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The United States is facing a growing physician shortage that threatens the ability of our healthcare system to provide needed services. This shortage will be more acutely felt in rural and underserved areas. Osteopathic medical education, with its priority of primary care specialties, plays a significant role in meeting the healthcare needs of rural communities in America. The fastest-growing demographic of osteopathic physicians is women under the age of 45 (American Osteopathic Association, 2021). Additionally, for the first time in history, women outnumber men in medical schools, accounting for 51% of current medical students (Boyle, 2019). Who is admitted to medical school is a fundamental issue in medical education. In an effort to alleviate the healthcare workforce maldistribution, preferences should be given to candidates with a higher likelihood of eventually practicing in rural or underserved communities. Studies have looked at factors that influence practice location, including age, the influence of a rural background, parental education, and gender. The literature describes factors that have a strong relationship with an eventual rural practice, including planning to practice family medicine and growing up rural. Women physicians are more likely to choose primary care than their male counterparts but are less likely to practice in rural areas. This non-rural preference, combined with the increase in the proportion of female medical students, represents a risk to the future supply of rural physicians. No studies have been conducted to understand what factors best predict a female osteopathic medical student's choice to practice in a rural setting. This study used multiple linear regression to investigate the relationship between female osteopathic medical students' attitudes toward practicing in a rural setting and their characteristics of a rural upbringing, a plan to practice in a primary care specialty, and degree of civic-mindedness. The results of this study illustrate three substantial effects. First, the greater the degree of civic-mindedness of the student, the more favorable the attitude toward practicing in a rural setting. Second, students who plan to practice family medicine have a more favorable attitude toward practicing in a rural setting. Third, a conditional effect of civic-mindedness was found in which, for students with high civic-mindedness, planning to practice family medicine is associated with a more favorable attitude toward rural practice than students with low civic-mindedness. Of note, although the literature overwhelmingly suggests that a rural background is a predictor of eventual rural practice for medical students in aggregate, the results did not indicate that this was true for female osteopathic medical students in Arkansas. This study has implications for medical school admission practices, and further investigation with a larger sample may provide added insight into what characteristics predict eventual rural practice for women physicians.

Dr. Andrew Taylor Still, the founder of osteopathic medicine, actively promoted gender parity in the field from its inception, at a time when few medical schools accepted women into their programs, and even fewer all-female medical schools existed (Quinn, 2017; Simpson & Weiser, 1996). Although an almost equal number of male and female students are enrolled in osteopathic medical schools, men far outnumber women in positions of leadership. While the data for the number of women deans and department chairs at osteopathic medical schools does not exist, research by the Association of American Medical Colleges (2021) showed that 24% of deans in allopathic medical schools were women. Utilizing open-ended, semi-structured interviews, this narrative case study will seek to provide understanding of the experiences of women deans and department chairs at an institution where 58% of the senior leadership are women. The institutional and personal factors that have contributed to their ascension to leadership of an osteopathic medical school could provide insights that are transferable to other male-dominated professions and institutions. Keywords: osteopathic medicine, women, leadership, gender parity

INTRODUCTION In the last decade, an urgency to move away from fragmented care into an integrated model of health care delivery has been meaningly pushed. Policymakers worldwide have been developing policies that promote care collaboration to address contemporary health issues. Nonetheless, in New Zealand, limited research is available highlighting the inclusion of osteopaths working in an integrated care environment. Current osteopathic research positions osteopaths alongside other health professionals within diverse health practice environments. Aims: To identify why osteopaths in New Zealand may have chosen to work in an integrated care environment and whether their experience was positive or negative. METHODS A descriptive qualitative study of seven registered osteopaths who have previously or currently worked in an integrated care environment was conducted. Osteopaths were interviewed using semi-structured indicative questions. Recordings were transcribed, and transcriptions were thematically analysed. RESULTS The three principal themes of ‘knowledge’, ‘operational management’, and ‘individual traits and skills’ were found to significantly influence the experience of an osteopath who chose to continue working in an integrated care environment. Each theme included two or three subthemes. ‘Knowledge’ included education and preparation. Management, time, and cost were the subthemes of ‘operational management’, and ‘individual traits and skills’ included communication, collaboration, and personality. No osteopaths in this study stated making a specific choice to work in an integrated care environment. CONCLUSION Although the osteopaths in this study did not choose to entre an integrated care environment to work alongside alternative registered health care professionals, a positive view was held by those osteopaths who continued to work in this environment. However, many inconsistencies in this model of care delivery exist, resulting in several key barriers. This study highlighted the necessity for future research to address multidisciplinary education and operational management within an integrated health care environment.

