The profile of French osteopaths: A cross-sectional survey

BackgroundOsteopathy is not a health profession in France but it was regulated in 2007. However, the profession is very popular, and the number of osteopaths is the largest in Europe. Since there is limited published data on the profile and characteristics of osteopaths practising in France, this study aimed to survey the current situation of osteopathic practitioners in France.MethodsA voluntary online-based survey was distributed to French osteopaths between March and July 2022. This survey consisted of 52 questions adapted from the original French version of the validated Benelux Osteosurvey.ResultsA total of 1461 osteopaths responded to the study, of which 785 (53.73%) were female. The majority of respondents were aged between 30 and 39 years (50.65%), had full-time training (89.73%), during 5 years (67.15%), were self-employed (99.59%), advertised themselves exclusively as osteopaths (90.35%) and showed a solid professional identity. The median number of consultations per week was 21–25, and nearly one-third of respondents (31.42%) reported having other professional activities outside their clinical practice as an osteopath. Osteopaths in France manage acute and chronic complaints in all body areas but mainly in the spine.ConclusionsThis study provides a first overview of the current profile of osteopathic practitioners in France since 2012. At present, it constitutes a new informative report of their characteristics and provides several perspectives on the profession's development in terms of status and training.Implications for practice

• ●The majority of respondents were aged between 30 and 39 years, had undergone a full-time five-year training, advertised themselves exclusively as osteopaths and manifested a strong osteopathic identity.
• ●Most reported being self-employed, and managing acute and chronic complaints located in all body areas, but mainly the spine.
• ●Respondents expressed a strong desire for a greater integration of osteopathy into the French health system, especially through better collaboration with other healthcare professionals.

     

Osteopathic education: The link between mission and accreditation

ObjectiveThis commentary promotes the role of accreditation in meeting a school's mission.BackgroundUnderstanding the parallels between the growth of osteopathic educational institutions and the increase in educational standards over time places a historical perspective on this subject.DataThe concept of minimum competence, exceeding minimum competence, and their link to the assurance of quality in osteopathic medical education is explored. Knowing that a school's mission speaks to excellence and quality, and that the accreditation process is a way to ensure quality, mission and accreditation are therefore linked.ConclusionThrough the accreditation process, we ensure that our schools' missions are met, and we assure our students and the public that we deliver an osteopathic medical education of the highest quality.     

Osteopathy: Italian professional profile. A professional commentary by a group of experts of the European community of practice

Osteopathy became recently regulated as a healthcare profession in Italy. The Italian legislation classifies osteopathy as a healthcare profession, which focuses on health prevention and maintenance with a role in rehabilitation and functional psychosocial recovery. The legislative framework also lays down the osteopathic professional profile. Osteopaths are described as healthcare practitioners who deliver osteopathic person-centered care focused on the musculoskeletal system and the concept of somatic dysfunction. Despite these positive developments in the legislation for osteopathy, the Italian law raises critical points regarding the validity of osteopathic care models, namely the concept of somatic dysfunction and the role of osteopaths in health promotion and prevention. The legislative developments currently occurring worldwide must be informed by a critical appraisal of osteopathic conceptual models and grounded on robust research. In the article, a panel of European osteopaths involved in clinical and academic practice, research and regulation, present this professional commentary to facilitate a critical discussion on the role, competencies and scope of practice of osteopaths in the light of the recently published Italian osteopathic professional profile.     

Sexuality after burn in Brazil: survey of burn health-care workers

Patients who survive a major burn must live with emotional and physical sequela. In a literature review, we found that sexuality concerns of burn victims are rarely a focus of therapy. After suggestions from Rimmer et al. [12], using their questionnaire translated into Portuguese, we held a survey of burn-care professionals at the VII Brazilian Burn Congress.More than 120 practitioners from 41 centres, aged in average 41.2 years (1 standard deviation 10.96), completed the survey. A proportion of 63.7% were female, and 58.1% were Caucasians; 37.1% were physicians, 20.9% nurse practitioners and 16.9 were occupational therapists/physical therapists (OTs/PT)s. Psychologists made up 3.2%. Only 28% of the respondents felt comfortable in initiating a conversation about sexual intimacy with their patients. The vast majority believed it should be done by the psychologist. Only 38% felt their burn centre did an adequate job in that area. When compared with a study of our country's general population, we find similar results indicating that intimacy, sexuality and sexual intercourse are considered most important in a relationship.There is a significant lack of literature in sexuality after burn; most likely meaning it is ignored by most centres. There is a need for other similar surveys to be performed, as well as a collective consciousness of the need for discussions about sexuality with patients and their partners, providing counselling and treatment, when need.     

