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Arrigoni A, Rossettini G, Palese A, Thacker M, Esteves JE. Exploring the role of therapeutic alliance and biobehavioural synchrony in musculoskeletal care: Insights from a qualitative study. Musculoskelet Sci Pract 2024; 73:103164. [PMID: 39151365 DOI: 10.1016/j.msksp.2024.103164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/06/2024] [Accepted: 08/09/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Person-centred care underscores the therapeutic alliance (TA) as fundamental, fostering positive treatment outcomes through collaborative patient-clinician interactions. Biobehavioural synchrony within the TA, essential for effective care, reflects an adaptive process where organisms align responses during interactions. Enactivism and active inference provide profound insights into human perception, reshaping musculoskeletal care understanding. Touch and verbal communication, integral to the TA, foster synchrony and alignment of personal beliefs. AIM This study aimed to identify the tools used by manual therapists in musculoskeletal care to establish a TA with patients. Furthermore, it endeavours to evaluate the alignment of these strategies with current literature and their correlation with biobehavioural synchrony, enactivism, and the role of touch in active inference. METHODS The methodology followed rigorous qualitative research principles, particularly Grounded Theory and interpretative-constructivist principles, conducting eleven semi-structured interviews with open-ended questions. RESULTS The core category identified in the study is elucidated as follows: "Interwoven Connection: The Fabric of Therapeutic Synchrony." The interviews unveiled three main categories, each comprising sub-categories: (1) Creating a meaningful dialogue; (2) Promoting active patient participation; (3) Synchronisation. CONCLUSION Fostering meaningful dialogue, patient involvement, and therapeutic synchrony is crucial for a robust therapeutic alliance in musculoskeletal care. This underscores the importance of establishing a deep connection between clinicians and patients, central to effective person-centred care. Clinicians must prioritise two-way communication, empathy, and patient collaboration in defining personalised goals. Emphasizing touch and seeking patient feedback are also pivotal. Further research is needed to explore these elements and their impact.
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Affiliation(s)
| | - Giacomo Rossettini
- School of Physiotherapy, University of Verona, Via Bengasi 4, 37134, Verona, Italy; Department of Physiotherapy, Faculty of Sport Sciences, Musculoskeletal Pain and Motor Control Research Group, Universidad Europea de Madrid, 28670, Villaviciosa de Odón, Spain.
| | - Alvisa Palese
- Department of Medicine, University of Udine, Udine, Italy.
| | - Mick Thacker
- Department of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Jorge E Esteves
- Malta ICOM Educational, Santa Venera, Malta; UCO School of Osteopathy, Health Sciences University, London, UK; Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy.
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Tomaiuolo F, Cerritelli F, Delli Pizzi S, Sestieri C, Paolucci T, Chiacchiaretta P, Sensi SL, Ferretti A. Data-driven analysis of whole-brain intrinsic connectivity in patients with chronic low back pain undergoing osteopathic manipulative treatment. Neuroimage Clin 2024; 43:103659. [PMID: 39208480 DOI: 10.1016/j.nicl.2024.103659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Chronic Low Back Pain (cLBP) poses a significant health challenge, leading to functional disability and reduced quality of life. Osteopathic Manipulative Treatment (OMT) is emerging as a therapeutic option for cLBP, but the brain mechanisms underlying its analgesic effect remain unclear. MATERIALS AND METHODS Thirty cLBP patients were randomly exposed to either four weekly sessions of OMT (N=16) or Sham treatment (N=14). Resting-state Magnetic Resonance Imaging (rs-MRI) scans and pain perception questionnaires were collected before and after treatment. A voxel-wise, rs-fMRI data-driven analysis was conducted to identify changes in the intrinsic functional connectivity across the whole brain that were associated with the OMT. Spearman's correlations were used to test for the association between changes in intrinsic connectivity and individual reports of pain perception. RESULTS Compared to the Sham group, participants who received OMT showed significant alterations in the functional connectivity of several regions belonging to the pain matrix. Specifically, OMT was associated with decreased connectivity of a parietal cluster that includes the somatosensory cortex and an increase of connectivity of the right anterior insula and ventral and dorsal anterolateral prefrontal areas. Crucially, the change in connectivity strength observed in the ventral anterolateral prefrontal cortex, a putative region of the affective-reappraisive layer of the pain matrix, correlates with the reduction in pain perception caused by the OMT. CONCLUSIONS This study offers insights into the brain mechanisms underlying the analgesic effect of OMT. Our findings support a link between OMT-driven functional cortical architecture alterations and improved clinical outcomes.
