Osteopathy Palpation

L'arte dello stare bene: l'armoniosa danza tra il Corpo, la Mente e lo Spirito-La salute nella storia e nella cultura- di Fabio Peruzzi, recentemente pubblicata sulla Rivista culturale che  abbraccia diverse prospettive è un contributo importante per ogni sincero ricercatore dell'Armonia nel solco della Tradizione.
“La salute è il più grande possesso. La contentezza è il più grande tesoro.”
Lao Tzu, Tao Te Ching

Enactivism is a philosophical and scientific approach that emphasizes the role of the body and its interactions with the environment in shaping cognitive processes and subjective experiences. Meanwhile, osteopathy is a person-centered health care discipline, highlighting the structure-function interrelationship of the body and its selfregulation mechanisms. Both approaches value the body and the environment in health. Several authors have been discussing the urgent need for a reconceptualization of osteopathy and also suggesting integrate biological, psychological and social aspects. Thinking osteopathy as a Therapeutic Rationality, implies recognize its fundamental dimensions: Human Morphology, Vital Dynamics, Medical Doctrine, Diagnostic System and Therapeutic System, all integrated by a philosophical Cosmology, as the original term Medical rationality states, but also embrace a broader perspective allowing an individual and unique process of each person, reflecting the transformation of contemporary medicine to a person approach. Enactivism principles can serve as a basis for a reconceptualization of osteopathy, integrating environmental, psychological, social, and spiritual factors. Osteopathic concepts can probably be updated through the convergence between enactivism and osteopathy, promoting more meaningful and evidence-based clinical practice. Advancing in this direction requires a collaborative dialogue between researchers, health professionals and interested people, seeking an integrated understanding of the relationship between body, mind, environment and health.

Osteopathy is categorized as complementary and alternative medicine. It is a profession which is present in most countries, with a variety of practices and regulations. While it is sometimes integrated within other disciplines of manual therapy, such as physiotherapy, unlike the latter, osteopathy continues to be based on philosophical principles that shape its identity, anchoring it to the 19th century. However, these osteopathic tenets do not meet the criteria of representativeness and truthfulness and thus, cannot coexist with a science-based medical practice. This commentary analyzes the underlying theoretical principles that dictate osteopathic care, its deficiencies and weaknesses and why they might place osteopathy in the realm of pseudoscience.

" in the December 1999 issue. We generally found the work of interest and quite commendable, with one exception. In the article, the authors indicate that they measured force via a dynamometer, reporting these values as being measured at a location "just proximal" to various bony landmarks or joints. As it is well known that the measured forces vary as a function of the distance of the forcemeasuring device from the axis joint rotation, the method-and meaningfulness for others-would be more appropriate if the precise distance were recorded and the torque calculated. The fact that the height of the subjects varied from 153 to 192 cm ensures that the distances were different. Thus, in works such as this and the normative data published by Andrews et al, 1 clinicians and investigators should record the force and the perpendicular distance to the joint axis and calculate torque, preferably in units of newtonmeters. Unless torque is measured, comparability across patients is not possible because the same joint torque is measured by dynamometry at different locations, yielding entirely different force values. Using something other than torque data does not meet the measurement standards we need in our practice.

Background: There is a lack of evidence to support a correspondence between osteopathic palpation and anatomical findings. The concept of dysfunction could be defined using more accurate words when describing palpatory findings if they could be explained by objective measurements. The forearm Interosseous Membrane (IOM) is a fascia often evaluated by osteopaths, searching for Fascial Dysfunction (FD). We measured IOM physical characteristics, such as elasticity and thickness, with ultrasound (US) and then compared it with osteopaths' FD assessment. Methods: Healthy subjects were recruited and their forearms were marked every centimeter. At every mark, 3 registered osteopaths assessed the potential FD (none, moderate or strong). Assessments were compared to the IOM elasticity and thickness measured by US. A mixed effect model was used to analyse the link between thickness and FD and a chi-2 test for the link between elasticity and FD. Result: 41 subjects were included. Mean age was 28.1, 46% were men. The average IOM length was 13.0 cm (±1.5), the average thickness was 1.29 (±0.41). The mixed model found a strong correlation between the grade of FD and the IOM thickness for all three osteopaths (p < 0.01). Moreover, correlations were found between thickness and elasticity of the IOM (p < 0.001). Conclusion: Manual evaluation of FD seems to be correlated to physical properties of the IOM. Our results suggest that the forearm IOM is thicker at FD locations. This study needs replications on several anatomical areas and on the IOM of symptomatic subjects to confirm these findings. Moreover, research could focus on tissue changes after osteopathic treatment.