With Lower Back Pain (LBP) affecting a large proportion of the population at one point in their life, it is important to explore the potential causes of such pain. Under the umbrella term of LBP, there is Spondylolisthesis (SPL) which affects around a tenth of the population. With such a proportion of the population being affected by the condition, it is important to explore and be aware of the different conservative management options available. The following thesis has been separated into four sections. The first section is a literature review which provides important background knowledge to understand the anatomy of the lumbar spine and how it relates to the progression of SPL. The literature review also provides key definitions to better understand SPL, a broad background of the models of pain, LBP, epidemiology and clinical symptoms of SPL. It also explores the different management interventions available for SPL and how they may benefit individuals with SPL. The second section outlines the methodology that is used in this thesis. It provides a background of scoping reviews and compares them to the more well-known systematic reviews. Subsequently, the rationale, aims, and objectives of this scoping review are discussed. Finally, the methodological framework is outlined and explored within the context of this scoping review. Section three contains a manuscript of the present study formatted for submission to the Spine Journal for publication. The manuscript provides a detailed account of the methods used to identify the articles in this scoping review. It follows on to provide the detailed findings identified during the charting of the information. Section three finishes with an in-depth discussion of the three emerging themes from the literature. The last section of this document comprises all the appended resources, including evidence such as the Unitec Ethics exemption approval and details around the characteristics of the studies included. To promote transparency during the review process and prevent duplication, the scoping review protocol was developed and registered on the Open Science Framework website

AIM The aim of this study was to investigate the experiences of New Zealand women regarding the osteopathic management of their dysmenorrhea. DESIGN Qualitative descriptive exploratory study. METHODS A convenience sample of eight women with dysmenorrhea (age 25-46 years) from osteopathic clinics and support groups in Auckland, New Zealand, participated in semi-structured face-to-face interviews between March and July 2021. Voice recordings of interviews were transcribed verbatim and coded. Data analysis involved a thematic framework approach to identify Themes. RESULTS: Thematic analysis of women’s responses identified three main themes: impact of dysmenorrhea on women’s quality of life, osteopathy as an effective strategy for managing dysmenorrhea, and barriers to beginning osteopathic management. CONCLUSION This research contributes to the currently limited literature on women’s experiences of osteopathic management for their dysmenorrhea. While osteopathy cannot cure dysmenorrhea, it seems to be an effective management tool for the symptoms that accompany it. Alternative therapies such as osteopathy should be recommended to more women who are suffering in silence from this condition. IMPACT: Dysmenorrhea affects an estimated 45%-95% of women aged 13-50 years old worldwide. However, dysmenorrhea is still commonly disregarded by health care professionals and women themselves. This leads to women not taking their dysmenorrhea seriously and continuing to suffer from their symptoms, leading to other medical conditions later in life. Female participants in this research found osteopathy to be an effective strategy for managing symptoms of dysmenorrhea. These findings can help inform researchers and health practitioners on how osteopathy may be useful in managing women’s dysmenorrhea symptoms.

Alterations in lower extremity kinematic and kinetics during functional tasks such as gait, running, landing and change of direction maneuvers are frequently seen long after anterior cruciate ligament reconstruction (ACLR) and have been hypothesized to contribute to the development of secondary anterior cruciate ligament (ACL) injury and post traumatic osteoarthritis (PTOA). The ACL typically provides afferent sensory information via mechanoreceptors, however, following an ACL injury these mechanoreceptors are disrupted. The central nervous system (CNS) as a result undergoes compensatory modifications prioritizing visual feedback in order to effectively organize neuromuscular control. When vision is obstructed, alterations in motor control during functional activities such as gait may increase secondary ACL injury risk and PTOA. Stroboscopic glasses reduce visual reliance for neuromuscular regulation of the injured limb by providing intermittent snapshots of an individual’s environment without completely obstructing it. Our goal was to assess the relationship between the biomechanical alterations that take place following an ACLR with variable levels of visual perturbation via stroboscopic glasses. We hypothesized knee flexion excursion, knee extensor moment, and knee abduction moment would be lower in the ACLR limb 4 compared to the healthy controls with further reductions in these variables with increasing levels of visual perturbation during gait. Twenty-four individuals completed a data collection session during which five separate walking gait trials were analyzed. The ACLR group (8 women, 4 men; age = 22.00 ± 2.45 years; height = 1.70 ± 0.10 m; weight = 67.67 ± 16.00 kg; Tegner Activity Scale score = 7.42 ± 1.08; time since surgery = 35.40 ± 24.67 months; hamstring grafts = 10, patellar tendon = 2) had been cleared for full return to physical activity by their physicians and were engaged in regular physical activity. The healthy control group (8 women, 4 men; age = 21.92 ± 2.47 years; height = 1.73 ± 0.10 m; weight = 69.61 ± 14.77 kg; Tegner Activity Scale score = 7.50 ± 1.17) had no history of lower extremity injury. Kinetic and kinematic outcomes measures were recorded during each trial. Biomechanical outcomes were presented using a limb symmetry index (left limb value/right limb value) x 100%. The primary variables of interest were knee flexion excursion (KFE), knee extensor moment (KEM), and knee abduction moment (KAM). Primary variables of interest were reported as limb symmetry index (LSI) percentages. A repeated measures ANOVA was conducted for each dependent variable (3) with the between subjects group (ACL vs. Controls) and the within subjects factor condition visual perturbation level). Post-hoc testing was conducted as appropriate. Alpha level was set at 0.05 for all analyses. KFE LSI was found to be significantly different between ACLR (92.82± 15.15) and healthy control (102.45± 10.08) groups regardless of visual perturbation. There was 5 no significant difference found between KEM LSI and KAM LSI when evaluating these two groups. The visual perturbation conditions elicited no statistically differences in the biomechanical variables of interest for our study across ACLR and healthy control groups. Stroboscopic visual perturbation did not alter the gait mechanics we evaluated in this study. However, a significant group effect was noted between ACLR and healthy controls. A reduction in KFE LSI indicates the involved limb went through less range of motion during the first 50% of stance phase which supports prior ACLR gait analysis studies. The neuromuscular effects of stroboscopic visual training may require a more demanding task to challenge cross-modal visual-spatial integration neural networks.

