Evidence, research and adverse reactions

Andrew Gilmour believes that there is no single undisputed reference which demonstrates the effectiveness of Osteopathic interventions for any particular group of ailments. However, there are many publications from around the world, which report trials and evaluations of Osteopathy and other physical treatment modalities, for musculoskeletal problems especially low back pain.
 
There are a number of systematic reviews of the literature supporting the use of manipulation. In particular those carried out by the Clinical Standards Advisory Group, The Royal College of General Practitioners and the National Institute of Excellence (as recently as 2009). In general, those addressing the Treatment of Acute Low Back Pain are supportive.
 
These reports and guidelines collated by Andrew Gilmour demonstrate that there are indications for the use of manipulation, particularly in relation to acute low back pain, but they do also acknowledge that the methodological quality of many of the research literature is poor.
 
There is research helpful to osteopathic practise and these fall into a number of categories:-
 1. For the use of Osteopathy for spinal pain, particularly low back pain.
 2. For the use of manipulation in general.
 3. For patient assessment, management and advice.
 4. For the use of treatment modalities shown to more effective than osteopathy for certain conditions.
 5. Research helpful to medical referrers.
 
There are many conditions which Osteopaths treat and so many elements to the history taking, assessment, investigation, diagnosis, management and treatment of each of these, that it would be impossible to gain evidence supporting or refuting elements for every aspect of the clinical intervention. There is, however, supporting evidence for some of the decisions we make, but by no means all.
 
The best way for Osteopaths to cope with this is to engage in a combination of prior learning through training, reflective practise, and a continual balancing of possible benefits versus risks when applying any particular treatment. The evidence available at the time and cost effectiveness of interventions should be borne in mind, as well as the frequency with which treatment may be needed. It is extremely difficult to judge at the outset of treatment how much treatment will be needed for a given condition.
As well as the effectiveness of treatment the compliance of patients in such things as 'dos', 'don'ts' and exercises is an important factor in optimising progress.
 
For the management of acute spinal pain several sources indicate that an average number of treatments for acute onset low back pain would be 6.
More important than judging the overall number of treatments needed, is for practitioner and patient to have in mind at the outset how many treatments should be given before both could reasonably be expected to see some progress. For many conditions this would occur within 3 or 4 treatments, but longer may be required in the case of particularly severe, established or complex cases.
Andrew Gilmour will not enter into 'open-ended' or 'ongoing' plans of treatment unless you have a thorough understanding of the reasons for it.
 
What are the possible side effects?
The most common side effect from hands on mechanical treatment is increase in pain or soreness in the first 24 to 48 hours following treatment.
The balancing act which Andrew Gilmour like all physical medicine practitioners tread is that, if treatment is pitched at too low a level it may take many more visits to achieve an effective result, but on the other hand, if the treatment is too strong then patients may react. A reasonable compromise is to achieve enough change in the working of the joints and tissues, accepting an element of short term soreness as long as there is gain following on from it. If you are concerned about the level of any such reaction you should initially speak to Andrew and particularly if the level of such reaction is unacceptable or lasts more than 48 hours.
 
Proper management of such side effects generally enables reactions to settle quickly. Some sources report exacerbation of certain conditions particularly in relation to cervical manipulation and lower lumbar disc problems.
 
However, since the advent of statutory regulation, which enforces practitioner standards there has been no completed study which directly asks questions regarding adverse reactions. One such study in progress by the Audit Development Group is concerned with the assessment of adverse reactions up to 10,000 consultations, but the results are not known at the date of publication. Risks are of manipulative treatment are acknowledged to be markedly reduced in the hands of properly trained and experienced practitioners following the well defined rules for when to and when not to manipulate patients.
 
If I suffer an adverse reaction what should I do?
If you suffer more than mild post treatment soreness which is common, you should contact Andrew Gilmour for appropriate advice. Proper management can quickly settle adverse reactions to treatment. 
 
However, if you are dissatisfied with your Osteopathic care you may seek further advice from the General Osteopathic Council which carries the Code of Conduct (published on the website www.osteopathy.co.uk) and has an ethical complaints procedure in place.(0207 357 6655)
Andrew Gilmour has his own complaints procedure which outlines what you can expect if you make a formal compaint and you can ask for this. Call 01394 387818 or visit www.gilmourosteo.co.uk


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