Background: Palpation constitutes a central element of osteopathic diagnosis and therapy. It is a complex tactile performance and as such also depends on cognitive factors. References by experienced osteopaths (EOs) suggest that the ability to visualise anatomical structures is essential during palpation. Scientific studies in this field can hardly be found. This study aimed to systematically determine what role mental imagery (MI) plays for osteopaths and especially what the benefits are when it is used spontaneously and deliberately. Material and Methods: The present study is a qualitative study. Nine interviews with EOs were carried out with the help of an interview guideline and analysed using a qualitative analysis of content using the software MAXQDA. Results: All EOs regarded MI as a tool as well as an interfering factor for palpation. Its supporting role was associated with the identification, recognition and comparing of anatomical conditions, with directing attention, with navigation and orientation. The limiting character showed up in distraction and deception by mental images. The results also revealed the situational use of MI as well as different mental images and influencing factors (e.g. visualisation training). Discussion: The study provides an insight into the application knowledge of EOs and shows some aspects of palpation, which have been subject to little research so far. Being aware of and understanding the role of MI as a top-down process in tactile-haptic perception should change the focus in palpation. The findings can be incorporated in daily practice as well as in the training system. To regard MI as a possible bias can lead to reassessment and realignment of reliability studies. This study offers a basis for other studies to work from to explore the nature of MI in the tactile-haptic perception of osteopaths.

Over the years, several authors have discussed the possibility of considering somatic dysfunction (SD) as a “nosological element” detectable on palpation. There are many aspects to consider regarding the etiology and diagnosis of SD, and the literature on osteopathic issues provides details on physiological signs that characterize it, including tissue texture changes. Recent knowledge suggests that how tissue and, in particular, connective tissue, responds to osteopathic treatment may depend on the modulation of the inflammation degree. Low-grade inflammation (LGI) may act on the extracellular matrix (ECM) and on cellular elements; and these mechanisms may be mediated by biological water. With its molecules organized in structures called exclusion zones (EZ), water could explain the functioning of both healthy and injured tissues, and how they can respond to osteopathic treatment with possible EZ normalization as a result. The relationship between inflammation and DS and the mechani...

Background: Palpatory findings are considered a central element of osteopathic practice, especially when associated with a patient’s altered regulative functions than with named somatic dysfunctions. Although osteopathic theories for somatic dysfunction could be plausible, the clinical applicability of the concept is debated, especially because it is largely related to simple cause–effect models of osteopathic care. In contrast to a linear kind of diagnosis of a “tissue as a producer of symptoms”, this perspective article aims to provide a conceptual and operational framework in which the somatic dysfunction evaluation process is seen as a neuroaesthetic (en)active encounter between osteopath and patient. Subsections relevant to the subject: To summarize all concepts of the hypothesis, the enactive neuroaesthetics principles are proposed as a critical foundation for the osteopathic assessment and treatment of the person, specifically addressing a new paradigm for somatic dysfunction...

The goal of this brief article is to accomplish two simple things. First, introduce a type of palpation adapted from the osteopathic world to serve the practice of acupuncture. While simple and easy to practice, it does take some time to become proficient at this technique. After practicing it for over ten years, I believe I have achieved a modicum of proficiency; enough in any case to present it to the audience of the NAJOM which is well versed in various palpatory techniques. After a brief description of the background to this technique and going over how to practice it, I would like to both talk about some clinical ramifications and use some of my findings utilizing it to look at some of meridian therapy's basic assumptions from a slightly different perspective.