Pain knowledge and fear-avoidance beliefs of French osteopathy students and educators towards chronic low back pain: An osteopathic educational institution-based cross-sectional survey

BackgroundPractitioners’ fear-avoidance beliefs can influence positively or negatively therapeutic outcomes in their patients. This study reports pain knowledge and fear-avoidance beliefs of French osteopathy students and educators towards the management of chronic low back pain (cLBP).MethodsAn online cross-sectional survey was proposed to educators and students. It included sociodemographic characteristics and two questionnaires: the FABQ-HC to assess beliefs on the effects of physical and work activities for people with cLBP, and the NPQ to assess participants' knowledge of pain.ResultsParticipants (N = 172) had mean FABQ-HC subscale scores of 11.02 ± 4.44 (Physical activity) and 24.37 ± 11.78 (Work). The mean NPQ total score was 11.90 ± 2.05. There were no significant score differences between students and educators (p > 0.05). Results showed that Year 4 students (N = 65) had a significantly better score (p < 0.05) at the FABQ-HC Physical Activity than Year 5 students (N = 71). Educators (N = 36) having less than 10 years of practice in osteopathy had better scores than other educators (p < 0.01) at the FABQ-HC Work. Educators and students in the study show similar scores to other French HCPs and international osteopaths on the FABQ-HC Physical activity. In contrast, they scored lower on the FABQ-HC Work.ConclusionsThe main finding was that educators and students belonging to the same OEI have no significantly different beliefs about cLBP and no significantly differing knowledge of pain. There is potential to improve pain education especially concerning the beliefs around cLBP concerning work activity.     

Futility and inappropriate care in pediatric intensive care: a cross-sectional survey

BACKGROUND: Over recent years, there have been increasing concerns regarding an increase in the number of futile and inappropriate admissions to pediatric intensive care units (PICUs) in the United Kingdom (UK). METHODS: A prospective cross-sectional survey was carried out using a data collection form distributed by mail to the directors of all PICUs in the UK. Respondents were asked to give details of all patients on their unit on a specific day including age, reason for admission and any preexisting medical conditions. An assessment was made by respondents of whether the care being provided in each case was, in their opinion, appropriate, futile or inappropriate according to standard definitions. RESULTS: We received responses from 21 units (68%) who reported the details of 111 patients. Care was felt to be appropriate in 88 of these cases (79%), futile in nine cases (8%) and inappropriate in 14 cases (13%). Futile cases were most commonly admitted with respiratory failure and all had preexisting medical conditions, most commonly developmental delay. Where care was felt to be inappropriate, respiratory failure was again the most common reason for admission and all had a preexisting medical condition, most commonly cardiovascular disease. CONCLUSIONS: The care being provided in 21% of the PICU cases, described in this study, was felt to be either futile or inappropriate by the directors of those units. There is an urgent need to, accurately, establish the resource consumption associated with these patients and to establish a standard approach to futility and inappropriate care in PICU in the UK.     

Facilitators & barriers and practices of early mobilization in critically ill burn patients: A survey

BackgroundEarly mobilization (EM) of intensive care (IC) patients is important but complex with facilitators and barriers. Compared to general IC patients, burn IC patients are more hyper-metabolic. They have extensive wounds, lengthy wound dressing changes, and repeated surgeries that may affect possibilities of EM. This study aimed to identify facilitators and barriers of EM in burn IC patients among all disciplines involved. Additionally, we assessed EM practices, i.e. when are which patients considered suitable for EM.MethodsA survey was sent to 139 professionals involved in EM of burn IC patients (discipline groups: Intensivists, medical doctors, registered nurses, therapists).ResultsResponse rate was 57 %. The majority found EM very important, yet different definitions were chosen. Perceived barriers mainly concerned patient-level factors, most frequently hemodynamic instability and excessive sedation followed by skin graft surgery, fatigue, and pain management. Most frequent barriers at the provider-level were limited staffing, safety concerns, and conflicting perceptions about the suitability of EM. At the institutional-level, we found no high barriers. Interdisciplinary variation on perceived barriers, when to initiate it, and permitted maximal activity were ascertained.ConclusionSkin grafts and pain management were barriers of EM specific for burn care. Opinions on frequency, dosage and duration of EM varied widely. Improving interdisciplinary communication is key.     

