside and Wrexham & Chester.
All outcomes were measured using postal questionnaires, one, three, and twelve months after randomisation.
In addition to clinical outcomes (general health, experience of back pain and beliefs about it) of the participants, economical analysis compared the benefits to participants with costs to both the NHS and the participants themselves.
The UK BEAM trial was funded by the Medical Research Council (MRC) and the NHS Research and Development Programme.
The Department of Health Sciences at the University of York and the MRC General Practice Research Framework (GPRF) were responsible for co-ordinating the trial.
Letter describing the difficulties facing the osteopathic profession in relation to osteopathic research from Professor Ann Moore, Chair of the National Council for Osteopathic Research and Director of the Clinical Research Centre for Health Professions, University of Brighton.
Tuesday, 23 May 2006
It was almost predictable that complementary therapies such as osteopathy would once again become the target of medical derision for the lack of a strong evidence base. The sad fact remains that osteopaths would welcome the opportunity to conduct further research to prove the efficacy of their interventions. Efforts are being made in this direction with the creation of the National Council for Osteopathic Research in 2004 and an evident increase in the numbers of osteopaths who are enrolling on research-based postgraduate education courses at Masters and Doctoral levels. There has also been a slow but steady rise in the number of osteopathic researchers.
However, it is worth noting the serious absence of funding to support any research in the healthcare arena that is not driven by the pharmaceutical industry or the medical profession. It is also remarkable that the signatories of this letter fail to realise that clinical trials are not the only way to gain evidence to support practice in healthcare.
Many clinical trials are ill informed and produce substantial waste in terms of financial resources and patients' time and goodwill. Much of this resource wastage could be avoided by utilising a range of other research approaches including baseline data collection and qualitative research which would more pertinently inform the research agenda and the conduct of relevant and robust clinical trials. However, funding bodies such as the Medical Research Council and the Department of Health seem to be thoroughly uninterested in funding any research other than randomised controlled trials; they are particularly reluctant to fund research in the field of complementary medicine such as osteopathy.
It should not be forgotten that the majority of healthcare practice in the United Kingdom, even medicine, is by no means founded on a complete evidence base. None of the professions, alternative or conventional, can afford to rest on their laurels. Instead of constantly criticising professions with low evidence levels it would be perhaps more efficacious for the signatories to put their weight behind supporting a shift in research funding towards those areas that are under researched.
Professor Ann Moore
Chair of the National Council for Osteopathic Research Director of the Clinical Research Centre for Health Professions, University of Brighton.
Tuesday, 23 May 2006
Calling on the NHS to abandon Complementary and Alternative Medicine is irresponsible and counter-productive to improving health services in Britain today. (NHS told to abandon alternative medicine, Times, Tuesday, 23 May2006.)
With existing NHS resources under intense pressure, patients, the public and the NHS are indeed best served by using available funds for treatments that are based on solid evidence. Osteopathic services adopted by the NHS across the UK are clear evidence of the cost-effectiveness of integrating a truly patient-centred, multi-disciplinary approach into standard NHS care. Fast access and the highly-skilled diagnostic intervention offered by osteopaths is indubitably helping to reduce the immense cost of musculoskeletal disorders (MSDs) to the UK economy, but there is clear and urgent need for further expansion into primary care. (MSDs make up 20% of GP consultations and the NHS spends an estimated £480 million a year on services used by people with back pain alone.) The public already recognise the value of these complementary services - researching options and choosing to invest £1.6 billion of private income each year to resolve personal health problems where conventional care has not succeeded. It is not acceptable in today's society that those of limited means have also to suffer limited healthcare options.
Never more so than at this time of economic strain in the NHS - and if it is really patients who are to benefit - it is beholden on healthcare leaders to look beyond the conventional.
Brigid Tucker
Head of Communications
General Osteopathic Council
Monday, 15 May 2006
Osteopaths across the country will all be aware of the widespread media coverage of a recent review of the efficacy of spinal manipulation (Ernst and Canter 2006), which hit the headlines on Wednesday, 22 March 2006.
Publishing the findings in the April issue of the Journal of the Royal Society of Medicine (JRSM), the authors concluded that “the data did not demonstrate that spinal manipulation is an effective intervention for any condition. Given the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment.”
In response to the attack on the osteopathic and chiropractic professions resulting from the sensationalist press release issued by the RSM, the Chair of the National Council for Osteopathic Research (NCOR,) Professor Ann Moore, hit back.
