Objective

To evaluate functional and oncological outcomes following resection of sacral tumours and discuss the strategies for instrumentation.

Purpose and Background

The MOCAM study is a major prospective questionnaire-based study investigating the relationship between low back pain (LBP) patient outcomes and non-specific treatment components, i.e., therapeutic relationship, healthcare environment, incidental treatment characteristics, patients' beliefs and practitioners' beliefs. Participating acupuncturists, osteopaths, and physiotherapists from the NHS and private sector have been asked to recruit at least 10 patients into the study. This paper aims to analyse current recruitment rates from MOCAM and identify barriers and facilitators to effective recruitment.

Purpose and background of the study. When talking to patients about pain, it has been shown that practitioners can positively or negatively influence health beliefs and treatment outcomes. Multidisciplinary physical and psychological interventions have demonstrated better outcomes for patients with long-term pain. Acceptance and Commitment Therapy (ACT) is a form of ‘third wave’ Cognitive Behavioural Therapy (CBT) that has been shown to promote resilience and wellbeing. A qualitative auto-ethnographic case study design was used to explore the communication processes and therapeutic outcomes associated with developing an innovative course integrating ACT interventions with osteopathic treatment, delivered by a single practitioner. Methods. Six individual consultations with four patients were audio-recorded, transcribed verbatim and coded. Linguistic Ethnography was used to identify pain discourses and analyse links with clinical decisions and patient responses. Transcript extracts were analysed at three levels; micro-level Conversation Analysis of communication processes; Interactional Sociolinguistic Analysis of changes in patient-practitioner roles; and macro-level Discourse Analysis of the wider biomedical and biopsychosocial context. Results. Two distinctive forms of discourse were identified. In predominantly ‘mechanistic’ communication, the ‘expert’ practitioner role was focused on fixing ‘broken’ parts and relieving pain. In ‘facilitative’ discourses, the ‘collaborative’ practitioner focused on promoting patients’ body awareness and active coping. Challenges included learning how to shift between discourses, which required mindfulness and willingness to tolerate uncertainty. Conclusion. This new inter-disciplinary approach enabled an osteopath to re-frame pain discourses to promote patient agency and resilience. Findings were subsequently used to design the OsteoMAP study (Osteopathy, Mindfulness and Acceptance-based Programme) to test outcomes with practitioners in other clinical settings. No conflicts of interest. No funding obtained

Purpose and background. 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. Methods and results. 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. Conclusions. Osteopaths recognized the relationship between CP-D. They considered the management of this presentation complex and challenging due to extensive clinical uncertainty. Osteopaths considered the therapist-patient interaction as a crucial vehicle for evaluating the individual patient presentation along with understanding patient's biopsychosocial factors and readiness to change, however a lack of rigor was identified with this process. Challenges related to evaluation were mainly related to patient characteristics and osteopath's lack of training. Further work is required to develop better evaluation and intervention strategies as well as understanding patient's attitudes to the relationship between CP and D. Conflict of interest: None. Sources of funding: None

The identification of the extent of neural damage in patients with acute or chronic spinal cord injury is imperative for the accurate prediction of neurological recovery. The changes in signal intensity shown on routine MRI sequences are of limited value for predicting functional outcome. Diffusion tensor imaging (DTI) is a novel radiological imaging technique which has the potential to identify intact nerve fibre tracts, and has been used to image the brain for a variety of conditions. DTI imaging of the spinal cord is currently only a research tool, but preliminary studies have shown that it holds considerable promise in predicting the severity of spinal cord injury.

This paper briefly reviews our current knowledge of this technique.