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Affiliation(s)
- Federica Tomaiuolo
- University "G. d'Annunzio" of Chieti Pescara - Engineering and Geology Department, Italy; Department of Neuroscience, Imaging, and Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Italy
| | - Francesco Cerritelli
- NYIT College of Osteopathic Medicine, Old Westbury, NY 11568, USA; Foundation COME Collaboration, Pescara, Italy.
| | - Stefano Delli Pizzi
- Department of Neuroscience, Imaging, and Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Italy; Institute for Advanced Biomedical Technologies (ITAB), "G. d'Annunzio" University, Chieti-Pescara, Italy; Molecular Neurology Unit, Center for Advanced Studies and Technology (CAST), University "G. d'Annunzio" of Chieti-Pescara, Italy.
| | - Carlo Sestieri
- Department of Neuroscience, Imaging, and Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Italy; Institute for Advanced Biomedical Technologies (ITAB), "G. d'Annunzio" University, Chieti-Pescara, Italy
| | - Teresa Paolucci
- Department of Medical, Oral and Biotechnological Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; CARES, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Piero Chiacchiaretta
- Molecular Neurology Unit, Center for Advanced Studies and Technology (CAST), University "G. d'Annunzio" of Chieti-Pescara, Italy; Department of Innovative Technologies in Medicine and Dentistry, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging, and Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Italy; Institute for Advanced Biomedical Technologies (ITAB), "G. d'Annunzio" University, Chieti-Pescara, Italy; Molecular Neurology Unit, Center for Advanced Studies and Technology (CAST), University "G. d'Annunzio" of Chieti-Pescara, Italy
| | - Antonio Ferretti
- Department of Neuroscience, Imaging, and Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Italy; Institute for Advanced Biomedical Technologies (ITAB), "G. d'Annunzio" University, Chieti-Pescara, Italy; UdA-TechLab, Research Center, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
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Bonanno M, Papa GA, Ruffoni P, Catalioto E, De Luca R, Maggio MG, Calabrò RS. The Effects of Osteopathic Manipulative Treatment on Brain Activity: A Scoping Review of MRI and EEG Studies. Healthcare (Basel) 2024; 12:1353. [PMID: 38998887 PMCID: PMC11241316 DOI: 10.3390/healthcare12131353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/01/2024] [Accepted: 07/04/2024] [Indexed: 07/14/2024] Open
Abstract
Osteopathic manipulative treatment (OMT) is a hands-on therapy aiming to achieve the global homeostasis of the patient. OMT focuses on treating the somatic dysfunctions characterized by tissue modifications, body asymmetry, and range-of-motion restrictions. The benefits related to OMT are thought to be associated with the interconnectedness of the body's systems and the inherent capacity for self-healing. However, whether OMT can influence brain activity, and, consequently, neurophysiological responses is an open research question. Our research investigates the literature to identify the effects of OMT on brain activity. The main purpose of the research question is: can OMT influence brain activity and consequently neurophysiological responses? A scoping review was conducted, searching the following databases: PubMed, Google Scholar, and OSTEOMED.DR (Osteopathic Medical Digital Repository), Scopus, Web of Science (WoS), and Science Direct. The initial search returned 114 articles, and after removing duplicates, 69 were considered eligible to be included in the final sample. In the end, eight studies (six randomized controlled trials, one pilot study, and one cross-over study) were finally included and analyzed in this review. In conclusion, OMT seems to have a role in influencing functional changes in brain activity in healthy individuals and even more in patients with chronic musculoskeletal pain. However, further RCT studies are needed to confirm these findings. Registration protocol: CRD42024525390.
