Research underpins the evidence base for osteopathic medicine

Article Outline

• Copyright

Osteopathic practice was founded on an idea that emerged from the research and careful observations that Andrew Taylor Still made of his patients, himself and the environment in which he lived. Still's ideas became the foundation of his new philosophy and unique style of clinical practice that he termed ‘osteopathy’. That osteopathy is founded upon careful observation and research continues today, but with the contemporary overlay that what is done by osteopaths to patients should be substantiated by an evidence base.

The current evidence base of osteopathy is mainly provided by the research undertaken by practitioners in their practices and in the centres of excellence created by the teaching institutions and often supported by the professional bodies regulating and governing the profession. I believe that the extent to which osteopathic research is disseminated to the academic and research community, and thereby to the public, will largely determine the viability of the profession's future. Such research may be seen broadly in terms of i) the efficacy of treatment outcomes; ii) the cost effectiveness of treatment; and iii) the risk/benefit ratio of treatment. These, and other outcome criteria, need to be evaluated if the profession is to continue to enjoy its current and a future place in contemporary healthcare.

The issues outlined above formed the focus of discussion in the mid to late 1990s by a small but active group of individuals working within osteopathy. They were concerned about the future progression of osteopathy and believed that a focussed and dedicated research thrust was essential. Two main groups emerged and despite considerable geographical separation (being located at Victoria University in Melbourne and BCOM in London) they shared similar ideas about the importance of conducting, coordinating and disseminating research. The activity of the Melbourne group lead to the formation of the Journal of Osteopathic Medicine (JOM), the pre-cursor journal to IJOM, and the BCOM group founded the International Conference on Advances in Osteopathic Research (ICAOR).

In 1997 there was no dedicated research conference for osteopaths and there was a paucity of osteopaths pursuing PhD study. There existed very few opportunities for nascent researchers to present their ideas to an audience wider than their own department. At that time, the BCOM proceeded to implement their own idea for a conference with a research focus.

BCOM's commitment to research was such that it was decided to set up an international conference to attract as wide a participating section of the osteopathic community as possible. This decision resulted in the creation of the International Conference on Advances in Osteopathic Research (ICAOR) which was conceived with the multiple objectives of raising the osteopathic research profile, sharing research outcomes with like-minded osteopaths, encouraging the development of a credible evidence base and engendering enthusiasm within the population of osteopathic students. This latter point was, and remains, vital for the future success of the profession. The hope is that creation of a research ethos amongst students results in an enthusiasm to maintain research awareness, if not direct involvement in research generation, in professional practice after graduation.

It is clearly unrealistic to expect all osteopaths to be active in research, but all can be research aware and develop a critical approach to reading published work. The application of published research findings into clinical practice should always be preceded by critical appraisal. Exposure to the formulation of new ideas and questions, review of relevant literature, project planning, consideration of research methodology, data analysis, and discussion of results, are all essential parts of the appraisal process and may all be experienced within a research conference environment.

In 1999, the first ICAOR meeting received 24 abstracts for consideration to present; by comparison, for ICAOR 7, which ran in September 2008 in Florida, 43 abstracts were reviewed. This represents a 79% increase in research submissions over the eight years ICAOR has been running. During this time 10 countries have been actively involved in submitting papers for consideration by the review committee, whilst delegates have represented approximately 20 countries. Contributions have arisen from five geographical regions, being Australia, New Zealand, United States, mainland Europe and the United Kingdom. ICAOR has so far been hosted in the UK, Australia and the USA, with mainland Europe the site for ICAOR 8 in Milan, Italy. Over the seven iterations of the conference to date, there have been over 200 research papers submitted, from which 143 have been selected by the review committees to be presented. The five regions have provided the following proportion of presentations across the seven conferences:

The 7th ICAOR meeting was held in September 2008 and was hosted in the USA for the second time by Lake Erie College of Osteopathic Medicine, this time in Bradenton Florida. Previous ICAOR venues have been in London, Melbourne and Lake Erie, Pennsylvania. The ICAOR 7 programme scheduled 26 oral and 12 posters, and the five-strong international review committee was drawn from four countries. The committee was in the desirable position of being able to select from 43 submissions from 7 countries, these being Australia, America, UK and four countries in Europe. The number and quality of submissions ensured a high standard of presentation and a wide range of research topics were covered.

Since its inception, the conference has flourished, serving as an important meeting point for those engaged in osteopathic research, with many presenters going on to refine and publish their research in journals and periodicals. All are encouraged to investigate new ideas, read the research literature and share their work with colleagues and students. This networking is of crucial importance in forging and maintaining research collaborations.

I firmly subscribe to the view that Osteopathic Education Institutions (OEIs) should be engaged in research activities in the broadest context. Research-active faculty is the norm within tertiary education, and this should be a goal within the OEIs despite osteopathic research being in its infancy. There are many benefits of maintaining a faculty that is research orientated, not least of which is the promotion of healthy culture of critical reflection – something also critical for competent clinical practice.

Osteopathic Education Institutions that can encourage a culture of research awareness throughout the curriculum, greatly benefit their students through the inclusion of new and emerging knowledge within their everyday teaching. Similarly, students who will practice in the current healthcare environment need access to staff who are equipped with the rich experience of practice, tempered with awareness of new and emerging research evidence to support best practice. Osteopaths involved with OEIs who can provide specialist consultancies to outside agencies will also assist in improving the profile of the profession within the wider healthcare community.

The way in which the whole profession regards research, and supports research infrastructure, will help determine how osteopathy and osteopaths are perceived, particularly by political leaders and future health funding authorities. The progress of osteopathy in the UK has been outstanding over the past ten years and this is starting to be reflected in other European countries. However, different countries and different models of osteopathic practice also need to be considered. Regardless of the style of clinical practice adopted by an individual, or indeed the practice profile of a whole country, all need to possess an evidence base that is informed by research.

The ICAOR conference is a vibrant, stimulating and occasionally controversial meeting, but is always welcoming and interested in new ideas and emerging evidence. The organising committee sincerely hopes that you, the practicing osteopath, educator, researcher or student will be interested in experiencing a future ICAOR meeting and engaging with osteopaths from around the world. I look forward to welcoming you to the next meeting, ICAOR 8, which is to be held in Europe.