Fryer Gary, Morse Christopher M, Johnson Jane C
AT Still Research Institute, AT Still University, Kirksville, MO, USA.
Department of Osteopathic Manipulative Medicine, Kirksville College of Osteopathic Medicine, Kirksville, MO, USA.
Osteopath Med Prim Care. 2009 Apr 14;3:4. doi: 10.1186/1750-4732-3-4.
Osteopathic manipulative medicine texts and educators advocate a range of approaches for physical assessment and treatment, but little is known about their use by osteopathic physicians in the United States.
A web-based survey using a 5-point Likert scale was developed and e-mailed to 777 practicing osteopathic physician members of the American Academy of Osteopathy. Responses in the "frequently" and "always" categories were combined for reporting purposes. Friedman tests were used to analyze the reported usage of each item. The effect of gender was analyzed using Mann-Whitney tests.
One hundred seventy-one osteopathic physicians completed the survey (22%). For the assessment of spinal somatic dysfunction, paraspinal tissue texture (98%), transverse process asymmetry (89%), and tenderness (85%) were most commonly reported. Myofascial release (78%), soft tissue technique (77%), and patient self-stretches (71%) were most commonly used for treatment of the spine. For assessment of pelvic landmark asymmetry, the anterior superior iliac spine (ASIS, 87%), sacral base (82%), posterior superior iliac spine (81%), sacral sulci (78%), iliac crests (77%), and inferior lateral angle of the sacrum (74%) were commonly palpated. For assessment of sacroiliac joint motion, ASIS compression (68%) was most commonly used. Sacroiliac pain provocation tests were also employed although their use was less common than asymmetry or motion tests. Muscle energy (70%), myofascial release (67%), patient self-stretches (66%), osteopathy in the cranial field (59%), muscle strengthening exercises (58%), soft tissue technique (58%), and articulatory technique (53%) were most commonly used for treatment of the pelvis and sacroiliac. The effect of gender was significant for many of the treatment procedures, with females using more soft tissue and muscle energy and males more high-velocity techniques. The majority of respondents document the types of osteopathic manipulative techniques used (83%), document somatic dysfunction with Fryette nomenclature (64%), and bill for osteopathic manipulative treatment (92%).
Respondents reported the use of a broad range of assessment and treatment approaches. Results suggest a higher use of myofascial release and cranial technique and lower use of high-velocity techniques in this group of physicians compared to previous studies.
整骨疗法医学教材和教育工作者倡导一系列用于体格检查和治疗的方法，但对于美国整骨疗法医生对这些方法的使用情况知之甚少。
设计了一项基于网络的调查，采用5级李克特量表，通过电子邮件发送给美国整骨疗法学会的777名执业整骨疗法医生会员。为便于报告，将“经常”和“总是”类别的回答合并。采用弗里德曼检验分析每个项目的报告使用情况。使用曼-惠特尼检验分析性别因素的影响。
171名整骨疗法医生完成了调查（22%）。对于脊柱躯体功能障碍的评估，最常报告的是椎旁组织质地（98%）、横突不对称（89%）和压痛（85%）。肌筋膜松解术（78%）、软组织技术（77%）和患者自我拉伸（71%）是治疗脊柱最常用的方法。对于骨盆标志不对称的评估，常触诊的部位有髂前上棘（ASIS，87%）、骶骨基部（82%）、髂后上棘（81%）、骶骨沟（78%）、髂嵴（77%）和骶骨下外侧角（74%）。对于骶髂关节活动度的评估，最常用的是ASIS挤压法（68%）。也采用了骶髂关节疼痛激发试验，但其使用频率低于不对称或活动度试验。肌肉能量技术（70%）、肌筋膜松解术（67%）、患者自我拉伸（66%）、颅部整骨疗法（59%）、肌肉强化锻炼（58%）、软组织技术（58%）和关节松动技术（53%）是治疗骨盆和骶髂关节最常用的方法。许多治疗程序的性别影响显著，女性更多使用软组织和肌肉能量技术，男性更多使用高速技术。大多数受访者记录了所使用的整骨手法技术类型（83%），使用弗莱耶特命名法记录躯体功能障碍（64%），并开具整骨手法治疗账单（92%）。
受访者报告使用了广泛的评估和治疗方法。结果表明，与先前的研究相比，该组医生中肌筋膜松解术和颅部技术的使用频率较高，高速技术的使用频率较低。
