BACKGROUND: Positional plagiocephaly is an asymmetrical flattened skull deformity whose incidence increased significantly in the last decades. Osteopathic treatment has been suggested to tackle early deformational sequences, in order to ensure the correct development of the child. The aim of the study was to assess the effectiveness of osteopathic treatment of positional cranial deformities in infants.
METHODS: Retrospective observational study carried out at the Section of Neonatology and Neonatal Intensive Care Unit of the Department of Interdisciplinary Medicine of University of Bari, Italy in collaboration with a specialized pediatric osteopath.
RESULTS: 424 infants were enrolled. Isolated positional plagiocephaly affected the vast majority of infants (n. 390, 91.98%); 34 patients (8.02%) were diagnosed with positional brachycephaly. Both infant groups (positional plagiocephaly and positional brachycephaly) had a median severity score of 3 (IQR: 3 - 3 and 2 - 3, respectively) and benefited from a median of 3 osteopathic sessions (IQR 3-4 and 2-4, respectively). Higher severity scores of positional asymmetries were significantly more common in preterm neonates (Pearson chi2: 11.58; p-value: 0.021) and in males (Pearson chi2: 10.06; p-value: 0.039).
CONCLUSIONS: Significant improvements in positional cranial deformations of children were obtained after only five osteopathic treatments provided in the first months of life. The osteopathic treatment could positively impact the clinical history of patients with positional plagiocephaly and positional brachycephaly.
CONCLUSIONS: • Positional plagiocephaly is increasingly common among infants and may cause moderate to severe neurodevelopmental adverse effects. • Osteopathic treatment may tackle early deformational sequences, in order to ensure the correct development of the child. • Our study reveals that cranial asymmetry of infants with positional plagiocephaly is significantly reduced after only five osteopathic treatments provided in the first months of life. • Osteopathic treatment should be offered as a first line approach to young infants diagnosed with positional plagiocephaly.

BACKGROUND: and purpose: Little is known about the training and experience of osteopaths who treat paediatric patients, and graduates report feeling unprepared for this aspect of practice. The purpose of this study was to investigate the lived experience of Australian osteopaths who regularly treat these patients, in order to better understand their individual educational pathways and their management of this population.
METHODS: Osteopaths who reported regularly treating paediatric patients were recruited through the Osteopathy Research and Innovation Network (ORION) national practice-based network. Semi-structured interviews were completed, transcribed and thematically analysed using the principles of Descriptive Phenomenology to compile qualitative data.
RESULTS: Ten osteopaths were interviewed, whose age ranged from 33 to 71 years and with 15-46 years of clinical experience. Proportion of paediatric patients ranged from 20 to 90 % of participants\' caseload according to self-report. Seven themes were identified that reflected the lived experience of treating paediatric patients: 1) Variable pathways to practice, 2) Challenges and rewards, 3) Scope of practice, 4) Team-based care, 5) Importance of entry-level skills, 6) Family-centred care, and 7) Success.
CONCLUSIONS: The study found a diversity of educational pathways, that paediatric practice was highly rewarding, the scope of practice was based on diagnostic skills and experience, the practitioners had extensive team-based professional networks, practice reflected a family-centred care model, and personal measures of success were multifactorial. These results give insight into this area of practice to guide further research.

Manual therapists apply physical interventions to the entire structure of the body to promote healing, prevent pathologies, and improve patient health. In osteopathic practice, palpatory evaluation is considered a fundamental clinical practice requirement for identifying somatic dysfunction. Most of the articles published in this area have failed to demonstrate a level of reproducibility that supports palpation in evidence-based clinical practice. When considering the poor reliability of the palpatory tests highlighted in the literature, a discrepancy is noted with what is known about the tactile sensitivity of human hands. For static touch, the minimum size that can be detected, in the absence of applied movement or vibration, is approximately 0.2 mm. Yet, it seems that this high level of precision is insufficient to ensure reliability in the tests used to evaluate osteopathic somatic dysfunction. The purpose that underscores this article is to determine how these two contradictory elements, high sensitivity and low reliability, can be present in palpatory tests. The article reports the literature findings regarding palpatory tests of pelvic, which is an important structure for clinical purposes. Additionally, a critical review of how these studies were conducted is provided to identify any elements that may justify the obtained results. Following recent accredited guidelines present in the literature, we propose suggestions on vision training methods, manual perception refinement training, the search for anatomical markers, and the position of the examiner in relation to the examinee that may be useful for future studies on the topic covered by the article.