The goal of this brief article is to accomplish two simple things. First, introduce a type of palpation adapted from the osteopathic world to serve the practice of acupuncture. While simple and easy to practice, it does take some time to become proficient at this technique. After practicing it for over ten years, I believe I have achieved a modicum of proficiency; enough in any case to present it to the audience of the NAJOM which is well versed in various palpatory techniques. After a brief description of the background to this technique and going over how to practice it, I would like to both talk about some clinical ramifications and use some of my findings utilizing it to look at some of meridian therapy's basic assumptions from a slightly different perspective.

Objective: The purpose of this study was to compare the posterior superior iliac spine (PSIS) and the iliac crest as accurate anatomical landmarks for identifying spinal level. Methods: This study was conducted in 2 stages. First, 4 examiners examined 60 patients and blindly identified iliac crest and PSIS levels, and the interexaminer reliability of PSIS and iliac crest palpation were then analyzed. Second, 4 examiners attached a radio opaque marker at presumed PSIS and iliac crest levels in 72 patients, and posteroanterior lumbar radiographs were then taken. Four examiners then confirmed PSIS and iliac crest levels after radiographically identifying the marker levels and checked the spinal level at which the spinous process or interspace was crossed by drawing a horizontal line drawn between radio opaque markers. Results: The interexaminer reliability of palpation was significantly greater for PSIS level than for the iliac crest (P b .05). Spinal levels of estimated PSISs identified by palpation ranged from the L5-S1 interspace to the S2 spinous process, and the spinal levels of estimated iliac crest ranged from the L2-3 interspace to the L5 spinous process. Conclusions: Although PSIS palpation showed statistically higher interexaminer reliability than iliac crest level, clinicians should be cautious when applying this method as a measurement tool because estimated spinal level by palpation can be influenced inadvertently by examiner skill and anatomical variations.

Background: Palpation constitutes a central element of osteopathic diagnosis and therapy. It is a complex tactile performance and as such also depends on cognitive factors. References by experienced osteopaths (EOs) suggest that the ability to visualise anatomical structures is essential during palpation. Scientific studies in this field can hardly be found. This study aimed to systematically determine what role mental imagery (MI) plays for osteopaths and especially what the benefits are when it is used spontaneously and deliberately. Material and Methods: The present study is a qualitative study. Nine interviews with EOs were carried out with the help of an interview guideline and analysed using a qualitative analysis of content using the software MAXQDA. Results: All EOs regarded MI as a tool as well as an interfering factor for palpation. Its supporting role was associated with the identification, recognition and comparing of anatomical conditions, with directing attention, with...

Objective: To determine if the physiological limits of human palpation influence traditional examination procedures. Methods: In this study, the threshold at which a change in spinal stiffness was detected was quantified in 12 experienced clinicians by changing the differential stiffness in two inflatable targets until the clinician could no longer identify which was stiffer. In the second part of the study, clinicians were then asked to palpate pre-identified pairs of vertebrae in an asymptomatic volunteer and to identify the stiffer of the pair (T7&L3, T7&L4, L3&L4) while the biomechanical stiffness of each vertebral pair was quantified objectively by a validated instrument. Results: The mean stiffness detection threshold for the clinicians was 8%. Objective measurement of the stiffness differential between vertebral pairs was 30% for T7* & L3 and 20% for T7* & L4 and 10% for L3* & L4 (*denotes the stiffer of the pair). Ten of 12 clinicians correctly identified T7 as more stiff when compared to L3 and T7 as more stiff than L4. Alternatively, when the differential vertebral pair stiffness was similar to the stiffness detection threshold (~8%), clinicians were less successful in identifying the stiffer vertebra of the pair; 4/12 clinicians correctly identified L3 as being more stiff compared to L4. Conclusion: These results suggest that the physiological limits of human palpation may limit the ability of clinicians to identify small alterations in spine stiffness.

