Researching osteopathy: Who is responsible?

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Research continues to be one of several important priorities for the osteopathic profession; important because so many of the functions, needs and future aspirations of the profession rely on information gained from purposeful investigation. An inquisitive mind, keen observation, and promotion of diagnostic and treatment outcomes were the foundation of the osteopathic profession, and today these remain amongst the key attributes that osteopaths require, irrespective of whether they are treating patients or undertaking research. Without research the profession would not have begun, and without continued research there will be threats to professional autonomy, professional development, and to the ongoing viability of our education programmes. For example, the tertiary educational landscape favours those professions with a demonstrated contemporary research base and disadvantages those who lack this base and struggle to engage in research that attracts grant funding, or that results in publication. In some countries, this has already been identified as a real threat to the continuing viability of some osteopathy programmes and the development of new ones.

Identifying a threat isn't particularly useful unless we also identify a way forward. As part of this process it is necessary to consider who is responsible for producing research in osteopathy. There are four general groups that may be responsible for research, being individual practitioners, professional organisations (registration agencies, professional associations and societies), academic staff, and student osteopaths.

We suggest that the responsibility for producing research does not generally reside with individual practitioners, whose primary concern is the clinical management of patients. It is expected that individual practitioners should participate in research mainly as consumers of research, drawing on evidence to inform practice where possible and integrating evidence and sound reasoning into the clinical encounter. A.T. Still was not only the first practising osteopath but was also the pioneer researcher of the profession. Therefore, when individuals or continuing professional development (CPD) providers make claims about treatment efficacy, they are responsible for demonstrating how research supports the use of their therapy. Such responsibility might involve active participation in research, donation of a proportion of course fees to fund research, or collaborating with more experienced researchers to commence clinical trials and experimental studies. First steps might include publication of a case study, followed by a single system research design. At that point funding for a more sophisticated design may be feasible. Without evidence of effectiveness, any claims we make as a profession, or as individuals, remain undifferentiated from the plethora of bogus healthcare claims cluttering the marketplace.

Responsibility also extends to the registration bodies that endorse CPD courses. Currently, registration bodies routinely approve CPD courses that promote therapeutic techniques without any requirement for course organisers to provide evidence of therapeutic efficacy or safety. If registration bodies were to take a closer watch over CPD courses teaching therapy, and required some basic evidence of efficacy and safety before course approval, we might see some rapid advances being made for the benefit of the profession and more importantly for the public.

Professional associations and societies exist for the benefit of their members. These organisations frequently make public claims through promotion and marketing campaigns. To the extent that these claims imply that osteopathy is of particular benefit for a special population or condition, promoters have a responsibility to support research that investigates the credibility of their claims, especially when these organisations are recognised as key stakeholders in the profession. Key stakeholders should be at the forefront of professional development and the advancement of knowledge in the field. Current best practice demonstrated by professional bodies includes facilitating access to funding, supporting the development of research activity by academic institutions, and promoting research culture amongst their members through conferences, CPD programmes and journal subscriptions.

And what of academic institutions? What part should they be playing in producing research? One of the profession's aims over the last 20 years has been establishing a stronger educational foundation within government funded tertiary institutions. Such affiliations bring many benefits including educational opportunities and an enhanced professional profile; yet they also come with additional responsibilities and obligations. In addition to teaching, universities are considered to have numerous other roles including research and community engagement, with a commitment to service, quality and leadership. There is increasing pressure on all academics in the tertiary sector to be actively engaged in research. For example, in New Zealand and the Australian States of Victoria and New South Wales, the accreditation of osteopathy programmes by registration bodies states very clearly the requirement that:

The policy goes further to state that institutions teaching osteopathy should provide documentary evidence of research projects, grants, and publications that academic staff have produced. Institutions that do not integrate research into their programmes not only fail on this standard, but are also ignoring an additional opportunity for students to develop critical thinking and problem solving skills that form the basis for an effective career in osteopathy. Failing to engender such skills amongst students also starves the profession of its future researchers.

For too long, and for numerous reasons, a majority of osteopathic academics haven't actively pursued research programmes within their own institutions; and although there is growing expertise within osteopathy in such areas as research design, grant writing and scientific publishing, this growth is germinal and requires an ongoing and substantial investment of time, money and other resources.

In this journal, the majority of research currently submitted for publication originates from within academic institutions, most commonly as the product of student collaboration with research supervisors. However, the extent of research involvement at different institutions varies across a spectrum. There are those whose academic staff have published research in both osteopathic and the wider healthcare journals, and those who have demonstrated no research activity in the last decade. Some institutions do not include research projects in their curriculum, while others do, yet rarely publish their findings. It is generally considered ethical practice to submit research findings for publication, and it is noteworthy that most human research ethics committees require applicants to indicate their intention to publish. It is undeniable that institutions and their academic staff should be the primary producers of research for and on behalf of the profession.

It is widely acknowledged that students don't typically enrol on an osteopathy programme to embark on a research career. But there is a requirement that research informs every aspect of their practicing career. This is an expectation of graduate degrees and of continuing professional development. However, should students be relied upon to provide research for the profession? Few other healthcare professions rely on student research to the extent that osteopathy does. By contrast, the majority of research produced by other healthcare professions comes from experienced researchers working collaboratively. The near absence of collaborative groups of experienced researchers working together in osteopathic research is an obvious area for improvement.

The provision of adequate research supervision is another major challenge for most institutions with osteopathic programmes. Students of osteopathy have a very broad base from which to develop research questions, and the quality and usefulness of projects are largely determined by the input of research supervisors. Today, as it was a decade ago, there remains a paucity of suitably qualified and experienced research supervisors who can shape a student's natural curiosity and channel it into research that is performed and reported to the requisite standard. In the shorter-term, this problem could be addressed by attracting experienced researchers from other fields to work alongside osteopaths. Many of the research questions that need investigation require the skills of researchers from fields as diverse as social science, life science and biomedicine. The challenge is therefore to make professional alliances with individuals from these fields.

In the longer-term, we also need to identify osteopathy students who demonstrate an interest and aptitude for research and develop a more defined career path for those who might become the researchers of the future. The current career pathway enables graduates to register and enter clinical practice, but does not provide clear opportunities to proceed easily into a research career. For example, the research experience generally provided in osteopathic education does not fulfil entry criteria for many PhD programmes, therefore requiring osteopaths to undertake 1–2 years of additional study before they can enrol in a PhD. Some osteopathy programmes have been developed to incorporate sufficient research experience within the pre-professional degree to enable graduates to move directly into doctoral studies, while other institutions, such as in the USA, provide joint DO/PhD programmes. This type of approach to osteopathic education should be considered by all curriculum committees in order to create additional career pathways for osteopaths.

In summary, we have identified that research is an important priority for the profession. It provides a basis for our education and clinical training, supports professional development and enables the critical evaluation of established and new ideas. It impacts policy and legislation. It benefits the public through ensuring safety and efficacy. While we are all responsible for establishing a research culture, we argue that it is osteopathic academics and professional bodies who are primarily responsible for providing leadership in osteopathic research.