Septic arthritis is an important cause of lameness in cattle. There are currently no antimicrobials labeled for treatment of septic arthritis in cattle in the United States. In addition to the well established anti-inflammatory and chondroanabolic properties of platelet-rich plasma (PRP), recent in-vitro experimental studies have also highlighted the immune-metabolic effects and antimicrobial properties of PRP when used alone, and in conjunction with antimicrobials. Given the regulatory restrictions associated with antimicrobial use in cattle, PRP is of potential therapeutic benefit to this common clinical problem. The objective of this study was to evaluate the chondroprotective effects of ampicillin/sulbactam (Amp-S), autogenous PRP alone (PRP) or combined with Amp-S (PRP+Amp-S) in an explant model of bovine Staphylococcus aureus induced septic arthritis. Autogenous PRP was prepared prior to euthanizing 6 cows. Articular cartilage explants were collected from stifle joints and incubated in synovial fluid with 1 x 105 CFU/mL S. aureus ATCC 25923. Cartilage explants were incubated with S. aureus infected synovial fluid alone (S. aureus control), or S. aureus infected synovial fluid with treatments PRP (25% culture medium volume), Amp-S (2 mg/mL Unasyn™), or PRP+Amp-S for 24 hours. Explant chondrocyte viability, metabolic activity and GAG content were measured via live-dead assay/confocal microscopy, Alamar blue assay and DMMB assay, respectively. Data was analyzed with one-way ANOVA (p≤0.05). Cartilage explants inoculated with S. aureus (control) resulted in 64±10.5% dead cells. Treatment PRP (26±2.8%), Amp-S (25±10.6%) and PRP+Amp-S (22±4%) significantly decreased cell death. There was no significant difference in explant cell death and metabolic activity among the treatments. These results indicate that PRP, Amp-S, and PRP+Amp-S mitigated S. aureus-induced chondrocyte death in this in-vitro explant model of bovine septic arthritis. This data serves as a foundation for further in-vivo evaluation.

Bone fractures are one of the most common injuries in the United States, encompassing 6.2 million incidences, and costing the healthcare system roughly $20 billion annually. The majority of this cost falls upon a unique type of fracture known as a non-union fracture, defined by incomplete healing after 9 months. The economic burden in combination with the frequency by which these incidences occur offer a unique opportunity for research and improvement in the healthcare field. Previous research on the fracture repair process showed that dietary deficiency led to delayed healing producing a rachitic-like effect on the endochondral bone formation process that occurs during fracture healing. This research will build off the understanding of hypophosphatemia on bone fracture repair utilizing a unique temporal clustering approach to assess changes in the transcriptomic expression within callus tissues of control fed and dietary phosphate restricted animals. Using a temporal cluster modeling technique developed by our group (Lu et al. 2019), twelve clusters were generated for the gene expression data extracted from the callus tissues of B6 strain mice at time points 3, 5, 7, 10, 14, 18-, 21-, 28-, and 35-days post fracture, in, control and phosphate restricted dietary groups. Groupings of clusters were used to establish the temporal expression patterns over the time course of healing and identify the movement of genes that changed their temporal expression patterns between the control and phosphate restricted diets. Biological process categories were established for each cluster, grouping using both Ingenuity Pathway Analysis (IPA) and the NIH DAVID Bioinformatics Database ontology assessment programs. Genes based on their association with four key tissue developmental processes in fracture repair, skeletogenesis, myogenesis, vasculogenesis, and neurogenesis were analyzed. The analysis showed shifts to later peak expression times for all four categories. Further analysis illuminated three specific regulatory pathways that were significantly impacted by hypophosphatemia, Hippo and WNT signaling pathways and the circadian rhythm pathway while oxidative phosphorylation was both shifted and showed reduced expression. The shifts in expression time and level of these pathways demonstrate their importance to bone fracture repair and their impacts on mesenchymal stem cell differentiation. From the data analysis it is clear that limiting dietary phosphate results in impaired mesenchymal stem cell differentiation caused by delayed Hippo and WNT signaling. Further it is evident that the processes of skeletogenesis, myogenesis, vasculogenesis, and neurogenesis are heavily interconnected, often showing overlapping genes through all four processes. Based on these shifts and impairments in specific signaling we identified novel mechanisms by which hypophosphatemia can impair fracture callus growth and development and delay healing.

INTRODUCTION Research indicates that when health practitioners communicate well, patients’ understanding of their presenting conditions may improve, enhancing healthcare outcomes. Despite the significance of effective communication within a health professional-patient relationship, there is little research exploring this phenomenon within osteopathy. AIMS AND RESEARCH QUESTIONS This study explored patients’ understanding of their presenting conditions following a consultation with a student osteopath in a New Zealand student osteopathic clinic. Research questions were: What themes exist within patients’ description of their conditions/s following an osteopathic consultation? What relationship exists between student-practitioners’ communication and the patient’s understanding of their conditions? METHODS Interpretive Description (ID) was the qualitative methodological approach adopted for the study. This approach was chosen because it has been utilised successfully by researchers investigating a range of clinical phenomena. Key data for analyses included the audio recordings of consultations between the student-participants (n = 11; fifth-year Master of Osteopathy students) and patient-participants (n = 20; patients of the student-participants) and short interviews with patients following consultations. The data were triangulated and analysed thematically. FINDINGS Three main themes were identified: a) it’s a process, b) building trust, and c) focussing on communicating and understanding. The first theme highlighted patients acknowledging that processes played a part in various aspects of their conditions, such as the development of and what would be required to improve their conditions. The second theme illustrated student-practitioner communication building patient trust. Trust seemed to be supported by patients’ confidence in student-practitioner’s abilities, training, and knowledge. The final theme showed student-participants focused on delivering effective and understandable communication. By customising messages, student-practitioners helped make the language used more understandable for patients. As patients started making sense of what was occurring with their bodies, they could link how various elements (such as habits and parts of the body) might be interconnected. The student-practitioner and patient relationship seemed to be underpinned by trust and confidence. CONCLUSION The findings highlighted communication strategies that might help patients’ health outcomes within an osteopathic setting. Student-practitioners ensured their communication was clear and accessible to patients, which supported the therapeutic relationship and helped deliver person-centred care.