There are numerous approaches to hands-on treatment used by the manual therapy professions. In osteopathy, manual manipulative techniques are often broadly defined by the terms ‘direct’ and ‘indirect’. Direct technique refers to the application of external force to engage a restrictive barrier and includes mobilisation with impulse technique, MET, articulation and soft tissue massage. In contrast, indirect techniques, such as functional technique, strain-counterstrain and facilitated positional release, are generally unconcerned with restrictive tissue barriers and attempt to bring about change via reflexive somatic responses.

Osteopathy is a discipline of healthcare that calls for systemic handling of patients. Osteopathy research has struggled to provide proof of the effectiveness of this practice. We think that osteopathy research needs to evolve in order to find a methodology that would allow it to account for its specificities and originality. This article notes the contribution of the philosophy of emergence in the elaboration of an epistemology suited to osteopathy as the precondition for a rationality adapted to the singular nature of this form of therapy.

Osteopathy is a discipline of healthcare that calls for systemic handling of patients. Osteopathy research has struggled to provide proof of the effectiveness of this practice. We think that osteopathy research needs to evolve in order to find a methodology that would allow it to account for its specificities and originality. This article notes the contribution of the philosophy of emergence in the elaboration of an epistemology suited to osteopathy as the precondition for a rationality adapted to the singular nature of this form of therapy.

The widespread use of the biopsychosocial model amongst various health professions, all of which claim to take a patient-centred approach to their practise, challenges what has been considered a unique and defining feature of osteopathy. This paper discusses the complexity of what is meant by patient-centeredness, and how it is practised and researched by other health professions. The assumption that osteopathy has always taken a patient-centred approach is questioned, and directions for further research are highlighted so that the profession can have a comprehensive working knowledge of its practise, thereby helping to define itself within the broad and competitive healthcare environment.

L’ostéopathie est une pratique soignante prenant en compte les éléments visibles et invisibles du corps et du langage. Elle constitue un trait d’union entre les dimensions du corps physique et du corps subjectif, ressenti par chacun. Auprès du nouveau-né, elle prend appui sur un contact précoce avec celui-ci, pour construire avec lui et ses parents une relation de soins fondée sur la confiance.
Le texte complet de cet article est disponible en PDF.

Mots clés : corps, langage, nouveau-né, ostéopathie, soin


Plan
Contact précoce avec le nouveau-né
Disponibilité du professionnel
Perceptions
Conditions de la rencontre
L’ostéopathie, à l’interface entre le visible et l’invisible
Conclusion
Déclaration de liens d’intérêts

American College of Osteopathic Family Physicians smart phone app DO REFLEXES provides a reference for diagnostic neuromuscular reflexes of visceral origin.
    How to obtain this information: DO Reflexes was an Apple platform app available through the American College of Osteopathic Family Physicians. It is no longer available. The content, however, is available in: Viscerosomatic and somatovisceral reflexes, Nelson, Allgeier. chapt. 7. In: Nelson, Glonek, eds. 2nd edition,, Somatic Dysfunction in Osteopathic Family Medicine. Baltimore, MD: Wolters Kluwer / Lippincott, Williams & Wilkins; 2014:50-70.

