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The development and exploratory analysis of the Osteopaths’ Therapeutic Approaches Questionnaire (Osteo-TAQ)

Published:August 05, 2020DOI:https://doi.org/10.1016/j.ijosm.2020.07.002

      Highlights

      • There is variation in how osteopaths approach patients, termed their ‘therapeutic approach’.
      • This variation includes their approach to clinical decision-making andlevel of patient involvement.
      • The Osteo-TAQ is a 30-item questionnaire developed from a qualitative grounded theory study.
      • The Osteo-TAQ appears to be a valid instrument to characterise osteopaths' therapeutic approaches.

      Abstract

      Background

      Clinical practice encompasses the complex interaction of different skills, knowledge and values in the context of a therapeutic relationship. Research has demonstrated a positive association between well-developed therapeutic relationships, patient satisfaction and clinical outcomes in musculoskeletal conditions. There has been little research into osteopaths’ decision making regarding choice of therapeutic approaches.

      Aim

      The aim of this study was to develop a new questionnaire to assess differences in osteopaths' therapeutic approaches, and to subsequently investigate the internal consistency of the factors identifying different underlying practice concepts and the validity and generalisability of a qualitative grounded theory on osteopaths’ therapeutic approaches and clinical decision-making.

      Method

      A 30-Item Osteopaths’ Therapeutic Approaches Questionnaire (Osteo-TAQ) was developed using modified verbatim phrases from a published qualitative grounded theory. UK osteopaths were invited to complete the Osteo-TAQ questionnaire. An exploratory factor analysis, using both the principal axis factoring method and principal components method, was performed on the responses.

      Results

      132 responses were received. Osteo-TAQ displayed acceptable level of modelling adequacy (χ2(435) = 1466.1, p < 0.001; KMO = 0.754) and internal consistency (α = 0.778). Exploratory analysis identified eight factors with eigenvalues >1, accounting for 63.5% of the variance.

      Conclusion

      The Osteo-TAQ identified factors that are congruent with a qualitative grounded theory on osteopaths’ therapeutic approaches. The Osteo-TAQ appeared to have good construct validity with four robust components identified and easily characterised. Further testing for construct validity should be carried out amongst a larger population of osteopaths and outside the UK to test and develop the questionnaire further.

