What is osteopathy, just entering the health professions, and why does anyone have doubts

The crux is that randomized controlled trials on osteopathy are still insufficient. However, there are researches that highlight some benefits and according to physiatrists the osteopath is an important figure

(photo: armon_88 via Pixabay)

L’osteopathy has just been recognized and established by the government as health profession in a Dpr (decree of the President of the Republic), with the consequent creation of a course of Graduation in this discipline. The first fundamental step for recognition took place with a law of 2018 (3/2018) created by Beatrice Lorenzin, now a deputy and at the time Minister of Health. Ai 10 countries (European and non-European) who have already institutionalized theosteopathy therefore also Italy is added. However, this formalization has caused discussion, in the scientific and media fields, on the role and essence of this discipline and on its entry into the health professions.

The reasons for the doubts concern the fact that theosteopathy is part of the medicine unconventional, but complementary and alternative, on which the publications of studies randomized controlled they are still limited. The practice is based exclusively on the use of the hands and on the idea that manipulation favors some properties of self-healing of our body. For this reason, some scientists, for example the national president of the Italian Association of Physiotherapy (Aifi), Davide B. Albertoni, he questioned entry into the health professions, operated by the government and announced with satisfaction by Minister Roberto Speranza, as, as Albertoni explains, this discipline it would not be based on solid scientific evidence. A strong back and forth has begun – here there answer of the President Roi – Register of osteopaths of Italy, Paola Sciomachen, which lists the presence of many studies on Pubmed on the benefits of osteopathy. Let’s try to understand something more about the fundamentals ofosteopathy and on the differences with the physiatry and the physiotherapy.

Osteopathy: what it is

“It is an important moment for many professionals and for those citizens who need their services”, the minister announced in a post Hope, with the applause of the deputy Lorenzin, who in 2018 had started the process of recognizing osteopathy. Founded in the mid-19th century by the American doctor and surgeon Andrey Taylor Still, osteopathy – as we read on page of the Osteopathic International Alliance and in a recent article its Scientific Reports of the group Nature – it is based on only one manual therapy, which consists of manipulating the musculoskeletal structures of our body to treat various health problems, from headaches to back pain and more. Attention is paid tounity that exists between anatomy and function and this therapy falls under type practices holistic and it’s complementary compared to classical medicine. A wide variety of manual techniques are used for improve physiological function or support homeostasis (stability) of tissues, organs and systems. The osteopath uses only the hands, while the physiotherapist (who can also be an osteopath at times) also uses others interventions, for example with tools electro-medical and with physical exercises for rehabilitation, and focuses more on the area where the symptom occurs.

How to become an osteopath

Physiotherapy and osteopathy have something in common but also numerous differences. To become osteopath these are the ways: to attend a full-time osteopathy course at the duration of five years, accessible to all people leaving high school, or a part-time course lasting five or six years, for those who already have a degree in medicine, physiotherapy or dentistry. Courses include subjects such as biology, histology, anatomy, physiology, orthopedics, Rheumatology, psychology, and osteopathy (of course). Until now, the courses were not included in the graduate courses of the delle delle health care professions (even if for example there were already university masters, like this della Sapienza), while from today and in the near future things will change with specific degrees based on the already consolidated course of study.

Differences with physiotherapy

The degree in physiotherapy it has a duration of three years, to which can also be added a specialization of two others, where some study subjects may be similar while others are not. “The degree in physiotherapy includes various different courses with respect to osteopathy”, points out a Wired Cristina Hrenuic, head of the rehabilitation unit of the Casilino Polyclinic, “And physiotherapy and osteopathy form skills e figure diverse, in my opinion not comparable. Osteopathy is effective for various ailments. It may happen that the osteopath better treats certain problems such as craniosacral ones, including some neck pain and headache due to Arnold’s neuralgia, while for other pathologies the physiotherapist, for example for muscle or neurological recovery with targeted exercises and other interventions“. In short, they are two separate areas, not to be compared.