UNASSIGNED: At the end of a long definition and legislative process (Law No.3 of 11 January 2018 and DPR No 131 of 2021), started under the thrust of the European directives, with the Decree of the Ministry of Universities and Research of 29 November 2023, in agreement with the Minister of Health, osteopathy in Italy has become a healthcare profession in all respects.
UNASSIGNED: In order to understand the current legislative and professional position of the Osteopath, research of the original definitions and the history of the profession has been carried out, assessing an overview of the current situations among EU countries. Therefore, an analysis of the current Italian legislation has been carried out in a medical-legal key, with a critical eye aimed above all at assessing the current shortcomings.
UNASSIGNED: The inclusion of osteopathy as a healthcare profession in Italy is a significant step towards the regulation and recognition of this practice, implying considerable innovations both in terms of access to the profession, both in the field of the professional health responsibility. Even if with the Decree of 29 November 2023, a significant step forward has been made, further regulatory and control measures are needed to ensure the quality, safety, and effectiveness of osteopathic treatments, as well as the protection of patients and the professionalism of operators.

BACKGROUND: Engaging in clinical research includes confronting challenges about the uncertainty around outcomes and ramifications the results may have on practice. This is pertinent for osteopathy where little is known about the experiences of osteopaths involved in clinical trials. The aim of this study was to explore the lived experience of osteopaths who participated in a randomised controlled trial for infantile colic. The study was informed by a principles-based approach to clinical ethics and their application to practice.
METHODS: Qualitative study using semi-structured interviews and reflexive thematic analysis.
METHODS: An international two-arm pragmatic randomised controlled trial (the CUTIES trial) to evaluate the effectiveness of osteopathic care for infantile colic.
METHODS: A principles-based approach to clinical ethics and their application to practice for osteopaths asked to make decisions about participating in a clinical trial was used. Osteopaths from the UK and Australia who completed the CUTIES trial training were invited to be interviewed about their experiences, regardless of whether they went on to recruit infants in the trial. Interviewees were asked about their reasons for wanting to participate in the CUTIES trial, why they decided to continue or not to continue in the trial and, for those who completed the trial, their personal experiences as participants in the trial. Data were analysed using reflexive thematic analysis.
RESULTS: Nine osteopaths were interviewed. Three themes were identified from the data: Paradigm dilemma - observed clinical outcomes vs scientific evidence for mechanism of effects; trial-related ethical dilemmas; and trial outcome dilemmas.
CONCLUSIONS: Participating in the CUTIES trial required osteopaths to overcome clinical ethical dilemmas for the benefit of patients, the research, and the profession.

Despite the care provided, some newborns, who are perfectly healthy, show functional alterations that impair a good breast attack in the first few days. This situation often leads to the early failure of lactation. We conducted a randomized single-blind controlled trial to evaluate whether four weeks of osteopathic treatment can normalize the sucking score in a group of neonates with impaired lactation ability. Forty-two healthy full-term neonates were enrolled in this study. On the basis of the sucking score and the assessment of the infant\'s breastfeeding skills, infants who had intrinsic breastfeeding difficulties were selected. The inclusion criteria were healthy infants born > 37 weeks, a suction score ≤ 6, and any breast milk at enrolment. At the end of the study, the sucking score was significantly greater in the osteopathic group than in the untreated group; the median sucking score in the treated group was in the normal range, while it remained lower in the untreated group. At the end of the follow-up, the percentage of exclusively breastfeeding infants in the treatment group increased by +25%. This pilot study demonstrates the efficacy of early osteopathic intervention to relieve breastfeeding difficulties in newborns in the first few weeks of life.

BACKGROUND: Musculoskeletal conditions are the leading contributor to global disability and health burden. Manual therapy (MT) interventions are commonly recommended in clinical guidelines and used in the management of musculoskeletal conditions. Traditional systems of manual therapy (TMT), including physiotherapy, osteopathy, chiropractic, and soft tissue therapy have been built on principles such as clinician-centred assessment, patho-anatomical reasoning, and technique specificity. These historical principles are not supported by current evidence. However, data from clinical trials support the clinical and cost effectiveness of manual therapy as an intervention for musculoskeletal conditions, when used as part of a package of care.
OBJECTIVE: The purpose of this paper is to propose a modern evidence-guided framework for the teaching and practice of MT which avoids reference to and reliance on the outdated principles of TMT. This framework is based on three fundamental humanistic dimensions common in all aspects of healthcare: safety, comfort, and efficiency. These practical elements are contextualised by positive communication, a collaborative context, and person-centred care. The framework facilitates best-practice, reasoning, and communication and is exemplified here with two case studies.
METHODS: A literature review stimulated by a new method of teaching manual therapy, reflecting contemporary evidence, being trialled at a United Kingdom education institute. A group of experienced, internationally-based academics, clinicians, and researchers from across the spectrum of manual therapy was convened. Perspectives were elicited through reviews of contemporary literature and discussions in an iterative process. Public presentations were made to multidisciplinary groups and feedback was incorporated. Consensus was achieved through repeated discussion of relevant elements.
CONCLUSIONS: Manual therapy interventions should include both passive and active, person-empowering interventions such as exercise, education, and lifestyle adaptations. These should be delivered in a contextualised healing environment with a well-developed person-practitioner therapeutic alliance. Teaching manual therapy should follow this model.