In an article published in the May issue of the journal Manual Therapy (Volume 11, Issue 2), Professor Moore, from the University of Brighton, and colleague Professor Gwen Jull, from the University of Queensland, Australia, question the methodology of the review and the true value of systematic reviews. They note that several studies showing the benefits of manual therapy were omitted, pre-existing systematic reviews were not critically appraised, and the authors' comments “appeared to be selectively biased … the systematic review is only as good as the original studies it includes and the systematic reviewers' interpretation of the studies”.
They also call for all professions involved to devote time to the well-designed research and evaluation of interventions, and the definition of manual therapy terminology to avoid misinterpretation.
Manual Therapy is available on a subscription basis – see www.sciencedirect.com/science/journal/1356689X.
NCOR (www.ncor.org.uk) are also currently awaiting confirmation of publication of their formal response to the Journal of the Royal Society of Medicine.
Thursday, 13 October 2005 - RESULTS OF LARGE DETAILED REPORT COMMISSIONED BY THE PRINCE OF WALES
Complementary therapies should be given a greater role in the NHS, according to a new report commissioned by The Prince of Wales. Results of a n independent investigation into the potential contribution to UK healthcare of the ‘Big Five'* complementary therapies – Osteopathy, Chiropractic, Acupuncture, Homeopathy and Herbal Medicine – were published on Thursday, 6 October and generated considerable media commentary.
The nine-month enquiry, led by Christopher Smallwood former chief economic advisor to Barclays Plc, investigated the evidence relating to effectiveness and associated costs of provision.
Osteopathy and chiropractic (considered together as “manipulation therapies”), along with acupuncture, are identified as three services where Complementary and Alternative Medicine (CAM) could play a larger role and help to fill recognised gaps in national healthcare provision – especially in the treatment of chronic conditions, including back pain, anxiety, stress and depression. The report concedes that wider use may not necessarily result in significant direct cost savings for the NHS, but would benefit the wider economy. Back pain alone accounts for 200 million days lost from work each year at an estimated cost of £11 billion in lost production.
The report also recognises that many people in less well-off areas do not have access to these services, citing the shortage of treatments such as osteopathy and acupuncture in poorer areas: “Complementary medicine remains out of the reach for many low income families, those who would have found most benefit from its provision.”
The key conclusions of the report are:
“Many of the most effective CAM therapies correspond to recognised ‘effectiveness gaps' in NHS treatment, which suggests that they may have the potential to make an important contribution to the delivery of healthcare in the UK. The main areas identified comprise chronic and complex conditions, anxiety, stress and depression, and palliative care relating particularly to pain and nausea.”
“Despite the fragmentary nature of the evidence, there seems good reason to believe that a number of CAM treatments offer the possibility of significant savings in direct health costs … [or] deliver additional benefits to patients in a cost-effective way. “
“Our principal recommendation therefore is that Health Ministers should invite the National Institute for Health and Clinical Excellence (NICE) to carry out a full assessment of the cost-effectiveness of the therapies which we have identified and their potential role within the NHS, in particular with a view to the closing of ‘effectiveness gaps.”
“Since the psychosocial and chronic ailments where CAM seems able to make its best contribution are particularly prevalent in the deprived communities where people lack the means to pay for such care … [there] will be a strong case for giving priority to extending the availability of CAM in these areas. “
“[There] are substantial regional differences in the provision of CAM … [these] disparities will also need to be addressed.”
As defined by the House of Lords Science and Technology Committee: 6 th Report. Complementary and Alternative Medicine, 2000.
MYALGIC ENCEPHALITS - Friday, 12 May 2006
At a recent meeting of the Parliamentary Group on Scientific Research into Myalgic Encephalomyelitis (ME), members received osteopathic research findings with interest. ME, the symptoms of which include unexplained exhaustion, muscle and joint pain, insomnia and nausea, has remained somewhat of a mystery to the medical profession for many years.
The Group, chaired by Dr Ian Gibson MP, is looking at progress made in understanding the cause of the condition since the Chief Medical Officer's Report into ME in 2002. It has heard from sufferers of ME, and will hear further evidence from leading medical experts and government officials. Osteopath Raymond Perrin PhD has been researching the cause of ME, also known as Chronic Fatigue Syndrome, for the last 17 years.
Following clinical trials at the Universities of Salford and Manchester, he has developed a diagnostic and treatment approach which he believes could provide significant benefits to sufferers. Dr Perrin says, "The group seemed interested in the physical signs that I have discovered. These signs are common to the hundreds of ME sufferers I have treated since 1989. However, further research is necessary to validate these findings which, if successfully confirmed, may make diagnosis easier and quicker, enabling patients to receive earlier treatment and a speedier recovery. "
For further information on this research, please contact: University of Salford : Rachel Conway or Wendy O'Brien T: 0161 295 5370 M: 07733 3074 09 E: r.conway@salford.ac.uk