But what is important to remember, and applies to both physiotherapists and osteopaths, is that these two professionals they cannot make the diagnosis, which must always be carried out by physiatrist, who is a doctor with a subsequent specialization in physiatry”, Continues Hrenuic. “Al physiatrist the decision of the type of therapy and it will be he who will indicate to the patient which of the two experts to go to, whether to the physiotherapist or osteopath or, as is often advisable, to both“. In other words, if you have back and muscle pains or if you have had an accident, as well as a trivial one collision with neck pain, you must first go to the doctor and physiatrist, and not directly to the osteopath or physiotherapist. The physiatrist will thoroughly evaluate the patient’s medical history and prescribe treatments. “It being understood that theosteopath it is and remains one valid and important figure, adds the physiatrist, “we must pay attention, in this phase of change and recognition of the new health profession, because in my opinion a any risk is that by entering the health professions, and following a five-year training, even some osteopaths may want to access the diagnosis, which is not and will not be possible”.

Studies are still lacking

The efficacy of osteopathy and its demonstration in clinical trials is one of the central points of today’s debate. And it is a complex issue to be addressed by the same specialists in the sector, some of whom disagree with each other. One 2013 study by two Australian authors, published its Bmc Muscoloskeletal Disorder, he considered 809 items (of which 772 discarded on the basis of the abstract only) on the effects of osteopathy in chronic low back pain. Among the 37 remaining publications, the authors excluded another 35 and the other two according to them however, they were not homogeneous from a methodological and clinical point of view. One of these two indicated one substantial similarity from l ‘osteopathic intervention, l’exercise and the physiotherapy.

On the English National Health Service page, for example, yes reads that there is limited evidence that osteopathy is effective for certain types of pain in the neck, shoulder or lower limbs and for recovery after hip or knee operations “: according to NHS there is some evidence, but still circumscribed. On the database of Pubmed numerous publications appear under the heading osteopathy O osteopathic manipulative treatment, but in many papers the results are limited, unclear and to be explored. Another study, conducted in 2017 by the University of Sidney, reports that there are gods positive results associated with osteopathy but that “Despite these results, the comparative studies published on the efficacy and economics in healthcare in osteopathic manipulative treatments (OMT) they are of insufficient quality and quantity to guide policies and practical actions. High-quality and well-constructed research that aligns with international best practices is strongly needed to build a pragmatic evidence-base for OMT “.

In short, the analysis indicates that are missing still or not enough i research work structured in a certain way, therefore with a large sample of participants, who are also randomized and controlled.

The clash over studies randomized controlled

The Sydney University study does not state however that theosteopathy is not effective and in some areas it deems it promising, also from the point of view of costs: for this it is necessary to study it more. It must also be remembered that this practice is recognized by international health institutions, such as the World Health Organization (WHO). In the latest WHO guidelines of 2010, later adopted also by the European Union, which contain the basic principles (and also the philosophical ones) ofosteopathy, and law that “Complementary and / or alternative medicine, if practiced correctly, can help improve the health and well-being of citizens”. With the official entry of the discipline into the health professions, (almost inevitably) the debate on these issues – from the still unfulfilled lack of large studies, structured in a certain way, to the possible benefits found in other publications – has reignited. with as often happens almost opposite factions. And the clash is played out precisely on the lack of studies randomized controlled.

President Aifi Albertoni underlines in one letter a Health newspaper also the frequent confusion between physiotherapy e osteopathy, whose boundaries are often thin, with the possible encroachment: the manual therapy, he explains in a case of a cited study, does not fall within unconventional or complementary medicine, so we must be careful about the definition of osteopathy and unconventional medicine.

Furthermore, the expert indicates that from the analysis of the publications collected so far evidence on osteopathy reported in randomized controlled trials they are very limited and explains why. President Roi is criticizing this Sciomaking he replies that the problems of small sample size, placebo effect and systematic errors, in his opinion, are the same for all evidence-based clinical practice. According to the expert these shortcomings also occur in studies on rehabilitation (non-osteopathic) and cites in this regard a systematic review by Cochrane which shows that the quality of the evidence on rehabilitation practice in chronic pain is limited. The debate remains Open, awaiting new trials and even larger studies.

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