RESEARCH QUESTION: What primary, peer reviewed research has been published where osteopathic manual therapy (OMT) is used as an intervention, between 2010 - 2021? ABSTRACT BACKGROUND: Evidence based practice (EBP) is an approach in healthcare that integrates the use of the best available research, practitioner experience and patient values into clinical decision making for optimal health outcomes. In the field of osteopathy practitioners are required to engage in the EBP process however, osteopathic practitioners feel challenged by a lack of time and relevant research in the field and a fear of losing professional identity in EBP. There are positive indications of growth in osteopathic research, but no study has been conducted that clearly outlines what research currently exists in the osteopathic literature and what the body of literature looks like. METHODS: A 5-stage scoping review framework was employed to explore the breadth and nature of research where osteopathic manual therapy (OMT) is used as an intervention. Searches were done across PubMed, ScienceDirect, EBSCO and BASE databases. Inclusion criteria involved peer-reviewed, empirical studies published in English between January 2010 – March 2021. Data was extracted and categorised into 10 broad topics based on the anatomical site or condition in which the OMT intervention was focused. RESULTS: The final review comprised 292 studies, including 78 case reports and 24 systematic reviews. Three qualitative studies and one mixed methodology study were present. Studies assessing OMT for lower back pain (LBP) was found to have the largest area of research. CONCLUSION: The osteopathic literature appears largely dominated by quantitative research. The research could be categorised across ten broad topics indicating OMT has been studied in a wide range of conditions. However, research gaps have been identified within the categories of this review suggesting the research has inconsistent coverage. Moreover, the number of isolated research publications gives a fragmented impression of the literature. Osteopathic research may benefit from a more considered research agenda, where research is methodically generated to fill contextual gaps in the literature.

RESEARCH QUESTION AND AIM What are the types of NPBAs and how are they defined, diagnosed and measured? There were six types of NPBAs identified: dysfunctional breathing, hyperventilation syndrome, vocal cord disorder, exercise induced bronchoconstriction, sighing dyspnoea and habit cough. ABSTRACT BACKGROUND Non-pathological breathing abnormalities are of varied interest to multiple health disciplines. Dysfunctional breathing is but one related phenomenon that has emerged from research published by these disciplines. Although methods of diagnosing and treating dysfunctional breathing have been in effect, there has been no consensus of its definition. The same can be said of other breathing abnormalities which are non-pathological. OBJECTIVES 1. To identify the types of available indexed evidence in the field of non-pathological breathing abnormalities 2. To clarify what non-pathological breathing abnormalities are as a key concept (i.e. record available definitions in the literature and synthesise how frequent these definitions are used) 3. To identify key characteristics or factors related to non-pathological breathing abnormalities (i.e. record both suggested signs, symptoms and measures in the literature and synthesise their frequency) 4. To identify and analyse gaps related to terminology, classification, diagnostics, epidemiology, aetiology, treatment and management in the knowledge base METHOD A scoping review was undertaken. A novel framework was created to achieve the objectives of this research. Search involved ten online databases with no date or geographical restrictions. RESULTS Eighty-four articles (63 peer reviewed; 21 grey literature) were selected for inclusion. Six non-pathological breathing abnormalities were discovered: dysfunctional breathing, hyperventilation syndrome, vocal cord disorder, exercise induced bronchoconstriction, sighing dyspnoea and habit cough. There were some close associations related to each abnormality discovered too. Multiple definitions, signs and symptoms, and measures relevant to each non-pathological breathing abnormality were recorded and synthesised. A visual map shows the types of literature published and the deficits that exist. CONCLUSION Either more research is required to better classify each non-pathological abnormality, or implementation of the Delphi technique to better define dysfunctional breathing and hyperventilation syndrome. Future research could build upon this existing scoping review framework to carry out a systematic review.

