Osteopathy has been shown to be effective in the management of chronic low back pain. Guidelines recommend biopsychosocial care for chronic, complex musculoskeletal conditions, including non-specific low back pain but there is a lack of evidence comparing standard osteopathic care, which has traditionally been based on dated and disputed biomechanical theories of dysfunction, with more contemporary biopsychosocial approaches. A multiple baseline single case experimental design trial with 11 UK osteopaths and 60 patients is currently assessing effectiveness of osteopathic treatment for patients with non-specific low back pain of more than 12 weeks’ duration. Patients are randomised to early, middle, or late treatment start dates to increase the validity of inferences about the effects of treatment. Osteopaths have participated in one course on the study protocol and processes pre-participation and will take an e-learning course on the biopsychosocial management of patients with low back pain after the first patient recruitment stage. Statistical analysis will assess the degree and rate of change between baseline, intervention and follow-up periods, and whether differences in effect are observed after the osteopaths have completed the biopsychosocial patient management training course. Primary outcomes will be the Numeric Pain Rating and Patient Specific Function Scales, measured daily at baseline and for 6 weeks during the intervention stage, and weekly or fortnightly during a 12-week follow-up period.Background
Methods and results
There is an increasing burden of LBP. Clinical guidelines promote physical activity (PA) and self-management strategies and aim to reform unhelpful clinical activity. This study explores osteopaths' beliefs about non-specific low back pain (NSLBP) and the role of activity in the treatment of NSLBP. Semi-structured interviews were conducted with a purposive sample of twelve qualified osteopaths in the UK. Interviews were transcribed verbatim and constructivist grounded theory was used to conceptualise, collect and analyse data.Background
Methods
Pain related distress is associated with poor low back pain outcomes, and is challenging for practitioners to address. This study investigated osteopaths' beliefs about the relationship between chronic pain (CP) and distress (D). The research aimed to explore how patient's distress is understood and managed by osteopath educator clinicians with an interest in the field. A qualitative research design using a constructivist grounded theory analytical approach was used to analyse semi-structured interviews. A purposive sample of seven osteopaths working at the British School of Osteopathy (BSO) with experience with CP-D was recruited. Data collection and analysis were carried out simultaneously. Audio-recording, verbatim-transcriptions, memos-writing and diary-keeping were used to develop themes and theory. Three main themes were identified: osteopaths understanding of the CP-D presentation, evaluation and assessment of the CP-D patient, the role of the osteopath and therapist-patient interaction in CP-D treatment. Three sub-themes were developed for each theme.Purpose and background
Methods and results
The biopsychosocial (BPS) model is recommended for managing non-specific low back pain (NSLBP) but the best method for teaching the BPS model is unclear. E-learning is a promising alternative to face-to-face methods. This study was a pilot randomised controlled trial (RCT) with embedded interview study to investigate the feasibility of conducting a main RCT and to explore the impact of an BPS for NSLBP e-learning programme on experienced practitioners' attitudes to back pain. Mixed methods evaluated the impact of an evidence-based e-learning programme on participants' attitudes to back pain. A pilot RCT assessed 45 experienced osteopaths' attitudes before and after the intervention, using the Pain Attitudes and Beliefs Scale (PABS) and the Attitudes to Back Pain Scale (ABS). The qualitative study explored 9 participants' views on the e-learning programme and possible impact on their clinical practice. 91% of participants completed the course and the overall satisfaction was very high. Participants' views on the BPS model ranged between not being structural enough, already done and transformative. The e-learning programme was well accepted. It would be feasible to run a main study using the same recruitment procedures, eligibility criteria, randomisation procedure, consent process, data collection and outcome measures.A statement of the purposes of the study and background
A summary of the methods used and the results
Low back pain (LBP) is the most common symptom encountered by osteopaths in the UK and affects a third of the UK population each year. Guidelines recommend using the biopsychosocial (BPS) model for non-specific LBP but it remains unclear what the BPS model actually is and how it applies in osteopathy. The aim of this study was to define the factors included in a BPS approach for non-specific LBP in a manual therapy using a systematic search and scoping review. An online search was performed on seven electronic databases. Guidelines and systematic reviews published after 2004 were included. 10% of the articles randomly selected were analysed by second reviewer to assess consistency of information extraction. Disagreements were discussed between the two reviewers. Mediation from the third author was not required.Background:
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