Campbell University School of Osteopathic Medicine, Buies Creek, NC, USA.
J Osteopath Med. 2021 Mar 1;121(3):265-270. doi: 10.1515/jom-2020-0120.
Despite the documented effectiveness of high-velocity, low-amplitude (HVLA) treatment of the cervical spine, concerns about patient safety potentially limit didactic instruction and use in clinical practice. Understanding how cervical HVLA is taught and employed is of interest to osteopathic educators and clinicians.
To characterize the perspectives of osteopathic manipulative medicine/osteopathic principles and practices (OMM/OPP) departments within colleges of osteopathic medicine (COMs) in the US regarding patterns of teaching and practice of HVLA treatment of the cervical spine.
A questionnaire was distributed on April 11, 2019 in paper format to OMM/OPP department chairs or designated faculty member attendees at the Educational Council on Osteopathic Principles biannual meeting. If the department chair was not available, the survey was provided to the faculty member designated to represent the Chair of the institution at ECOP. All respondents in this category returned the survey in paper before they left the meeting. The OMM/OPP department chairs who did not attend or send representatives to the ECOP meeting were sent the survey by email on April 11, 2019 and given three opportunities over 6 weeks at 2-week intervals to reply to this voluntary online survey. The survey was given or sent to a total of 51 OMM/OPP department chairs or representatives. Six questions elicited demographic information pertaining to status, age, gender, ethnicity, board-certified specialty, and COM affiliation. Nine questions examined perspectives related to the instruction of cervical HVLA manipulation and treatment.
Of the 51 OMM/OPP department chairs surveyed, 38 (74.5%) responded, 32 to the paper survey at the ECOP meeting and six to the digital survey. Respondents were primarily dual Board-certified in Family Medicine and Neuromuscular Medicine (55.3%). At over 90% (35) of the COMs for which department chairs responded to the survey, cervical HVLA instruction occurs in the curriculum primarily during program years 1 and 2. Instruction in cervical HVLA to the 2nd through 7th cervical vertebral levels occurred in 97% (37), while 11% (4) of the COMs excluded the occipital-atlanto (OA) and atlanto-axial (AA) joints. A high percentage (81.6%; 31) of the OMM/OPP department chairs or representatives reported employing cervical HVLA techniques within their practice. Among the respondents, 40.5% (15) reported that 0-25% of their school's medical school class could perform cervical HVLA competently upon graduation, whereas 27% (10) said that 51-75% of their class could perform cervical HVLA.
A majority of COMs provide education in their curricula related to cervical HVLA primarily in the first 2 years of medical education. However, instruction often excludes cervical HVLA to the upper regions of the cervical spine. At COMs where HVLA to the cervical spine is not taught, that decision is because the techniques are thought to be too difficult and the attendant medicolegal risk perceived to be too high. OMM/OPP department chairs expressed confidence in only a small proportion of their graduates having the ability to competently apply HVLA to the cervical spine immediately after completing their predoctoral medical training.
尽管高速度、低振幅（HVLA）颈椎治疗已被证明有效，但患者安全方面的担忧可能限制了理论教学和临床实践中的应用。了解如何教授和应用颈椎 HVLA 是骨疗教育者和临床医生感兴趣的问题。
描述美国骨疗医学院（COMs）中的骨疗手法医学/骨疗原则和实践（OMM/OPP）系在教授和实践颈椎 HVLA 治疗方面的模式。
2019 年 4 月 11 日，以纸质形式向 OMM/OPP 系主任或参加教育理事会骨疗原则双年会的指定教员分发问卷。如果系主任无法参加，将向指定代表机构参加 ECOP 的教员提供该调查。所有参加本次会议的受访者都在离开会议前以纸质形式返回了调查问卷。没有参加或没有派代表参加 ECOP 会议的 OMM/OPP 系主任于 2019 年 4 月 11 日通过电子邮件收到了调查，并在 6 周内分 3 次机会回复了这一自愿在线调查。共向 51 名 OMM/OPP 系主任或代表发送或寄发了调查。6 个问题收集了与地位、年龄、性别、族裔、认证专业和 COM 隶属关系有关的人口统计信息。9 个问题调查了与颈椎 HVLA 操作和治疗教学相关的观点。
在接受调查的 51 名 OMM/OPP 系主任中，有 38 名（74.5%）做出了回应，其中 32 名在 ECOP 会议上以纸质形式回复，6 名以数字形式回复。受访者主要是家庭医学和神经肌肉医学的双重认证（55.3%）。在系主任对调查做出回应的超过 90%（35）的 COM 中，颈椎 HVLA 教学主要在课程的第 1 年和第 2 年进行。97%（37）的 COM 教授第 2 至第 7 颈椎的 HVLA，而 11%（4）的 COM 排除枕骨-寰枢（OA）和寰枢（AA）关节。81.6%（31）的 OMM/OPP 系主任或代表报告在其实践中使用颈椎 HVLA 技术。在受访者中，40.5%（15）报告说，他们学校的医学生中，只有 0-25%的人在毕业后能够胜任颈椎 HVLA，而 27%（10）的人说，他们学校有 51-75%的人能够胜任颈椎 HVLA。
大多数 COM 在其课程中提供与颈椎 HVLA 相关的教育，主要在医学教育的前 2 年进行。然而，教学通常不包括颈椎 HVLA 到颈椎的上部区域。在不教授颈椎 HVLA 的 COM 中，这一决定是因为认为这些技术太难，而且认为相关的医疗法律风险太高。OMM/OPP 系主任对只有一小部分毕业生在完成预科医学培训后立即有能力熟练地将 HVLA 应用于颈椎表示信心。
