In-patient OMM Brian Loveless, DO - Associate Professor, Vice-Chair Department of NMM/OMM, WUHS/COMP - Find a Physician
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In-patient OMM
Brian Loveless, DO
Associate Professor, Vice-Chair
Department of NMM/OMM, WUHS/COMP
AAO Convocation 2019Disclosure I have no actual or potential conflict of interest in relation to this program/presentation.
Review Explore Incorporate
Review current Explore a process Incorporate those
research into for quickly acquiring findings into an
inpatient care relevant evidence-based
Objectives
models examination treatment plan
findings •Integrating osteopathic
philosophy“To find health should be the object of the doctor. Anyone can find disease” Philosophy
Are we doing OMM in the hospital? Carruzzo (2013) ◦ 37 Swiss hospitals surveyed ◦ 19 hospitals reported offering at least one CAM ◦ Most frequent was acupuncture, followed by manual therapies, osteopathy, and aromatherapy ◦ This is a 54% increase in ~10 years Rhon (2018) ◦ Military hospital, 7566 patients with spine or shoulder conditions in 2009 ◦ Tracked manipualtive treatment by DO, DC, PT ◦ 26.6% received manipulative treatment at least once, average of 3.3 visits per patient ◦ Thoracic complaints most likely (50.8%), shoulder complaints least likely (24.2%) ◦ 29% of the manipulation was by DO
Are we doing OMM in the hospital? Aveni (2016) ◦ Swiss hospital, staff surveyed to assess attitudes toward complementary medicine for chronic pain ◦ 96.6% in favor of CM (hypnosis, osteopathy, acupuncture) ◦ Over half (58.3%) had never referred for CM, 84.3% felt the lacked the knowledge to inform their patients about CM Smith-Kelly (2016) ◦ 474 employees at an American hospital in Oregon ◦ Housed AOA residencies in FM, IM, Orthopedics, General Surgery, and Psychiatry ◦ 25.7% reported that they were not at all knowledgeable about OMM ◦ This group inclouded RN, CNA, NP, PA and "Other" (clerical, therapy, technicians)
Osteopathic Recognition 213 programs as of February 2019 No specific requirement for inpatient OMM but many programs have inpatient rounds ◦ Who is leading those?
Should we be doing OMM in
the hospital?
Baltazar (2013) - Postoperative Noll (2010) - Pneumonia
ileus
Pizzolorusso (2014) - Preterm
Cerritelli (2013) - NICU infants
Crow (2009) - Postoperative ileus Probst (2016) - Postop bowel
Fleming (2015) - Postoperative Racca (2017) - Postop sternotomy
ileus
Swender (2014) - Cystic fibrosis
Hastings (2016) - PostpartumShould we be doing OMM in the hospital? Bagagiolo (2016) ◦ "The available studies in neonatal settings provide evidence that OMT is effective in reducing the hospital length of stay of the treated infants, therefore, (sic) suggesting that robust cost-effectiveness analyses should be including in the future clinical trial's design to establish new possible OMT_shared strategies within the health care services provided to newborns."
How do we do OMM in the hospital?
OA/AA
Cervical TART
changes
T1/supraclavicular
fossa/1st rib/clavicle
Thoracic TART
changes Review of
Ribs
Hospital
T12
Exam
Lumbar TART
changes
L5
SI/ASIS/PelvisRespiratory/
Circulatory
Biomechanical Neurological
OMM
Behavioral MetabolicABCs of OMT •Autonomics •Biomechanics •Circulation •screening
Comparison of Approaches
Exam Noll Radjeski Clark MOPSE Swender
Condylar Condylar
OA/AA Decomp Decomp Subbocc ihn Decomp
Cervical ST ST/HVLA ST
T1 MFR 1st rib CS MFR MFR
Paraspinal
Thoracic Inhibition ST/ CS ST
Rib Rib Raising Ant CS Rib Raising Rib Raising Rib Raising
Doming Doming Doming
T12 Diaphragm Diaphragm Diaphragm
Lumbar ST/CS
L5 CS LS decomp
Pelvis IS mob
Lymphatic Pectoral Lymphatic
Lymphatic Pump Traction Pump Pedal/Thoracic Thoracic Pump
Other Sternal MFR SBS DecompUsing Osteopathic Principles lApplication of osteopathic principles, not techniques lInfluencing physiology using the musculoskeletal system as a handle lNeed to get away from the disease model of care lTreat the patient, not the disease
Proposed “Framework”
Sacral/Pelvic balance
l Scapulae
l
L/S decompression
l Thoracic inlet
l
Lumbar treatment
l First rib
l
T/L junction
l Cervical treatment
l
Thoracic diaphragm
l OA/AA
l
Thoracic treatment
l Lymphatic pump
l
Ribs
lContraindications lPatient refusal lNo supervision lCancer? lInfections? lFractures? lHeart Failure?