OBJECTIVE To explore the breadth and depth of the low back pain (LBP) literature in rowing and to identify areas for future research. DESIGN Scoping review BACKGROUND LBP is highly prevalent in the rowing population. The body of existing research variously investigates risk factors, prevention, and treatment methods. Literature search: PubMed, Ebsco, ScienceDirect: inception to November 1, 2020. STUDY SELECTION CRITERIA We included published, peer-reviewed, primary, and secondary data pertaining to LBP in rowing. DATA SYNTHESIS Arksey and O’Malley’s framework for guided data synthesis was used. Reporting quality of a subsection of the data was assessed using the STROBE tool. Results: Following the removal of duplicates and abstract screening, a set of 78 studies were included and divided into the following categories: epidemiology, biomechanics, biopsychosocial, and miscellaneous. The incidence and prevalence of LBP in rowers were well mapped. The biomechanical literature covered a wide range of investigations with limited cohesion. Significant risk factors for LBP in rowers included back pain history and prolonged ergometer use. CONCLUSION A lack of consistent definitions within the studies caused fragmentation of the literature. There was good evidence for prolonged ergometer use and history of LBP to constitute risk factors and this may assist future LBP preventative action. Methodological issues such as small sample size and injury reporting increased heterogeneity and decreased data quality. Further exploration is required to determine the mechanism of LBP in rowers through research with larger samples.

PURPOSE: The purpose of this study was to assess the validity of pre-surgery PROMS completed retrospectively 6 and 24 months after hip arthroscopy compared with prospective completion. Validity was judged in relation to preoperative test-retest reliability. METHODS: Three separate groups of hip arthroscopy patients were recruited. In two retrospective groups, patients who had undergone a hip arthroscopy and had completed preoperative PROM questionnaires were contacted 6 or 24 months after surgery and asked to recall their preoperative state. In a third test-retest group, patients completed prospective PROMs twice prior to surgery, 2–8 weeks apart. PROMs included Non-Arthritic Hip Score (NAH), Hip Disability and Osteoarthritis Outcome score (HOOS), International Hip Outcome Tool (IHOT- 12), and Visual Analogue Scale (VAS) for Medical Care, Feeling and Pain. RESULTS: In the 6-month, 24-month and test-retest groups, patient sample sizes were 52, 40 and 61, respectively. Retrospective 6- and 24-month and test-retest PROMs demonstrated ‘moderate’ to ‘very large’ correlations (ICC=0.42–0.79), except for 6-month VAS-Medical- Care and VAS-Feeling (‘small’) and 24-month VAS-Feeling (‘trivial’). PROMs for the 24- month group reduced, from prospective to retrospective, for NAH-Total (MD -4.10 [-7.93–- 0.27; (95%CI)]; p=0.03), HOOS Symptoms (-8.21 [-13.44–-2.97]; p=0.003), HOOS-Daily- Living (-7.53 [-12.71–-2.36]; p=0.005), HOOS-Sports (-6.49 [-12.97–0.00]; p=0.05), and HOOS-Short-Form (-5.16 [-9.83–-0.49]; p=0.03). Similar non-significant reductions were observed for 6-month retrospective PROMs, except for VAS-Feeling which increased retrospectively (7.47 [0.13–14.81]; p=0.05). Three test-retest PROMs also showed statistically significant reduction, with worse outcomes approaching surgery: HOOS-Daily- Living (-.3.87 [-7.73–0.00]; p=0.05), HOOS-Short-Form (-4.49 [-8.41–-0.53]; p=0.03), and IHOT-12-Total (-4.91 [-8.7–-1.23]; p=0.01). CONCLUSION: Correlations for retrospective versus prospective PROM scores spanned a similar range to test-retest correlations. Therefore, PROM scores relating to pre-surgery condition, but completed 6 or 24 months after surgery, showed agreement with PROM scores completed before surgery which were consistent with the day-to-day variability expected before surgery. This consistency supports the use of retrospective PROMs completed up to 2 years after hip arthroscopy.

BACKGROUND: As New Zealand’s society becomes increasingly multicultural osteopaths are delivering care to a more diverse population than ever before. The provision of high-quality, culturally safe and effective care begins with cultural self-awareness. Cultural self-awareness is the recognition of one’s values, biases, beliefs and stereotypes. The recognition and development of cultural self-awareness early in a student osteopath’s education allow for improved communication, rapport building and patient satisfaction that transitions into professional practice. This study aimed to identify the levels of cultural self-awareness of student osteopaths and to explore the factors that may be associated with these levels. METHOD: A cross-sectional study of osteopathy students from the School of Osteopathy at Unitec Institute of Technology was conducted using an online self-administered survey. The survey contained three questionnaires: A demographic questionnaire, The Cultural Awareness Scale (CAS) questionnaire and the Marlowe-Crowne Social Desirability (MCSD) Scale Short Form-C. Data was analysed using SPSS version 26. RESULTS: A total of 28 students participated in this study (75% response rate). Overall, students reported a moderately high level of cultural self-awareness. Results showed that students who had higher levels of cultural self-awareness also reported higher levels of social desirability response bias. The demographic variables of age and ethnicity had a significant influence on cultural self-awareness regarding students’ general educational experience and cognitive awareness. CONCLUSION: These findings provide osteopathic educators with knowledge regarding baseline levels of cultural self-awareness and identifies factors that may need to be addressed to develop cultural self-awareness in future practice. This is the first known study addressing cultural self- awareness in Unitec osteopathy students and adds to a growing body of research addressing cultural self-awareness in the continued development of culturally congruent healthcare