BACKGROUND: Studies of leg-length discrepancies (LLD) have been the subject of debate for almost 200 years. A large number of studies have emerged, most frequently using assessment criteria based on painful symptoms or joint damage.
METHODS: While many authors argue for a threshold of 10-20 mm to establish a link between pain and LLD, most publications based on radiography show lesion stigmata on lumbar, hip and knee joints as early as 6 mm. This would be linked to comorbidities.
CONCLUSIONS: Some studies argue forcefully that leg-length correction below 20 mm is of no benefit. The authors of the present article, on the other hand, evoke the notion of lesion risks in the absence of correction, even for small deviations in the presence of certain associated factors and according to their importance.
CONCLUSIONS: The authors argue for the need to define in the future a lesion significance score that would not be correlated to painful symptomatology, but rather to the presence of co-morbidities such as age, anatomical variability, sports practice and/or patients\' professional activities. Other parameters, such as mobility, should also be taken into consideration, while gender, height and weight do not appear to be significantly related.

UNASSIGNED: Osteopathic manual techniques are now widely used in medicine worldwide. At present, there are no clear conclusions regarding the possibility of affecting the function of the autonomic nervous system (ANS), respiratory system and head-cervical-shoulder complex by manual osteopathic techniques.
UNASSIGNED: The aim of the study was to review the current literature regarding the possible impact of osteopathic manual techniques on the state of the autonomic nervous system, spirometric parameters of the respiratory system and the state of the head-collar-shoulder complex.
UNASSIGNED: Publications have been searched in the following databases: PubMed, Virtual Health Library and Cochrane Central Register of Controlled Trials. The search strategy included keywords related to manual osteopathic treatment, autonomic nervous system, spirometry, respiratory function and head, neck and shoulder pain. The methodological quality of the included studies was assessed. The PRISMA guidelines were used for the systematic review. Studies from 2010 to 2023 were selected.
UNASSIGNED: Using the proposed descriptions and manual searches from the literature of other works, 40 studies were found, out of which 22 were rejected because they did not meet the inclusion criteria. The analysis included: 15 randomized controlled trials, 3 pilot studies.
UNASSIGNED: Studies clearly show the effect of OMT on both spirometric parameters and the condition of the head-collar-shoulder complex. Most often this translates into improved ANS performance, but there are exceptions.
UNASSIGNED: https://www.crd.york.ac.uk/prospero/, CRD42023476963.

BACKGROUND: Interoceptive bodily awareness (IBA) is one\'s attentional focus on and relationship with comfortable and uncomfortable (e.g., pain) internal body sensations. Integrating IBA into research on osteopathic manipulative treatment (OMT) is growing, both as an outcome and predictor of treatment outcomes; however, it has yet to be studied in a clinical setting.
OBJECTIVE: We aimed to conduct a pilot study to measure IBA, with the Multidimensional Assessment of Interoceptive Awareness (MAIA), in patients seeking OMT for pain, and to test if OMT exposure may be associated with higher IBA as measured by the MAIA. The primary outcome was the change in MAIA scores, and the secondary outcomes were reduction in pain intensity, reduction in pain interference, and increase in participants\' perception of change post-OMT.
METHODS: A convenience sample was recruited from individuals presenting for OMT appointments at a College of Osteopathic Medicine OMT teaching clinic. Participants were recruited into our single-arm observational cohort study (n=36), and categorized into one of two groups, OMT-naïve (n=19) or OMT-experienced (n=17), based on prior exposure to OMT. We measured MAIA scores and clinical pain-related outcomes prior to, immediately after, and at 1 and 3 weeks after a usual-care OMT session in the clinic. Covariates including experience with mind-body activities, non-OMT body work, and physical and emotional trauma were also collected to explore potential relationships. We utilized t tests to compare MAIA scores and pain outcomes between groups and across time points. Stepwise regression models were utilized to explore potential relationships with covariates.
RESULTS: The OMT-experienced group scored higher on the MAIA scales \"Not-worrying\" (p=0.002) and \"Trusting\" (p=0.028) at baseline. There were no significant changes in the MAIA scores before and after the single OMT session. Analysis of secondary outcomes revealed that all pain outcomes significantly decreased post-OMT (p<0.05), with the largest relative improvements in the acute pain and OMT-naïve subgroups, with diminishing effects over time.
CONCLUSIONS: Assessing IBA with MAIA in a clinical OMT setting is feasible. There were significant positive correlations between OMT exposure and two of the eight MAIA scales. Future studies are justified to further explore this relationship.