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Affiliation(s)
- Mirjam Bonanno
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy
| | | | - Paola Ruffoni
- International College of Osteopathic Medicine, 20092 Milan, Italy
| | | | - Rosaria De Luca
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy
| | - Maria Grazia Maggio
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy
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Baroni F, Schleip R, Arcuri L, Consorti G, D’Alessandro G, Zegarra-Parodi R, Vitali AM, Tramontano M, Lunghi C. Functional Neuromyofascial Activity: Interprofessional Assessment to Inform Person-Centered Participative Care-An Osteopathic Perspective. Healthcare (Basel) 2023; 11:2886. [PMID: 37958030 PMCID: PMC10667998 DOI: 10.3390/healthcare11212886] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Introduction: Health professionals and bodyworkers may be pivotal in promoting prevention programs, providing tailored advice and guidance to patients' adherence to self-care strategies, such as physical activity. Contemporary evidence encourages manual therapists to involve patients in decision-making and treatment procedures integrating passive and active approaches in treatment planning. This manuscript provides a definition and applications of neuromyofascial movement patterns, discusses the significance of functional assessment, and gives an example of clinical applications in the osteopathic field to highlight how this assessment can promote interdisciplinarity. Methods: The reporting framework used in the current manuscript followed guidelines for writing a commentary. Results: The manuscript highlights the crucial role that the neuromyofascial system plays in human movement and overall well-being and the importance of a functional neuromyofascial activity assessment in the context of person-centered participative care. Conclusions: Understanding individual neuromyofascial patterns could help healthcare practitioners, movement specialists, and bodyworkers in tailoring treatment plans, meeting patients' unique needs, and promoting a more effective personalized approach to care. The current perspective could spark debates within the professional community and provide a research roadmap for developing an evidence-informed interprofessional framework.
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Affiliation(s)
- Francesca Baroni
- BMS Formation, 75116 Paris, France; (F.B.); (C.L.)
- Osteopatia Lunghi-Baroni Private Practice, 00146 Rome, Italy
| | - Robert Schleip
- Department of Sport and Health Sciences, Conservative and Rehabilitative Orthopedics, Technical University of Munich, 80333 Munich, Germany;
| | - Lorenzo Arcuri
- Clinical-Based Human Research Department, Foundation COME Collaboration, 65121 Pescara, Italy
| | - Giacomo Consorti
- Education Department of Osteopathy, Istituto Superiore di Osteopatia, 20126 Milan, Italy
| | - Giandomenico D’Alessandro
- Clinical-Based Human Research Department, Foundation COME Collaboration, 65121 Pescara, Italy
- Centre pour l’Etude, la Recherche et la Diffusion Ostéopathiques “C.E.R.D.O.”, 00199 Rome, Italy
| | | | | | - Marco Tramontano
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero, Universitaria di Bologna, 40126 Bologna, Italy
| | - Christian Lunghi
- BMS Formation, 75116 Paris, France; (F.B.); (C.L.)
- Osteopatia Lunghi-Baroni Private Practice, 00146 Rome, Italy
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Doran-Sherlock R, Devitt S, Sood P. An integrative review of the evidence for Shinrin-Yoku (Forest Bathing) in the management of depression and its potential clinical application in evidence-based osteopathy. J Bodyw Mov Ther 2023; 35:244-255. [PMID: 37330777 DOI: 10.1016/j.jbmt.2023.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 11/04/2022] [Accepted: 04/11/2023] [Indexed: 06/19/2023]
Abstract
There is growing interest in the idea of integrating Nature Therapies into the multidisciplinary management of complex conditions such as depression. Shinrin-Yoku (Forest Bathing), a practice involving spending time in a forested environment while paying attention to multi-sensory stimuli has been proposed as one such modality. The objectives of this review were to critically analyse the current evidence base on the efficacy of Shinrin-Yoku for the treatment of depression, and to examine how the findings may reflect and/or inform osteopathic principles and clinical practice. An integrative review of the evidence for Shinrin-Yoku in the management of depression published between 2009 and 2019 was conducted resulting in n = 13 peer-reviewed studies meeting inclusion criteria. Two themes emerged from the literature, the positive effect of Shinrin-Yoku on self-reported mood scores, and physiological changes arising from forest exposure. However, the methodological quality of the evidence is poor and experiments may not be generalisable. Suggestions were made for improving the research base via mixed-method studies in a biopsychosocial framework, and aspects of the research which may be applicable to evidence-based osteopathy were noted.