      Keywords

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      References

        • Borrell-Carrió F.
        • Suchman A.L.
        • Epstein R.M.
        The biopsychosocial model 25 years later: principles, practice, and scientific inquiry.
        Ann Fam Med. 2004; 2: 576-582
        • Stilwell P.
        • Harman K.
        An enactive approach to pain: beyond the biopsychosocial model.
        Phenomenol Cognitive Sci. 2019; 18: 637-665
        • GOsC
        General osteopathic Council.
        Osteopathic Practice Standards, 2018
        • Bar-Zaccay A.
        • Bailey D.
        The attitudes and beliefs of UK osteopaths towards the management of low back pain: a cross-sectional study.
        Int J Osteopath Med. 2018; 28: 42-47
        • Macdonald R.J.
        • Vaucher P.
        • Esteves J.E.
        The beliefs and attitudes of UK registered osteopaths towards chronic pain and the management of chronic pain sufferers-A cross-sectional questionnaire based survey.
        Int J Osteopath Med. 2018; 30: 3-11
        • Abrosimoff M.
        • Rajendran D.
        ‘Tell me your story’-How osteopaths apply the BPS model when managing low back pain-A qualitative study.
        Int J Osteopath Med. 2019; 35 (March 2020): 13-21
        • Sampath K.K.
        • Darlow B.
        • Tumilty S.
        • Shillito W.
        • Hanses M.
        • Devan H.
        • Thomson O.P.
        Barriers and facilitators experienced by osteopaths in implementing a biopsychosocial (BPS) framework of care when managing people with musculoskeletal pain–A mixed methods systematic review protocol.
        International Journal of Osteopathic Medicine. 2020 Mar 1; 35: 41-45
        • Penney J.N.
        The Biopsychosocial model: redefining osteopathic philosophy?.
        Int J Osteopath Med. 2013; 16: 33-37
        • Thomson O.P.
        • Petty N.J.
        • Moore A.P.
        Reconsidering the patient-centeredness of osteopathy.
        Int J Osteopath Med. 2013; 16: 25-32
        • Reynolds A.
        Patient-centered care.
        Radiol Technol. 2009; 81: 133-147
        • Thomson O.P.
        • Petty N.J.
        • Moore A.P.
        Clinical decision-making and therapeutic approaches in osteopathy–a qualitative grounded theory study.
        Man Ther. 2014; 19: 44-51
        • Strutt R.
        • Shaw Q.
        • Leach J.
        Patients' perceptions and satisfaction with treatment in a UK osteopathic training clinic.
        Man Ther. 2008; 13: 456-467
        • Ferreira P.H.
        • Ferreira M.L.
        • Maher C.G.
        • Refshauge K.M.
        • Latimer J.
        • Adams R.D.
        The therapeutic alliance between clinicians and patients predicts outcome in chronic low back pain.
        Phys Ther. 2013; 93: 470-478
        • Miciak M.
        • Mayan M.
        • Brown C.
        • Joyce A.S.
        • Gross D.P.
        The necessary conditions of engagement for the therapeutic relationship in physiotherapy: an interpretive description study.
        Arch.Physiother. 2018; 8: 3
        • Greenhalgh T.
        • Howick J.
        • Maskrey N.
        Evidence based medicine: a movement in crisis?.
        BMJ. 2014; 348
        • Fawkes C.
        • Leach J.
        • Mathias S.
        • Moore A.
        Profiling osteopathic practice in the UK using standardised data collection.
        Int J Osteopath Med. 2013; 16: e10
        • Bradbury K.J.
        • Bishop F.L.
        • Yardley L.
        • Lewith G.
        Patients' appraisals of public and private healthcare: a qualitative study of physiotherapy and osteopathy.
        J Health Psychol. 2013; 18: 1307-1318
        • Mead N.
        • Bower P.
        Patient-centredness: a conceptual framework and review of the empirical literature.
        Soc Sci Med. 2000; 51: 1087-1110
        • Kornhaber R.
        • Walsh K.
        • Duff J.
        • Walker K.
        Enhancing adult therapeutic interpersonal relationships in the acute health care setting: an integrative review.
        J Multidiscip Healthc. 2016; 9: 537
        • Babatunde O.O.
        • Jordan J.L.
        • Van der Windt D.A.
        • Hill J.C.
        • Foster N.E.
        • Protheroe J.
        Effective treatment options for musculoskeletal pain in primary care: a systematic overview of current evidence.
        PloS One. 2017; 12e0178621
        • O'Keeffe M.
        • Cullinane P.
        • Hurley J.
        • Leahy I.
        • Bunzli S.
        • O'Sullivan P.B.
        • O'Sullivan K.
        What influences patient-therapist interactions in musculoskeletal physical therapy? Qualitative systematic review and meta-synthesis.
        Phys Ther. 2016; 96: 609-622
        • Bastemeijer C.M.
        • Voogt L.
        • van Ewijk J.P.
        • Hazelzet J.A.
        What do patient values and preferences mean? A taxonomy based on a systematic review of qualitative papers.
        Patient Educ Counsel. 2017; 100: 871-881
        • Lim Y.Z.
        • Chou L.
        • Au R.T.
        • Seneviwickrama K.M.D.
        • Cicuttini F.M.
        • Briggs A.M.
        • Sullivan K.
        • Urquhart D.M.
        • Wluka A.E.
        People with low back pain want clear, consistent and personalised information on prognosis, treatment options and self-management strategies: a systematic review.
        J Physiother. 2019; 65: 124-135
        • Kinney M.
        • Seider J.
        • Beaty A.F.
        • Coughlin K.
        • Dyal M.
        • Clewley D.
        The impact of therapeutic alliance in physical therapy for chronic musculoskeletal pain: a systematic review of the literature.
        Physiother Theor Pract. 2018; : 1-13
        • Thomson O.P.
        • Petty N.J.
        • Moore A.P.
        A qualitative grounded theory study of the conceptions of clinical practice in osteopathy–a continuum from technical rationality to professional artistry.
        Man Ther. 2014; 19: 37-43
        • Orrock P.J.
        The patient experience of osteopathic healthcare.
        Man Ther. 2016; 22: 131-137
        • Leach C.J.
        • Mandy A.
        • Hankins M.
        • Bottomley L.M.
        • Cross V.
        • Fawkes C.A.
        • Fiske A.
        • Moore A.P.
        Patients' expectations of private osteopathic care in the UK: a national survey of patients.
        BMC Compl Alternative Med. 2013; 13: 1
        • Cross V.
        • Leach C.M.J.
        • Fawkes C.A.
        • Moore A.P.
        Patients' expectations of osteopathic care: a qualitative study.
        Health Expect. 2015; 18: 1114-1126
        • Formica A.
        • Thomson O.P.
        • Esteves J.E.
        ‘I just don't have the tools’-Italian osteopaths' attitudes and beliefs about the management of patients with chronic pain: a qualitative study.
        Int J Osteopath Med. 2018; 27: 6-13
        • Kasiri-Martino H.
        • Bright P.
        Osteopathic educators' attitudes towards osteopathic principles and their application in clinical practice: a qualitative inquiry.
        Man Ther. 2016; 21: 233-240
        • Figg-Latham J.
        • Rajendran D.
        Quiet dissent: the attitudes, beliefs and behaviours of UK osteopaths who reject low back pain guidance–a qualitative study.
        Musculoskeletal .Sci. Pract. 2017; 27: 97-105
        • Inman J.
        • Thomson O.P.
        Complementing or conflicting? A qualitative study of osteopaths' perceptions of NICE low back pain and sciatica guidelines in the UK.
        Int J Osteopath Med. 2019; 31: 7-14
        • Thomson O.P.
        Clinical decision making and therapeutic approaches of experienced osteopaths.
        (Unpublished PhD thesis) University of Brighton, 2013
        • Pincus T.
        • Vogel S.
        • Santos R.
        • Breen A.
        • Foster N.
        • Underwood M.
        The attitudes to back pain scale in musculoskeletal practitioners (ABS-mp): the development and testing of a new questionnaire.
        Clin J Pain. 2006; 22: 378-386
        • Pincus T.
        • Vogel S.
        • Breen A.
        • Foster N.
        • Underwood M.
        Persistent back pain—why do physical therapy clinicians continue treatment? A mixed methods study of chiropractors, osteopaths and physiotherapists.
        Eur J Pain. 2006; 10 (67): 67
        • Naing L.
        • Winn T.
        • Rusli B.
        Practical issues in calculating the sample size for prevalence studies.
        Arch Orofac Sci. 2006; 1: 9-14
        • IBM S.
        IBM SPSS statistics version 25.
        International Business Machines Corp., 2017 (Boston)
        • Tabachnick B.G.
        • Fidell L.S.
        • Ullman J.B.
        Using multivariate statistics.
        Pearson Boston, 2007 (MA)
        • Liem T.
        Pitfalls and challenges involved in the process of perception and interpretation of palpatory findings.
        Int J Osteopath Med. 2014; 17: 243-249
        • Seffinger M.A.
        • Najm W.I.
        • Mishra S.I.
        • Adams A.
        • Dickerson V.M.
        • Murphy L.S.
        • Reinsch S.
        Reliability of spinal palpation for diagnosis of back and neck pain: a systematic review of the literature.
        Spine. 2004; 29: E413-E425
        • Bengaard K.
        • Bogue R.J.
        • Crow W.T.
        Reliability of diagnosis of somatic dysfunction among osteopathic physicians and medical students.
        Osteopathic Family Physician. 2012; 4: 2-7
        • Rossettini G.
        • Carlino E.
        • Testa M.
        Clinical relevance of contextual factors as triggers of placebo and nocebo effects in musculoskeletal pain.
        BMC Muscoskel Disord. 2018; 19 (27)
        • Vaughan B.
        Evaluation of teaching in a student-led clinic environment: assessing the reliability of a questionnaire.
        Int J Osteopath Med. 2019; 31: 28-35
      1. Meisingset, I., O. Vasseljen, N. K. Vøllestad, H. S. Robinson, A. Woodhouse, K. B. Engebretsen, M. Glette, C. K. Øverås, A. L. Nordstoga, K. A. I. Evensen and E. S. Skarpsno "Novel approach towards musculoskeletal phenotypes." Eur J Pain n/a(n/a).