BACKGROUND: Swimming is a popular and accessible recreational activity and competitive sport in New Zealand. It is also the foundation of many other recreational activities and sports based in, on, and around water. Due to the high level of training that competitive swimmers partake in, the current literature discusses the injuries that may occur from swimming including swimmers’ shoulder, swimmers’ knee, and back pain. Rehabilitation of swimming injuries is paramount to helping swimmers returning to full training and competing capabilities. AIM: To investigate the perception of swimming coaches regarding swimming injuries and their self-reported actions towards injury management in swimming. METHOD: Five swim coaches from New Zealand were recruited to take part in a series of one-toone interviews. These interviews were then recorded and transcribed. The qualitative approach of interpretive description was used to analyse the data and find key themes from the data. RESULTS: Three key themes were identified from this study 1) coaches’ perceptions of injuries, 2) self -reported actions, 3) communication with health care providers. The participants perception of injuries in swimming mainly focused on an event occurring out of the water, that would then be further aggravated and cause issue for the swimmer when training. There was little perception of injuries occurring directly because of swimming. The participants discussed good management strategies that are in line with guidelines to managing injured athletes. Their actions reported decreasing the frequency and intensity of training sessions, while monitoring the strength and fitness of a swimmer returning to full training. The coaches did not communicate with health care providers directly very often and were more often informed of injuries and rehabilitation progress through the swimmer.

BACKGROUND: Psychosocial strategies may be useful in sports-injury rehabilitation by positively influencing rehabilitation outcomes. While there has been some investigation into the use of psychosocial strategies by physiotherapists and athletic trainers, there is no research concerning the views and practices of osteopaths in the area of psychosocial content. OBJECTIVE: To examine osteopaths’ attitudes and self-reported practices towards psychosocial content in sports-injury rehabilitation via an adaption of the Athletic Trainer and Sport Psychology Questionnaire (ATSPQ). METHODS: An online cross-sectional survey using an adapted version of the ATSPQ was used. All respondents were registered osteopaths who have at least two years’ experience, from the United Kingdom, Australia or New Zealand. Descriptive analyses of the data were undertaken. RESULTS: A total of 66 participants (36 male, 30 female) were included. Almost all participants (98.5%) reported that athletes were negatively psychologically affected due to their sports-injury, with the top three negative psychological responses post-injury reported as ‘stress or anxiety’, ‘treatment compliance problems’, and ‘exercise addiction’. Having a positive attitude/optimism was identified as the top characteristic of injured athletes who cope successfully with injury. Poor compliance was identified as the top characteristic of injured athletes who do not cope successfully with injury. The top four psychosocial strategies used in management were ‘encouraging positive self-thoughts’, ‘encouraging effective communication skills’, ‘using short-term goals’, and ‘enhancing self-confidence’. The top three rated psychosocial strategies osteopaths deem important to learn more about were ‘using short-term goals’, ‘reducing stress or anxiety’, and ‘encouraging effective communication skills’. Of the sample, 53 osteopaths (80.3%) indicated that they have no access to an accredited sport psychologist. However, 19 osteopaths (28.8%) make referrals to counselling services, with the average number of referrals per annum being 0.48. A further 61 osteopaths (92.4%) do not have a written procedure for referrals. CONCLUSIONS: This study suggests that osteopaths believe injured athletes are affected psychologically. Associations found between psychosocial responses, behaviours and rehabilitation outcomes, suggest that osteopaths need to be identifying and providing psychosocial support to injured athletes. This study suggests that osteopaths desire to increase their current knowledge and understanding of psychosocial intervention use, therefore, osteopaths may benefit from further education and support in this area. Further research involving larger sample sizes should be undertaken to validate the present findings.

Purpose: To develop a conception of osteopathic practice that assists in defining the profession. Practices by those who comprise a profession are representative of the profession. As such, practices of professional osteopaths were analysed: what they were and how they were conducted, to develop a conception of practice. The key research questions were: What role does clinical reasoning play in defining osteopathic practice? What are the acts that constitute osteopathic clinical practice? How might Pragmatism provide a philosophy that informs the principles and practice of osteopathy? Can Pragmatism provide a bridge to the issues within osteopathy? Method: Pragmatism provided the epistemology with meaning occurring from socially situated acts. Fifteen Australian registered osteopathic practitioners volunteered to have their practice videoed and then respond to a semi-structured interview. The interview addressed questions about the acts that occurred in the consult, with the video recording as a prompt. The transcripts were interpreted, coded and the emergent themes from all transcripts were then pooled and coded to develop knowledge themes. Conclusions: Osteopathic practice is a professional social behaviour that interprets a patient’s concerns with a series of gestures and acts to construct a shared meaning as a basis for ongoing acts that are aligned with establishing meaning relating to the sensitising impulse. Key to these gestures and acts is a structured organised approach that consists of social praxis that supports the conducting of phronesis in the betterment of society. The professional social behaviour contains within it all that is the osteopathic profession and is focused on an individualized experience that occurs within the consult, as the key vehicle of the acts of the profession.

Vibration based monitoring techniques are widely used to detect damage, monitor the growth of inherent defects, system identification, and material parameter estimation for various engineering applications. These techniques present a non-invasive and relatively inexpensive tool for various biomedical applications, for example, in characterizing the mechanical properties of the bone and muscles of humans as well as animals. In recent years, it has been shown that fundamental natural frequencies and corresponding damping ratios can be correlated to the bone health quality indicators as associated with osteoporosis, osteoarthritis etc. In this research, through the investigation of clinical data, an analysis procedure is developed to investigate the correlation between the damping properties associated with both lower and higher modes of vibration and bone health quality. Subsequently, a data-driven system identification tool for reconstructing the parameters (mass, stiffness, damping distributions) in a low-dimensional human model is developed which utilizes selected measurements from the clinical study. It is anticipated that the analysis process and parameter identification techniques presented here can be developed and tuned for any individual human model and can be can be used as osteological monitoring tool for predicting early diagnostics pre-cursors of the bone or muscle related conditions or diseases.