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Consorti G, Castagna C, Tramontano M, Longobardi M, Castagna P, Di Lernia D, Lunghi C. Reconceptualizing Somatic Dysfunction in the Light of a Neuroaesthetic Enactive Paradigm. Healthcare (Basel) 2023; 11:healthcare11040479. [PMID: 36833014 PMCID: PMC9957393 DOI: 10.3390/healthcare11040479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/27/2022] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
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. Conclusions, and future directions: The present perspective article represents a proposition to blend technical rationality informed by neurocognitive and social sciences, and professional artistry clinical experience informed by traditional tenets, to overcome the controversy around somatic dysfunction, rather than dismissing the concept.
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Affiliation(s)
- Giacomo Consorti
- Education Department of Osteopathy, Istituto Superiore di Osteopatia, 20126 Milan, Italy
- Correspondence:
| | - Carmine Castagna
- Education Department of Osteopathy, Istituto Superiore di Osteopatia, 20126 Milan, Italy
| | - Marco Tramontano
- Fondazione Santa Lucia Istituto di Ricovero e Cura a Carattere Scientifico, 00179 Rome, Italy
- Centre Pour l’Etude, la Recherche et la Diffusion Osteopathiques, 00199 Rome, Italy
| | | | - Paolo Castagna
- Education Department of Osteopathy, Istituto Superiore di Osteopatia, 20126 Milan, Italy
| | - Daniele Di Lernia
- Human Technology Laboratory, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20100 Milan, Italy
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Arcuri L, Consorti G, Tramontano M, Petracca M, Esteves JE, Lunghi C. “What you feel under your hands”: exploring professionals’ perspective of somatic dysfunction in osteopathic clinical practice—a qualitative study. Chiropr Man Therap 2022; 30:32. [PMID: 36045398 PMCID: PMC9429724 DOI: 10.1186/s12998-022-00444-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/17/2022] [Indexed: 11/30/2022] Open
Abstract
Background Despite controversy regarding its validity and clinical usefulness, manual examination findings still have an important role for manipulative therapies. As an example, somatic dysfunction (SD) remains central to osteopathic practice.This study aims to explore the experienced osteopaths' attitudes concerning SD and its role in osteopathic practice. This qualitative research could contribute to building a consistent paradigm for manual intervention in all musculoskeletal manipulations. Methods A thematic analysis with grounded theory elements was used. Data were collected through semi-structured interviews carried out between February and April 2021. A purposive sample of twenty professional osteopaths with past experience in osteopathic care was chosen to reflect the phenomenon's variety. The data analysis was done inductively and in tandem with the recruiting to keep track of data saturation. Results Eleven osteopaths participated in the study. Three main themes emerged from the data analysis: (1) SD as a safe tissue-touch-based communication tool between operator and person complex adaptive health system; (2) The treatment of SD is shareable between osteopaths, other health professionals, and the patients involved in the therapeutic pathway improving body awareness and health; (3) The development of the SD concept in research and practice to better clarify osteopathic profession identity and definition. Conclusions A panel of expert osteopaths consider the concept of SD as a valuable tool integrated into the osteopathic evaluation and treatment process. The shared concept and clinical application of SD is informed by person-centered care concepts and from the fields of neuroscience, cognitive and complexity science. Our study reports a common need among osteopaths to develop an evidence-based framework of SD to allow the best development of the osteopathic profession. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-022-00444-2.
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