COPD and OMT
l“Immediate Effects of Osteopathic Manipulative Treatment in Elderly
Patients With Chronic Obstructive Pulmonary Disease” Noll, et al May 2008
Worsening of air trapping following a session of OMT
l
l“The immediate effect of individual manipulation techniques on pulmonary
function measures in persons with chronic obstructive pulmonary disease”
Noll, et al Oct. 2009
Use of thoracic pump with activation increases post treatment residual volume
lDosing of OMT
Not longer than the patient can tolerate
l
lMake an initial treatment as focused and brief as necessary
lRe-assess to evaluate the patient's response
lFurther treatments longer or shorter as appropriate
lTypical treatment lastsFrequency of OMT
lNo more frequent than the patient can handle
lTypically treat daily
Sicker patients may benefit from shorter, more frequent treatments
l
As the patient improves may increase time between treatments
lInformed Consent l Nature of the procedure l Reasonable alternatives to the proposed intervention l Explanation of l Risks l Benefits l Uncertainties l Assessment of understanding l Acceptance of intervention
“I have no desire to be a cat, who walks so lightly
that it never creates a disturbance. I want to be
myself, not ‘them,’ not ‘you,’ not ‘Washington,’ but
just myself; well plowed and cultivated”
AutobiographyReferences 1. LBORC A. Inpatient Osteopathic SOAP Note Form. In. 2. Aveni E, Bauer B, Ramelet AS, et al. The Attitudes of Physicians, Nurses, Physical Therapists, and Midwives Toward Complementary Medicine for Chronic Pain: A Survey at an Academic Hospital. Explore (NY). 2016;12(5):341-346. 3. Bagagiolo D, Didio A, Sbarbaro M, Priolo CG, Borro T, Farina D. Osteopathic Manipulative Treatment in Pediatric and Neonatal Patients and Disorders: Clinical Considerations and Updated Review of the Existing Literature. Am J Perinatol. 2016;33(11):1050-1054. 4. 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. 5. Carruzzo P, Graz B, Rodondi PY, Michaud PA. Offer and use of complementary and alternative medicine in hospitals of the French-speaking part of Switzerland. Swiss Med Wkly. 2013;143:w13756. 6. Cerritelli F, Pizzolorusso G, Renzetti C, et al. Effectiveness of osteopathic manipulative treatment in neonatal intensive care units: protocol for a multicentre randomised clinical trial. BMJ Open. 2013;3(2). 7. Clark RC, McCombs TM. Post operative osteopathic manipulative protocol for delivery by students in an allopathic environment. The AAO Journal. 2006;16(2):19-21.
References (cont.) 8. Crow WT, Gorodinsky L. Does osteopathic manipulative treatment (OMT) improves outcomes in patients who develop postoperative ileus: A retrospective chart review. International Journal of Osteopathic Medicine. 2009;12(1):32-37. 9. Fleming RK, Snider KT, Blanke KJ, Johnson JC. The effect of osteopathic manipulative treatment on length of stay in posterolateral postthoracotomy patients: A retrospective case note study. International Journal of Osteopathic Medicine. 2015;18(2):88-96. 10. Hastings V, McCallister AM, Curtis SA, Valant RJ, Yao S. Efficacy of Osteopathic Manipulative Treatment for Management of Postpartum Pain. J Am Osteopath Assoc. 2016;116(8):502-509. 11. Noll DR, Degenhardt BF, Johnson JC, Burt SA. Immediate effects of osteopathic manipulative treatment in elderly patients with chronic obstructive pulmonary disease. J Am Osteopath Assoc. 2008;108(5):251- 259. 12. 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. 13. Noll DR, Johnson JC, Baer RW, Snider EJ. The immediate effect of individual manipulation techniques on pulmonary function measures in persons with chronic obstructive pulmonary disease. Osteopath Med Prim Care. 2009;3:9. 14. Nuno V, Pena NJ, Hughes TNF, Cuny LAM, Pierce-Talsma SL. Teaching Osteopathic Principles and Practices: Easy as ABCs. The AAO Journal. 2018;28(2):34-38.
References (cont.) 15. 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. 16. Probst P, Buchler E, Doerr-Harim C, et al. Randomised controlled pilot trial on feasibility, safety and effectiveness of osteopathic MANipulative treatment following major abdominal surgery (OMANT pilot trial). International Journal of Osteopathic Medicine. 2016;20:31-40. 17. Racca V, Bordoni B, Castiglioni P, Modica M, Ferratini M. Osteopathic Manipulative Treatment Improves Heart Surgery Outcomes: A Randomized Controlled Trial. Annals of Thoracic Surgery. 2017;104(1):145-152. 18. 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. 19. Rhon D, Greenlee T, Fritz J. Utilization of Manipulative Treatment for Spine and Shoulder Conditions Between Different Medical Providers in a Large Military Hospital. Archives of Physical Medicine and Rehabilitation. 2018;99(1):72-81. 20. Smith-Kelly JB, Cardenas A. Assessment of Hospital Staff's Knowledge of Osteopathic Manipulative Medicine: A Survey-Based Study. J Am Osteopath Assoc. 2016;116(12):764-769. 21. Swender DA, Thompson G, Schneider K, McCoy K, Patel A. Osteopathic manipulative treatment for inpatients with pulmonary exacerbations of cystic fibrosis: effects on spirometry findings and patient assessments of breathing, anxiety, and pain. J Am Osteopath Assoc. 2014;114(6):450-458.
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