INTRODUCTION: The term Cerebrovascular accident (CVA) describes all of the clinical consequences emerging from a cerebral vessels lesion, whether there is one or more affected. The patient can experiment a diversity of problems in those functions: motricity, sensory, cognitive, communication or urinary. He could feel emotional unease and experience diverse symptoms like fatigue. Data from 2015 indicated that CVA was the second cause of mortality in the world. The trends of the absolute numbers regarding the incidence and the prevalence of CVA are going to potentially increase during the next thirty years in the world, Canada and Quebec.
Thanks to numerous researches a health continuum and rehabilitation program have been created on a medical level. Osteopathy does not belong to the continuum in the three countries from which came the participants: Canada, England and France. Even if the continuum allows for patient's management care, new researches are still broadening the field of knowledge, notably on how the brain works, neuroplasticity, recovery mechanisms and rehabilitation methods. Those researches allowed to challenge the myth of the immutable brain bringing out the knowledge on neuroplasticity and the myth of the six months delay on post CVA recovery.
METHODS: This study subscribes in the constructive paradigm in qualitative research. The design is a focussed ethnography. The chosen sampling method was non probabilistic and the sampling type was done by networking. Population was constituted of two groups: patients and osteopaths. Six patients and seven osteopaths (6 DO and 1 IO) were recruited. Osteopaths-participants came from three different countries as to where they were trained and where they practiced. The patients-participants were all Canadians. Semi-directed interviews permitted to collect data which was analyzed according to the analysis method by writing. Numerous strategies were put in place to reach a certain methodology rigour: verification of the collecting data tools, triangulation, peer debriefing, saturation, additional training of the researcher and logbook.
RESULTS: Results were articulated in four axes: protagonists (patient and osteopath) and their exchanges (uni-directional exchanges like advices and bi- directional like the protagonist’s synergy) ; approaches, clinical principles, specificity and utility of osteopathy ; the therapeutic component (and especially the results) osteopathic intervention and the factors influencing this intervention.
DISCUSSION AND CONCLUSION: Data originating from the participants was a lot richer than data coming from the collected literature. This present study carries strength like the strategy used to reach a certain methodology rigour, bilingualism, country diversity in training and practice (3 countries) for the osteopath-participants and additional training undertook by the researcher. Weaknesses are in relation with the data collecting tool, the origin of the patients-participants (only Canada) and a
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bias of social desirability which was controlled. Given the state of current knowledge and this study results, it seems appropriate to perform new qualitative and quantitative studies on the osteopathic intervention in a CVA context.
To conclude, the osteopathic intervention in a CVA context is complex. It articulates around the patient and the osteopath. Various elements like personal experience, attitudes, beliefs, patient and osteopath perceptions are all important factors influencing the osteopathic intervention and its results.
Keywords : Cerebrovascular accident, osteopathic intervention, personal experience, patients, osteopaths, brain, neuroplasticity, qualitative study, focussed ethnography.

Abnormal uterine bleeding is characterized by painful and/or excessive menor-rhea, chronic pelvic pain due to the endometriosis (Em). Osteopathic treatment is commonly used in the gynecological dysfunctions. The aim of the present case study was to explore the effect of osteopathic treatment (OT) for a woman with abnormal uterine bleeding related pain

Background: With the development of increasing evidence for the use of manipulation in the management of musculoskeletal conditions, there is growing interest in identifying the appropriate indications for care. Recently, attempts have been made to develop clinical prediction rules, however the validity of these clinical prediction rules remains unclear and their impact on care delivery has yet to be established. The current study was designed to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation. Methods: Structured searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand searches of archives, to identify studies of the diagnostic reliability and validity of common methods used to identify the site of treatment application. To be included, studies were to present original data from studies of human subjects and be designed to address the region or location of care delivery. Only English language manuscripts from peer-reviewed journals were included. The quality of evidence was ranked using QUADAS for validity and QAREL for reliability, as appropriate. Data were extracted and synthesized, and were evaluated in terms of strength of evidence and the degree to which the evidence was favourable for clinical use of the method under investigation.

The tissue origin of low back pain (LBP) or referred lower extremity symptoms (LES) may be identified in about 70% of cases using advanced imaging, discography and facet or sacroiliac joint blocks. These techniques are invasive and availability varies. A clinical examination is non-invasive and widely available but its validity is questioned. Diagnostic studies usually examine single tests in relation to single reference standards, yet in clinical practice, clinicians use multiple tests and select from a range of possible diagnoses. There is a need for studies that evaluate the diagnostic performance of clinical diagnoses against available reference standards. We compared blinded clinical diagnoses with diagnoses based on available reference standards for known causes of LBP or LES such as discography, facet, sacroiliac or hip joint blocks, epidurals injections, advanced imaging studies or any combination of these tests. A prospective, blinded validity design was employed. Physiothe...

