Heath Deborah M, Makin Inder Raj S, Pedapati Chandhana, Kirsch Jonathon
From the A.T. Still University-School of Osteopathic Medicine in Arizona (Mesa).
From the A.T. Still University-School of Osteopathic Medicine in Arizona (Mesa)
J Am Osteopath Assoc. 2014 Dec;114(12):918-29. doi: 10.7556/jaoa.2014.179.
The first 2 years of osteopathic medical school involve training in osteopathic principles and practice, including understanding the tenets of osteopathic medicine and developing palpatory skills for clinical application. Although this training emphasizes the link between somatic dysfunction and physiologic function, it does not include the opportunity for students to quantitatively assess the physiologic effect of osteopathic manipulative treatment (OMT) using physiologic measurements.
To evaluate an approach for integrated OMT training coupled with physiologic measurements of relevant parameters, whereby first-year osteopathic medical students assess the quantitative, real-time changes in specific physiologic signals during instruction.
During mandatory musculoskeletal and cardiovascular demonstration laboratories at a single osteopathic medical school, students were divided into small groups and performed OMT on each other while recording real-time measurements of physiologic functions such as maximum clench force, time to fatigue for the forearm flexor muscles, heart rate, and peripheral vascular flow. After data were collected, students analyzed pre- and post-OMT measurements and discussed underlying physiologic principles in a large group format. At the end of the sessions, students completed a brief survey on the usefulness of the integrated laboratories.
Overall, 13 of 28 student groups (46.4%) measured a pre- to post-OMT increase in maximum clench force, and 16 (57.1%) observed an increase in time to fatigue for the forearm flexor muscles. Twenty-three of 27 student groups (85.2%) observed a reduction in heart rate and 19 (70.4%) measured an increase in peripheral vascular flow after OMT. Student satisfaction was generally favorable, with overall mean (SD) ratings of 6.38 (1.86) for the musculoskeletal laboratory and 7.81 (1.69) for the cardiovascular laboratory out of a maximum of 10 points. In open-ended comments, students deemed the combined laboratories as clinically applicable but desired more time for completing the laboratories.
Measurement of specific physiologic musculoskeletal and cardiovascular parameters before and after OMT enabled quantification of physiologic responses to OMT. Students' favorable feedback indicated that the quality of learning in the laboratories was enhanced by the addition of physiologic measurements.
整骨医学院的前两年涉及整骨疗法原理与实践的培训，包括理解整骨医学的宗旨以及培养用于临床应用的触诊技能。尽管该培训强调躯体功能障碍与生理功能之间的联系，但并未为学生提供使用生理测量方法来定量评估整骨手法治疗（OMT）生理效果的机会。
评估一种将OMT培训与相关参数的生理测量相结合的方法，通过这种方法，整骨医学院一年级学生在培训过程中评估特定生理信号的定量实时变化。
在一所整骨医学院的强制性肌肉骨骼和心血管示范实验室中，学生被分成小组，互相进行OMT，同时记录生理功能的实时测量数据，如最大握力、前臂屈肌疲劳时间、心率和外周血管流量。收集数据后，学生分析OMT前后的测量结果，并以大组形式讨论潜在的生理原理。课程结束时，学生完成了一份关于综合实验室实用性的简短调查问卷。
总体而言，28个学生小组中有13个（46.4%）测量到OMT后最大握力增加，16个（57.1%）观察到前臂屈肌疲劳时间增加。27个学生小组中有23个（85.2%）观察到OMT后心率降低，19个（70.4%）测量到外周血管流量增加。学生满意度普遍较高，肌肉骨骼实验室的总体平均（标准差）评分为6.38（1.86）分，心血管实验室为7.81（1.69）分（满分10分）。在开放性评论中，学生认为综合实验室具有临床实用性，但希望有更多时间来完成实验室操作。
OMT前后对特定生理肌肉骨骼和心血管参数的测量能够量化对OMT的生理反应。学生的积极反馈表明，增加生理测量提高了实验室的学习质量。