        • James D.E.
        • Schraw G.
        • Kuch F.
        Using the sampling margin of error to assess the interpretative validity of student evaluations of teaching.
        Assess Eval High Educ. 2015; 40: 1123-1141
        • National Institute for Health and Care Excellence
        Low back pain and sciatica in over 16s:assessment and management.
        2016
        • Petty N.J.
        Becoming an expert: a masterclass in developing clinical expertise.
        Int J Osteopath Med. 2015; 18: 207-218
        • Bergman B.
        • Hallberg L.R.M.
        Women in a male-dominated industry: factor analysis of a women workplace culture questionnaire based on a grounded theory model.
        Sex Roles. 2002; 46: 311-322
        • Tusubira F.
        • Mulira N.
        • Kahiigi E.
        • Kivunike F.
        • Printery K.
        • Ullrich J.
        • Wieseke J.
        • Christ O.
        • Schulze J.
        • Van Dick R.
        • Tabachnick B.
        • Fidell L.
        Using multivariate statistics, allyn & bacon, needham heights, MA.
        [Manual request][Infotrieve] Thomas, S.(1996), Decision Making with Dependence and Feedback: Anal.Netw. Process.RWS.Chapter One.Introd .Backgr. 2001; 10: 493
        • Charmaz K
        Constructing grounded theory. Sage, 2014