Journal of Complementary and Integrative Medicine, 2018/12, 15(4):eA27. doi: 10.1515/jcim-2018-2000, type of study: ,mms,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

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Keywords:

foundations [3]
mixed method study [114]
theoretical approach [1]

Abstract:

Background: In recent years, osteopathy seems to be gaining popularity among patients. Anecdotal and empirical evidence is growing about the efficacy of this type of manual therapy. However, how the therapy works for different health conditions remains unclear, both in terms of mechanisms of action and contextual care factors surrounding successful treatment. Objectives: To explore the theoretical foundations of osteopathy and its conception of efficacy, provide initial clues into the epistemological status of osteopathy and to assess the legitimacy of this discipline within the evidence-based medicine system. Methods: We first conducted an exploratory focus group interview with the leaders and champions of a future Canadian Master’s program of osteopathy to highlight issues concerning academic knowledge building. We also critically reviewed various scientific and philosophical literature to identify the scientific bases of osteopathy (e.g., concepts of holism and vitality), how efficacy is assessed in this research field, and how osteopathic interventions might operate beyond biomechanical theories. Results: The results of our focus group and critical literature review suggested that the concept of specific efficacy is not sufficient to explain how osteopathic interventions work, which opened up to alternative explanations: e.g. contextual placebo effect (practitioner’s effect, care ritual, etc.), natural course of illness/physical condition, and regression to the mean. The suggestion of both the expected effects and mechanism of action of the treatment by the practitioner was also discussed as an alternative explanation to the efficacy of osteopathy. Conclusion: These findings suggest the existence of two opposing dissonant visions of efficacy: one specific of the treatment and one contextual. The latter has to be considered in practice. Next step is to explore ethical issues related to treating while taking account of contextual effects in an evidence-based medicine system, as some complementary and alternative medicine practitioners seem to do.