BACKGROUND: ‘Tennis leg’, defined as injury to the distal musculotendinous junction of the medial gastrocnemius, is a relatively common injury sustained during sports and day to day activity. This condition is generally considered to most frequently affect people of middleage. Ultrasound imaging studies have demonstrated that the medial gastrocnemius is the injury most often observed in posterior leg injuries while magnetic resonance imaging studies generally show that soleus is more frequently injured. To date, current ultrasound studies do not report on all characteristics shown on ultrasound, unlike magnetic resonance imaging studies. AIM: To describe the characteristics of clinical information for patients referred for ultrasound imaging of the posterior leg during a 12-month period within a musculoskeletal ultrasound clinic in Auckland, New Zealand. METHODS: 3437 ultrasound reports from the 1st January 2018 to 31st December 2018 were retrospectively reviewed. 63 reports of calf muscle tear were included for final review, and all reported ultrasound imaging findings were extracted into a spreadsheet. RESULTS: This study found 52 reports involving medial gastrocnemius, 9 reports of soleus tear, 1 report of lateral gastrocnemius and 1 report of plantaris tear. The distal musculotendinous junction of medial gastrocnemius was involved in 43 and 7 reported cases of medial gastrocnemius and soleus muscles respectively. In 12 reported cases, a tear was appreciated in the aponeurosis. A total of 22 haematomas were reported, 21 were appreciated alongside medial gastrocnemius tears, while one was in association with a soleus tear. Two reports were indicative of both a tear and associated deep vein thrombosis. CONCLUSION: This study supports that the distal musculotendinous junction of the medial gastrocnemius is the site most frequently injured within the calf, and at least in this sample the middle-aged population were the most represented age group presenting for imaging. Ultrasound imaging appears to be useful in determining the site and extent of injury and also to determine the presence of associated pathology (particularly deep vein thrombosis) in order to determine the most appropriate management for the patient. Future research should determine the relationship between site and size of musculotendinous injury and the time taken to return to activity.

INTRODUCTION AND AIM: There is mounting evidence regarding the existing relationship between stress and adverse health outcomes. As stress is multidimensional, the need for a multimodal approach to manage stress is warranted. There is a high incidence of stress among women compared to men, which can be due to various factors including financial, housing, personal health and occupational stress. Despite some literature indicating the positive effect massage therapy has on stress, there is limited research demonstrating the effects general osteopathic therapy has, either with or without stress management education on reducing stress. Therefore, the aim for this project was to conduct a pilot study assessing the feasibility of a therapy package application on reducing stress in women. METHOD: This was a pilot uncontrolled trial with mixed pragmatic and exploratory design. The therapy package comprised of ten general osteopathic techniques and ten minutes of scripted stress management education, which was applied in two sessions over two consecutive days. The effects of the therapy package were assessed by measuring pre- and post-intervention scores of self-reported perceived stress (Perceived Stress Scale-10 and Profile of Mood Scale) and salivary levels of physiological biomarkers (cortisol, secretory Immunoglobulin A and Interleukin-6). In addition, feedback from participants and challenges experienced by both participants and the researcher assessed. RESULTS: The therapy package was easy to administer to apply to the small sample size in an osteopathic clinical setting. A total of 11 female participants (age = 33.72 years, SD = 12.8) were enrolled, with a 100% retention rate. There were no recorded dropouts and no follow ups. The early morning sessions over two consecutive days were challenging for the majority of the participants. However, all women felt “relaxed” after the therapy package with no reported adverse effects. A significant decrease was observed across all participants in the scores of Perceived Stress Scale-10 over the course of the intervention (p = < 0.03). There were also significant decreases in the subscale scores of the Profile of Mood Scale (Tense, Fatigue, Depression, Anger). Cortisol, interleukin-6 and secretory immunoglobulin-A levels did not show any specific pattern of change over the course of the intervention. Overall there was no clear relationship observed between perceived, psychological stress scores and physiological stress biomarker levels or any clear patterns of change. CONCLUSIONS: The application of the therapy package was feasible. The overall decrease in the Perceived Stress Scale-10 scores in the majority of participants suggests that the plausibility of this therapy package (ten selected osteopathic techniques, in combination with stress management education), contributed to reducing perceived stress. However, the effect on physiological stress was not clear, the results need further investigation. Future studies may benefit by employing randomised controlled trial design, with a larger sample size. Additionally, future researchers may need to consider utilising physiological biomarkers without diurnal variation and employing a flexible time for therapy application.