Appendix : A review of literature on the osteopathic profession, osteopathic practice and osteopathic regulation in the UK Appendix 2: A review of literature on professions, health professional regulation, revalidation and continuing fitness to practise Appendix 3: Survey questionnaire Appendix 4: Survey results

Gastrointestinal tract dysfunction such as Irritable Bowel Syndrome (IBS) is one of the most common intestinal complaints that prompts an individual to consult a doctor. However, ambiguities in defining it and slow accumulation of evidence on the benefits of treatment have made this syndrome notoriously difficult to diagnose and treat. Our goal has been to prepare a text that provide an overview of IBS and the main concepts and practice of osteopathy and nutrition. The result is a book, which presents IBS management using OMT, dietary modifications, and nutritional supplements according to current evidence-based literature. We have also added some appendices on practical applications which might then serve as a simple treatment plan for a broad range of healthcare professionals including osteopaths, physiotherapists, manual therapists, sports science graduates, massage and bodywork therapists and nutritionists, to reduce the chronic pain and inflammation that are associated with IBS.

avoid direct painful contraction of a muscle that requires lengthening, such as in the case of piriformis, but there is little published research into these techniques, their relative effectiveness or therapeutic comfort. Design: A randomised controlled trial was performed on 30 asymptomatic male subjects, who were randomly allocated into one of 2 groups (PIR and RI) each of 15 subjects. The study was designed to establish any significant change in hip internal rotation range of movement following application of either PIR or RI muscle energy technique compared to control. Comparative outcome differences between the techniques were also assessed. Methods: One group received a post-isometric relaxation muscle energy technique, the other received a reciprocal inhibition muscle energy technique, both involving subsequent stretch to piriformis. Internal rotation of the hip was measured at 3 stages: control prior to treatment, after a sham treatment, and after the relevant intervention. Prone position was used throughout, and the measurements taken using a digital handheld inclinometer applied to the tibia. The data was analysed using Graphpad Prism 4 software; intra-group results were treated as one-way ANOVA comparisons of range of motion (control vs sham vs intervention), and inter-group results were treated as unpaired t tests comparing range of motion and change in range of motion. Results: Significant increases were found within both groups when comparing range of motion before and after treatment (P<0.0001). When comparing the groups, no significant differences were found either in range of motion, or change in range of motion after treatment. Conclusion: The study found that both techniques resulted in statistically and clinically significant increases in internal rotation range of motion of the hip, but found no statistical or clinically significant difference between the techniques. A larger study would be required to establish the strength of this finding.

Introduction: The sacral positional test consists in palpating the inferior and lateral angles of the sacrum and deepness of the sacral sulcus. The goal of the test is to determine the position of the sacrum between the innominate bones. The sacral positional test offers poor inter-examiner reliability. The reliability of the palpation of the sulcus and of the angle is poor to fair . If the training improves reliability, it is not sufficient enough to make it a reliable test. However, recent studies show that osteopaths include this test in their routine clinic exam . The purpose of this study is to make a precise review of the thickness of the tissue layers palpated which cover the posterior face of the sacrum. Materials and methods: Our review screened 2 databases (Pubmed and Springer) and French and Anglophones osteopathic publications, on a period from 1990 to 2013. The search was mainly based on these keywords: thickness, subcutaneous fat, sacral skin, gluteus maximus, erector ...

M uscle energy technique (MET) is a common conservative treatment for pathology around the spine, particularly lumbopelvic pain (LPP). MET is considered a gentle manual therapy for restricted motion of the spine and extremities 1 and is an active technique where the patient, not the clinician, controls the corrective force 2 . This treatment requires the patient to perform voluntary muscle contractions of varying intensity, in a precise direction, while the clinician applies a counterforce not allowing movement to occur 2 . For many years, MET has been advocated to treat muscle imbalances of the lumbopelvic region such as pelvis asymmetry. The theory behind MET suggests that the technique is used to correct an asymmetry by targeting a contraction of the hamstring or the hip flexors on the painful side of the low back and moving the innominate in a corrected direction. It is worth noting however, that evidence suggests that nonsymptomatic individuals have also been shown to have pelvis asymmetries. Despite this, MET is frequently used by manual therapy clinicians.

One house staff member accounted for the majority of house staff patient admissions that did not have an osteopathic examination in the postintervention data. If these admissions were excluded from analysis, the percentage of patients receiving an osteopathic examination would be 96.5 (82 of 85 patients). † Statistical significance cannot be determined because 0% cannot be used as a baseline measurement.