Sexual activity, sexual dysfunction and associated help-seeking behaviours in middle-aged and older adults in Spain: a population survey

To study sexual activity, the prevalence of sexual dysfunction and related help-seeking behaviours among mature adults in Spain, a telephone survey was conducted in Spain in 2001–2002. This was completed by 750 men and 750 women aged 40–80 years. Eighty-eight percent of men and 66% of women had engaged in sexual intercourse during the 12 months preceding the interview. Early ejaculation (31%) and lack of sexual interest (17%) were the most common male sexual problems. A lack of sexual interest (36%) and an inability to reach orgasm (28%) were the most common female sexual problems. Approximately 80% of men and women with a sexual problem had not sought help from a health professional. Many men and women in Spain report continued sexual interest and activity into middle age and beyond. Although a number of sexual problems are highly prevalent, few people seek medical help.     

A long COVID patient and their experience of osteopathic care: A case report

BackgroundLong COVID is an emerging syndrome that is poorly understood in terms of aetiology, symptom picture, treatment and prognosis.ObjectivesThis case report contributes a twelve-month history of a female patient's experience of Long COVID and her motivation for, experience of and response to osteopathic care. The decision to write a case report was made retrospectively, with some attempt made at symptom quantification but with no numeric data on outcomes.Clinical featuresThe patient's mental symptoms included brain fog and loss of agency, while physical symptoms included chest heaviness, fatigue and breathing difficulty. During the study year the patient suffered bereavements and dental health issues in addition to Long COVID.Intervention and outcomesThe osteopath found that dysautonomia, dysfunction of the thoracic diaphragm and endothelial activation underlay the symptom picture. Osteopathic care included OMT, support and reassurance, leading to a greater sense of wellbeing and reduction in symptoms.ConclusionsThe possible role of immune hyperactivity in the aetiology of Long COVID is discussed. The role of the osteopath as ‘health coach’ as well as hands on therapist is reviewed. Further research is required to determine the benefits of osteopathic care in this population.     

Short Form health surveys and related variants in spinal cord injury research: A systematic review

Context

‘Short Form’ health surveys – such as the SF-36 and SF-12 – are widely used in medical research. Spinal cord injury (SCI) is no exception, despite oft-cited concerns regarding measurement properties for populations with physical impairment.

Objective

To provide a comprehensive overview of the use of Short Form health surveys and their variants within the SCI literature.

Methods

Papers published between database inception and September 2012 were identified from 11 electronic databases; a supplementary reference list search was also conducted. Data extraction focused on details regarding the range of different Short Form surveys and variants used in SCI research, the respective frequency of use, the nature of reporting (complete versus partial reporting) and the method of survey administration.

Results

One hundred seventy-four papers were identified. Thirty-six-item Short Form health surveys were frequently administered as complete instruments (n = 82); in 69 of these 82 studies (84%), it was not clearly stated which 36-item version had been used (e.g. SF-36v1, SF-36v2, RAND-36). Data for individual items and domains were often reported (29% of identified studies), indicating significant partial use of standardized measures. Modified variants of standardized health surveys were administered in 12 studies.

Conclusion

Although standardized Short Form health surveys are common within SCI research, attempts to add, delete, or modify items have resulted in a number of variants, often with minimal supportive psychometric evidence. Using established, generic outcome measures is appealing for a number of reasons. However, validity is paramount and requires further explicit consideration within the SCI research community.     

