This study described osteopathic practise activity, scope of practice and the osteopathic patient profile in order to understand the role osteopathy plays within the United Kingdom’s (UK) health system a decade after the authors’ previous survey.
The researchers used a retrospective questionnaire survey design to ask about osteopathic practice and audit patient case notes. All UK-registered osteopaths were invited to participate in the survey. The survey was conducted using a web-based system. Each participating osteopath was asked about themselves, and their practice and asked to randomly select and extract data from up to 8 random new patient health records during 2018. All patient-related data were anonymized.
The survey response rate was 500 osteopaths (9.4% of the profession) who provided information about 395 patients and 2,215 consultations. Most osteopaths were:
- self-employed (81.1%; 344/424 responses),
- working alone either exclusively or often (63.9%; 237/371),
- able to offer 48.6% of patients an appointment within 3 days (184/379).
Patient ages ranged from 1 month to 96 years (mean 44.7 years, Std Dev. 21.5), of these 58.4% (227/389) were female. Infants <1 years old represented 4.8% (18/379) of patients. The majority of patients presented with musculoskeletal complaints (81.0%; 306/378) followed by pediatric conditions (5%). Persistent complaints (present for more than 12 weeks before the appointment) were the most common (67.9%; 256/377) and 41.7% (156/374) of patients had co-existing medical conditions.
The most common treatment approaches used at the first appointment were:
- soft-tissue techniques (73.9%; 292/395),
- articulatory techniques (69.4%; 274/395),
- high-velocity low-amplitude thrust (34.4%; 136/395),
- cranial techniques (23%).
The mean number of treatments per patient was 7 (mode 4). Osteopaths’ referral to other healthcare practitioners amounted to:
- GPs 29%
- Other complementary therapists 21%
- Other osteopaths 18%
The authors concluded that osteopaths predominantly provide care of musculoskeletal conditions, typically in private practice. To better understand the role of osteopathy in UK health service delivery, the profession needs to do more research with patients in order to understand their needs and their expected outcomes of care, and for this to inform osteopathic practice and education.
What can we conclude from a survey that has a 9% response rate?
Nothing!
If I ignore this fact, do I find anything of interest here?
Not a lot!
Perhaps just three points:
- Osteopaths use high-velocity low-amplitude thrusts, the type of manipulation that has most frequently been associated with serious complications, too frequently.
- They also employ cranial osteopathy, which is probably the least plausible technique in their repertoire, too often.
- They refer patients too frequently to other SCAM practitioners and too rarely to GPs.
To come back to the question asked in the title of this post: What do UK osteopaths do? My answer is
ALMOST NOTHING THAT MIGHT BE USEFUL.
20 Responses to What do UK osteopaths do?
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I know not whether any osteopaths are following this blog (though I suggest, they should), but I would like to ask:
“What attracted you to the finalcial benefits and apparent professional status of being an osteopath, rather than training and becoming a physiotherapist, nurse, chiropractor, masseur, psychotherapist or medical doctor?”
That is to say: “What is the USP of osteopathy?
What is it that osteopaths do that could not be done by members of any of those other professions, with appropriate training post-graduation?”
I was a patient attendee on a MSK conference in UK and got the opportunity to ask this question to a chiropractor. The reply was that if you train as a physio you HAVE to work for the NHS before you can work in private practice. The chiro said that he wanted to be able to treat his friends directly. I was completely unconvinced – I believe that the NHS exposure could only have been of benefit in terms of exposure to depth and breath etc. He made it sound like treating someone was like ‘having one’s nails done’!!
On a separate note I have been asking questions as to why Osteopaths are part of the NHS FCP initiative. Chiropractors are not but for some reason osteopaths are but only if they offer treatment according to NICE guidelines
This worries me greatly because it blurs the lines and confuses patients- clearly private osteopaths do not.
Personally, I’m an osteopath and I had seen many practitioners such as physios, massage therapists in my pre osteopathic life for a variety of issues snd found that i got the most benefit from osteopathy so when deciding to become a practitioner that was my choice. It’s true we are taught a lot that I find very questionable but the profession is changing and many osteopaths that qualify now will be evidence based like myself.
“but the profession is changing”
‘The profession’ doesn’t know what it is doing, hence the 2009 and 2018 surveys.
Nearly every profession changes with time therefore your claim is obvious and trite.
Ollie: Are you saying you based your career choice, and decision to “become a practitioner” – all that studying and hard work – on the basis of one person’s (your) experience of “benefit from osteopathy”, as opposed to treatment by practitioners such as physios, massage therapists “for a variety of issues”?
What is the USP of osteopathy?
That spinal manipulation can free up vascular efficiency (as opposed to chiropractic which release pressure on ‘innate’)?
Your studies will have shown you there is no evidence for this, so why did you persist?
Lost Cost Fallacy?
A fallacy nonetheless.
Best wishes and may the Wu be with you.
Interesting that prior to seeing an osteopath 41.3% had consulted with their GP.
This is purely because waiting lists to see anyone on NHS are long. The real problem is that a lot of MSK issues will get better on their own but such is the world we need something quick. The osteopaths visit is just placebo but placebo is powerful to the patient and lucrative fir the oateopath
Interesting.
I had some persistent back and neck problems, which started after being bounced off the bonnet of a car going at 30 mph and then landing again on my back on the verge. (Genuinely could have been worse.)
I then strained everything and ignored the discomfort, making it much worse.
I went to the NHS physios who were sympathetic and gave me exercises to do (which I did), but eventually I went to a private physio nearby. She was good at first, but then I felt spent a lot of the session talking and too much of it on pilates.
Covid then came so I stopped going, but the injuries persisted.