Objective: Poor reproducibility of spinal palpation has been reported in previously published literature, and authors of recent reviews have posted criticism on study quality. This article critically analyzes the literature pertaining to the interand intraobserver reproducibility of spinal palpation to investigate the consistency of study results and assess the level of evidence for reproducibility.

Objective: Poor reproducibility of spinal palpation has been reported in previously published literature, and authors of recent reviews have posted criticism on study quality. This article critically analyzes the literature pertaining to the interand intraobserver reproducibility of spinal palpation to investigate the consistency of study results and assess the level of evidence for reproducibility.

Workplace-based assessment is commonplace, particularly in medicine. These assessments typically involve the assessment of a student conducting a consultation, or part thereof, on a real patient in an authentic clinical practice setting. In disciplines such as medicine substantial work has been directed towards the evaluation of the processes and tools used to perform these assessments and understand their educational impact. At present, there is little literature on the tools used for workplace-based assessment in osteopathy yet they form a picture of the student’s capability. The current study presents data from a new workplace-based assessment tool for osteopathy, the mini Clinical Examination (mini-CEX) and is used to inform the implementation of the mini-CEX more broadly. Data presented here suggest the mini-CEX in this cohort is feasible, efficient, acceptable to stakeholders, internally consistent, and can differentiate between students at different stages of an osteopathic teaching program. Further research into the use of the mini-CEX in osteopathy is required, particularly focusing on educational impact, the reliability of the tool and its generalisability to clinical learning environments in other osteopathy teaching institutions.

Stem cell therapy in recent years has gained much attention as the modern therapeutic approach to treat diseases. Mesenchymal stem cells (MSCs) are seen as the most reliable cells applied in therapy over other stem cells because of their versatility. Bone and cartilage diseases (osteo-diseases) are the major target of therapy using MSCs. In this perspective, we have statistically analyzed the data available on clinical trials registry databases regarding the mesenchymal stem cell based therapy for a number of mentioned diseases and paid attention towards the osteodiseases. We report that MSC therapy for osteodiseases needs optimization in its standards to achieve acceptable results so that we can apply it in daily routine clinical practice.

Stem cell therapy in recent years has gained much attention as the modern therapeutic approach to treat diseases. Mesenchymal stem cells (MSCs) are seen as the most reliable cells applied in therapy over other stem cells because of their versatility. Bone and cartilage diseases (osteo-diseases) are the major target of therapy using MSCs. In this perspective, we have statistically analyzed the data available on clinical trials registry databases regarding the mesenchymal stem cell based therapy for a number of mentioned diseases and paid attention towards the osteodiseases. We report that MSC therapy for osteodiseases needs optimization in its standards to achieve acceptable results so that we can apply it in daily routine clinical practice.

Background: The use of palpation to diagnose musculoskeletal dysfunction is commonly taught within osteopathy and other manual therapies. However the clinical tests used to detect sacroiliac joint dysfunction have not shown good reliability. Objectives: To investigate the inter-examiner reliability of osteopaths to detect asymmetries of the posterior superior iliac spine (PSIS), and to determine if inter-examiner reliability was affected by the level of practitioner experience. Methods: Fifteen final year osteopathic students (n Z 15), fifteen third year osteopathic students (n Z 15) and ten experienced osteopaths (n Z 10) manually palpated the levels of the PSIS in one model nine consecutive times. A hidden 5 mm heel wedge was used to alter the height of the PSIS which was hidden from the examiners. Scores were analysed using Fleiss Kappa (Fk) statistics and one way analysis of variance on ranks (ANOVA). Results: All three groups produced Fk results below 0.4 (0.025e0.065), indicating poor interexaminer reliability. Fk values less than 0.4 are considered to be clinically unreliable. ANOVA testing did not show any significant difference between groups. Conclusion: This study showed 'poor' inter-examiner reliability in detecting asymmetries of the PSIS. This is in accordance with other studies in the field. It is suggested that the inclusion of this osteopathic model within osteopathic education should be reviewed. ª