Clinical Risk, Osteopathy and Management. The CROaM Study

Vogel, S, Mars, T, Barton, T, Marlin, N, Froud, R, Eldridge, S, Underwood, M and Pincus, T (2013) Clinical Risk, Osteopathy and Management. The CROaM Study. [Report]

Vogel et al 2013 CROAM report.pdf

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Key Summary Points What we already know: There is an ongoing debate about the possible link between manipulation and negative outcome in patients. This has focussed on manipulation of the neck and stroke. In addition, there is a growing interest in other treatment reactions, such as increased pain and the appearance of new symptoms after treatment. To date, the evidence about manipulation is contradictory and there is little existing published information about these types of outcomes in osteopathy. What we did: A survey to all UK practising osteopaths was carried out, followed by in-depth interviews of selected osteopaths. Osteopaths also invited patients to provide information about their experience of osteopathic care and its outcomes. Patients were surveyed before treatment, one day and two days after treatment and at six weeks. Selected patients were interviewed. 1,082 (27.8%) osteopaths completed the practitioner survey. Interviews took place with 24 osteopaths. 2,057 patients, recruited from 212 osteopaths, completed questionnaires before their treatment. 1782 patients (86.6%) agreed to be followed up at 6 weeks; of these, 1,387 (77%) patients returned six week follow-up questionnaires. Interviews took place with 19 patients. What we found: Four percent of patients reported that they had experienced temporary dis-ability that was attributed to their osteopathic treatment. Ten of these patients were interviewed and only two described serious problems, neither of which were stroke. Osteopaths reported that they had seen patients who had experienced serious problems after treatment. A range of events occurring in the preceding year were described by 4% of osteopaths. The most common event described was the occurrence of pain associated with a trapped nerve. There were also 7 reports of stroke like symptoms. Between 10% and 20% of patients experienced increased symptoms/pain related to their main complaint in the days immediately following treatment, and this was highest amongst new patients. At six weeks, 10% of the patients had seen another healthcare practitioner because of the worsening of their main complaint, which they associated with the osteopathic care that they had received. The comparison between those that received manipulation and those that did not suggests that manipulation was not linked to outcomes. Osteopaths reported obtaining consent from patients less often than is required by osteopaths' Standards of Practice. This was especially low in returning patients and for techniques familiar to the patient. Patients reported being asked for their consent less often than the frequency with which osteopaths reported receiving consent. About one-third of patients reported that they had received information about risks and about 40% reported that they had received information from their osteopaths about alternative or no treatment options. Over half of the patients (55%) achieved at least a 30% decrease in symptoms/pain by day two post treatment. Similar improvement was seen at 6 weeks. Those with widespread pain were least likely to improve. New patients and those returning with a new episode of pain improved most. The majority of osteopaths favoured the establishment of an adverse events register. What this means for practice and policy: The evidence suggests that serious problems following osteopathic care are rare, but do occur. Whilst the link between any speci�fic treatment technique and these outcomes was not supported, osteopaths should be aware of the possibility of serious events occurring during or after treatment. With respect to stroke associated with neck and head pain, osteopaths should be vigilant about known risk factors and presenting symptoms of vascular pain arising from the neck. Osteopaths should inform patients about the possibility that they may experience increases in symptoms/pain associated with their main complaint shortly after treatment. This information should be given to all patients regardless of the site of presenting complaint and the nature of the treatment the osteopath proposes. There is a need to develop further guidance and educational materials for osteopaths regarding the process of consent. Further activity is indicated to assess the cost and feasibility of a reporting and learning system for adverse events and treatment reactions in osteopathy.

Item Type: Report
Divisions: Faculty of Medicine, Health and Life Sciences > School of Medicine
Depositing User: Dr Hilary Abbey
Date Deposited: 25 Mar 2021 19:22
Last Modified: 25 Mar 2021 19:22

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