The nature and reported incidence of suspected perioperative allergic reactions: A cross-sectional survey

Study objectivePerioperative allergic reactions (POHs) are common and can lead to severe intraoperative instability and even mortality. In contrast to the situation in developed countries, where databases of perioperative anaphylaxis are well documented and analyzed, relevant data are lacking in China. Therefore, we aimed to conduct a national survey to explore the characteristics of perioperative allergic reactions, as well as the knowledge and attitudes toward management and reporting among anesthesiologists.DesignCross-sectional survey.SettingAnesthesia department.PatientsA nationally representative sample comprising anesthesiologists from 12 province-level regions was selected.MeasurementsA 20-item questionnaire was designed and validated using the Delphi method. Survey distribution was performed between June 2019 and January 2020 by the Chinese Society of Anesthesiology (CSA), which is the official academic society of Chinese anesthesiologists. Responses were compiled and analyzed.Main resultsWe received responses from 4389 anesthesiologists across China. The estimated rate of suspected POH was 2/1000 patients (0.2%). On average, an anesthesiologist encountered 2.1 suspected POH cases per year. Neuromuscular blocking agents (NMBAs) were perceived as the most common causative agents, followed by antibiotics and succinylated gelatin. The rates of referral and allergy consultations were very low. Institutional support, including protocol development, cognitive aids, and tool kits, was not ideal. Additionally, the management of POH varied substantially. Most anesthesiologists believed that reporting and documenting POH was necessary.ConclusionsOur survey revealed that POH is commonly encountered by Chinese anesthesiologists, but few patients are referred to allergy specialists or clinics for further investigation. A standardized recommendation based on research and data derived from Chinese patients is required.     

The use of occupation-based interventions and assessments in hand therapy: A cross-sectional survey

IntroductionThe purpose of this study was to gather information on how hand therapists incorporate occupation-based interventions in their clinical practice and what outcome measures hand therapists use to measure the occupational performance of their clientsStudy DesignCross-Sectional Survey Design.MethodsThe 16-item Survey was distributed to members of the American Society of Hand Therapists on two occasions.ResultsThree hundred eleven hand therapists responded to the survey. Hand therapists use a variety of occupation-based interventions (OBI) in clinical practice and most believe they are important. Findings from this study reveal that incorporating an occupation-based assessment along with or in place of an assessment of body functions and structures is not performed routinely. One hundred twenty-six (41%) respondents indicated that they use occupation-based activities 26-50% of the time with their clients.DiscussionThe top three OBI interventions used by hand therapists included dressing tasks, cooking and meal preparation, and in hand manipulation of coins and medication. The lack of understanding of the theoretical models regarding occupation-based interventions may be a barrier toward implementation of occupation-based interventions and assessments as many hand therapists may have trained under a medical model.ConclusionMost respondents to this survey indicated that they believe OBI should be performed by hand therapists and use them routinely in practice. The most frequently used type of assessment was the DASH (Disabilities of the Shoulder Arm & Hand). The least frequently used assessment was the Short Form 36 and patient specific occupation-based assessment.     

Racial Disparity in Delivering Definitive Therapy for Intermediate/High-risk Localized Prostate Cancer: The Impact of Facility Features and Socioeconomic Characteristics

Background

The gap in prostate cancer (PCa) survival between Blacks and Whites has widened over the past decade. Investigators hypothesize that this disparity may be partially attributable to differences in rates of definitive therapy between races.

The utilisation and attitudes to patient reported outcome measures by Australian osteopaths: A cross sectional study

ObjectivePatient-reported outcome measures (PROMs) provide information on patients’ views of their symptoms, functional status, health related quality of life and are an important part of evidence-informed practice and patient-centred care. The utilisation of and attitudes to PROMs by Australian osteopaths is unknown.MethodsAn online survey was designed to investigate the self-reported utilisation of PROMs by Australian osteopaths, including the frequency of use, the types of PROMs used, the features of PROMs are most useful, the attitudes towards PROMs, and the barriers and enablers for use of PROMs. The survey was a 14-item questionnaire that used a 5-point Likert scale or required free text answers. The effect of gender and years in practice was analysed using Mann-Whitney U tests. Effect sizes were calculated where possible.Results166 (male = 69, female = 97) osteopaths participated in the survey. Nearly half (47.6%) reported that pain scales were used ‘frequently’ or ‘always’, but there was less frequent use of PROMs other than pain scales (14.2%), except for third party paying patients (57.4%). Australian osteopaths reported using PROMs most frequently for patients with neck pain (31%) and low back pain (29%). The majority agreed PROMs were important for tracking improvement in patients (61%). The greatest barrier identified by osteopaths was the burden on consultation time.ConclusionThis study highlighted only the minority of Australian osteopaths use PROMs frequently and consider them important. Professional organisations should consider professional development aimed to upskill and support practitioners in the efficient use of PROMs in practice.Implications for clinical practice

• •Nearly half (47.6%) of 166 osteopaths reported using pain scales ‘frequently’ or ‘always’, but there was a less frequent use of PROMs other than pain scales (14.2%), except for third party paying patients (57.4%).
• •The majority of osteopaths agreed that PROMs were important for tracking clinical improvement in patients (61%), although only 48% agreed that PROMs were important in osteopathic practice.
• •The greatest barrier identified by osteopaths to using PROMs was the burden on consultation time and most common enabler was the requirement of PROMs by third party payers.