After a while I went back to the same clinic but saw another physio who was much better. There is some slight damage to neck and back, but the rest is muscular. I had a few really good sessions with him and then he said that I should see the clinic osteopath.
I was a bit dubious, but he had been so good that I trusted him and thought I’d give it a go.
I went to the osteopath and essentially he gives me a sports massage. He’s also told me to do exercises. The second (good) physio is an ex-semi-pro footballer and the osteopath is captain of a local cricket club which plays in highest level below county. I kind of trust them as being non-bs.
Essentially I get stiffness and mini-spasms and he works to ease the ‘tight spots’. At the end, there is a little bit of ‘clicking’ but it seems an extension of the massage rather than mumbo-jumbo.
The clinic does use acupuncture. I said at the beginning I wasn’t interested. The osteopath forgot and did give it to me one session. I could have objected, but was kind of curious so let him go ahead. Waste of time.
It all seems standard and just a longer session of what the physios (both NHS and private) do.
I saw him quite regularly at first, but now (on his advice) only go from time to time. I have noticed a massive improvement with the discomfort and spasms and have much better range of movement.
So that’s what this one does with me.
He has this qualification, which at a glance seem to be a mix of proper science and some that is not.
https://www.swansea.ac.uk/undergraduate/courses/health-social-care/osteopathy-most/
Well, the ‘a lot get better on their own’ is being questioned.
“Recurrence of low back pain is very common, with more than two-thirds of individuals having a recurrence within 12 months after recovery. Prognostic factors for a recurrence include exposure to awkward posture, longer time sitting, and more than two previous episodes.”
https://www.jospt.org/doi/10.2519/jospt.2017.7415?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
“About 20 percent of people affected by acute low back pain develop chronic low back pain with persistent symptoms at one year.”
https://www.ninds.nih.gov/low-back-pain-fact-sheet
‘DC’ wrote: “Well, the ‘a lot get better on their own’ is being questioned.”
‘DC’ quoted: “About 20 percent of people affected by acute low back pain develop chronic low back pain with persistent symptoms at one year.”
Therefore 80% of people affected by acute low back pain do not develop chronic low back pain with persistent symptoms at one year. In other words: ‘a lot get better on their own’; the vast majority get better on their own.
Depends how one defines “gets better”.
If one has recurrent back pain for 40-50 years are they really better?
‘DC’ wrote “If one has recurrent back pain for 40-50 years are they really better?”
Are you trying to be an idiot, yet again [another instance here].
You previously quoted: “About 20 percent of people affected by acute low back pain develop chronic low back pain with persistent symptoms at one year.”
If you eventually manage to get clear in your mind the difference between the medical terms “acute” and “chronic“, then reread my previous reply on Tuesday 08 November 2022 at 15:43, s‑l‑o‑w‑l‑y, as many times as it takes you to adequately grasp its succinct message.
1. ‘DC’: Well, the ‘a lot get better on their own’ is being questioned.
2. ‘DC’: “About 20 percent of people affected by acute low back pain develop chronic low back pain with persistent symptoms at one year.”
3a. PA: Therefore, 80% of people affected by acute low back pain do not develop chronic low back pain.
3b. In other words, the following statements are adequately similar:
• ‘a lot get better on their own’;
• the vast majority get better on their own;
• four out of every five people (80%) affected by acute low back pain get better on their own [because these are the 80% who do not develop chronic low back pain].
Good grief!
See also:
“Health literacy”, Wikipedia
https://en.m.wikipedia.org/wiki/Health_literacy
Apparently you don’t know how chronic and recurrent low back pain are usually defined.
Chronic is based upon time…> 3 months
Recurrent is based upon frequency…most define it as 2-3 episodes within 1 year.
Thus there are several possibilities. For example…
One can have chronic recurrent back pain that is or is not chronic back pain
One can have chronic back pain that is or is not chronic recurrent back pain
Do try to be up on the research, you look foolish, again
Again, you are no good at defending the indefensible.
“About 20 percent of people affected by acute low back pain develop chronic low back pain with persistent symptoms at one year.”
They are the ones who visit the osteos believing that repeat visits keep the problem at bay- just plays into the hands of the osteopaths
Burdle: They are the ones who visit the osteos believing that repeat visits keep the problem at bay- just plays into the hands of the osteopaths
That could also be said about MDs and their pills.
no, it cannot – at least not in most European countries where the doctor does not earn according to the number of consultations.
In response to critics of Osteopathy, DC says:
Elsewhere a defense lawyer uses DC’s strategy to win his case:
“Your honor! burglaries happen all the time, therefore my client should be acquitted even though he illegally entered victim’s house and committed robbery. I rest my case!”
John Peters:
“I saw him quite regularly at first, but now (on his advice) only go from time to time.
I have noticed a massive improvement with the discomfort and spasms and have much better range of movement.”
I am very pleased for you.
We in the medical profession call your experience ‘natural history’ and ‘passage of time’.
I don’t doubt that the ‘sports massage’ helped you, but what did ostepathy/the osteopath provide that could not have been provided by another practitioner?
Remember – osteopathy was devised as an alternative to ‘regular medicine’ by a US army medical assistant who, unlike his father, could not qualify as a doctor.
So, if you want an alternative, so be it, but don’t let youself be kidded. Please.
I’m not kidded by anything.
In fact, I thought it was clear that I don’t think he has been doing anything ‘alternative’. I was merely answering the question as to what this particular osteopath is doing in this particular case.
I had been having problems for over a year before the physio and this osteopath worked on me. It was not improving. The benefit from the physio and then the osteopath was stark.
The help in managing things remains substantial.