     

The eXpectations of Parents regarding Anesthesiology Study (XPAS) from a parental perspective: a two-phase observational cross-sectional cohort study

Background

Uncertainty concerning anesthetic procedures and risks in children requiring anesthesia may cause concerns in parents and caregivers.

Aims

To explore parental expectations and experiences regarding their child's anesthesia using questionnaires designed with parental input.

Methods

This observational cross-sectional cohort study included parents (including caregivers) of children undergoing anesthesia in a tertiary pediatric referral university hospital. The study consisted of two phases. In Phase 1, we developed three questionnaires with parental involvement through a focus group discussion and individual interviews. The questionnaires focused on parental satisfaction, knowledge, concerns, and need for preparation regarding their child's anesthesia. In Phase 2, independent samples of parents completed the questionnaires at three time points: before the preanesthesia assessment (T1), 2 days after the preanesthesia assessment (T2), and 4 days after the anesthetic procedure (T3).

Results

In Phase 1, 22 parents were involved in the development of the questionnaires. The three questionnaires contained 43 questions in total, of which 10 had been proposed by parents. In Phase 2, 78% (474 out of 934) parents participated at T1, 36% (610 out of 1705), at T2 and 34% (546 out of 1622) at T3. Parental satisfaction scores were rated on a visual analogue scale for the preanesthesia assessment with a median of 87/100, and with a median of 90/100 for the anesthetic procedure (0: not satisfied and 100: satisfied). Parental concerns were rated with a median of 50/100 (0: no concerns and 100: extremely concerned). Parental answers from the questionnaire at T2 revealed significant knowledge deficits, with only 73% reporting that the anesthesiologist was a physician. Parents preferred to receive more information about the procedure, especially regarding the intended effects and side effects of anesthesia.

Conclusions

Overall, parental satisfaction scores regarding the pediatric anesthesiology procedure were high, with a minority expressing concerns. Parents indicated a preference for their child's anesthesiologist to visit them both before and after the anesthetic procedure. Parental expectations regarding anesthesia did not completely correspond with the information provided; more information from the clinician about the intended effects and side effects of anesthesia was desired.     

Racial disparity in quality of care and overall survival among black vs. white patients with muscle-invasive bladder cancer treated with radical cystectomy: A national cancer database analysis

Objectives

To examine the impact of race on quality of care and overall survival (OS) among patients with muscle invasive bladder cancer (MIBC) treated with radical cystectomy (RC) in the U.S.

Dental care and oral health in solid organ transplant recipients: a single center cross-sectional study and survey of German transplant centers

Aim of this study was to collect information about oral health of patients before and after SOT as well as information about center‐based recommendations for dental care. In a single center cross‐sectional study, the oral situation of 20 patients before and 20 after SOT were examined including dental (DMF‐T), periodontal (PSR^®/PSI), and oral hygiene findings (modified QHI). In a second project, a survey among 50 transplant centers in Germany was questioned regarding their recommendations for dental care of SOT recipients. Patients before and after SOT showed similar quality of dental findings (DMF‐T), but worse compared to the general population. In addition, most patients in both groups showed pronounced periodontal treatment need (PSR^®/PSI score 3 or 4). Oral hygiene findings (modified QHI) after SOT were significantly worse than in patients on the waiting list (P = 0.032). In a second project, the questionnaire was returned by 28 of 50 centers. Interpretation of data showed that 89% carry out a dental examination before SOT and 67% contacted the patients’ dentists. After SOT, 83% of the transplant centers recommend antibiotic cover before dental measures. The results of our study revealed lacks in the dental care of SOT recipients. Consistent recommendations regarding the dental care of patients before and after SOT should be determined.