BACKGROUND: Novice healthcare practitioners experience challenges to their understanding of their profession when entering the new environment of clinical practice. These challenges inevitably affect professional identity development. The literature demonstrated a connection between professional identity, job satisfaction and attrition which is why there is a need to understand how professional identity develops. AIM: To explore the lived experiences of novice osteopaths as it relates to the development and influences on their professional identity. METHOD: A descriptive phenomenological study of seven novice osteopaths currently practising in New Zealand. The novice osteopaths were interviewed using semi-structured interviews. Recordings were then transcribed and transcripts were thematically analysed. RESULTS: Influences on professional identity development of the novice osteopaths in this study were classified as extrinsic and intrinsic. Extrinsic influences included realities of practice, mentorship and support, and education. Intrinsic influences included self-identity and life experiences. CONCLUSION: The results from this study strengthen and confirm the knowledge in the literature surrounding professional identity development, that both intrinsic and extrinsic influences affect how professional identity develops. In this study, extrinsic influences emerged as the dominant influences. The participants in the study put great emphasis on the effect that extrinsic influences like education, experiences with other practitioners and mentorship had on professional identity construction. The findings of the study highlighted a need for greater awareness and understanding of osteopathy by the New Zealand public. Furthermore, it was apparent that new practitioners

RESEARCH QUESTION: How feasible and effective is the therapy package in reducing perceived and physiological stress in men? ABSTRACT: BACKGROUND Stress is thought to have negative effects on the cardiovascular, nervous, immune, gastrointestinal and reproductive systems. Multimodal interventions may confer benefits for stressed populations. They are time effective and are thought to address multiple types of stresses. However, there is limited research examining the effects of manual therapy with or without psychoeducation on promoting relaxation and reducing stress. In particular, studies examining male population are rare, despite the incidence of stress and mental health concerns in men coming more into focus. METHODS: This pilot, uncontrolled trial with mixed pragmatic and explanatory design, assessed the feasibility of applying a therapy package designed to reduce stress in men. The objectives of this study were to: (1) assess the feedback from participants and challenges encountered; (2) assess the health status in 7 men using health screening measures, such as blood pressure, pulse and adapted medical history; (3) to determine baseline levels of physiological stress biomarkers (cortisol, sIgA and IL-6); (4) to assess baseline perceived stress in 7 men, using the adapted Perceived Stress Scales and Profile of Mood Scale; and (5) to undertake an uncontrolled trial with mixed pragmatic and explanatory design to assess the feasibility and effects of a therapy package on stress (psychological and physiological), delivered on 7 men, on two consecutive days. The therapy package included ten general osteopathic techniques, ten minutes of stress management education and an education pamphlet. The effect of the therapy package was assessed through pre- and post-intervention salivary levels of stress biomarkers (cortisol; secretary Immunoglobulin A; Interleukin-6) and self-report of stress (Perceived Stress Scale- 10; Profile of Mood Scale). RESULTS: The therapy package was easy to administer and its application in a clinical osteopathic practice setting with a small number of male participant (n=7) was feasible. The follow up and retention of participants was positive. The timing of sessions on consecutive days was challenging and this may have affected the recruitment of participants. A significant decrease was observed across all participants in Perceived Stress Scale-10 over the course of the intervention (ps < 0.05). There were also significant decreases in some of the subscales of the Profile of Mood Scale (Tense, Fatigue, Depression, Anger). In contrast, cortisol, secretary Immunoglobulin A and Interleukin-6 levels increased in the majority of participants and no clear relationship between psychological and physiological stress measures could be observed. DISCUSSION: The application of the therapy package and the collection of saliva was feasible. Participants of the study showed an overall decrease in psychological stress suggesting that manual therapy in conjunction with stress management education may work to promote relaxation and reduce stress. The effect on physiological stress in men was, however, less clear. Future studies with larger sample size and the use of non-diurnal samples, such as hair samples, may usefully extend the examination of the effects of a therapy package consisting of manual therapy and stress management education.

RESEARCH QUESTIONS: (1) What are the clinical outcomes of patients receiving a corticosteroid injection into the SASD bursa for SASD bursitis (2) If patients return to their referring rehabilitation provider following the injection, how does this affect their outcomes compared to those that do not return? 3) If patients are prescribed rehabilitative exercises by their referring rehabilitation provider, how does adherence to these exercises affect their outcome? ABSTRACT: BACKGROUND: Shoulder pain is among the most common musculoskeletal complaints, and subacromial impingement syndrome (SIS) is the most common cause. The subacromialsubdeltoid (SASD) bursa can become irritated and inflamed in SIS, leading to a diagnosis of SASD bursitis. Corticosteroid injection (CSI), manual therapy and rehabilitative exercises are common treatment options for shoulder pain. Manual therapy and rehabilitative exercises may be useful in the period of short-term pain relief following CSI. For SASD bursitis, it is relatively unknown to what extent CSI and subsequent manual therapy and rehabilitative exercises affect outcomes. Therefore, this study aimed to establish the clinical outcomes of patients after receiving a single CSI into the SASD bursa for SASD bursitis and to investigate how returning to a rehabilitation provider and being adherent to rehabilitative exercises postinjection affects outcomes. METHODS: A total of 64 participants diagnosed with SASD bursitis by a sonographer based on ultrasound imaging received an ultrasound-guided injection of corticosteroid and local anaesthetic into the SASD bursa. The recruitment period was 2 February until 21 May 2019. Participants completed questionnaires at pre-injection and at time intervals of 3-5-days, 3- weeks and 3-months post-injection. The Shoulder Pain and Disability Index (SPADI) was the primary outcome measure while the Pain and Sleep Questionnaire three-item index (PSQ-3) was the secondary outcome measure. The Exercise Adherence Rating Scale (EARS) was used to obtain information on participants adherence to rehabilitative exercises. RESULTS: There were statistically significant decreases in SPADI scores 3-5-days (p≤0.001), 3-weeks (p≤0.001) and 3-months (p≤0.001) post-injection. There were also statistically significant decreases in PSQ-3 scores 3-5-days (p≤0.001), 3-weeks (p≤0.001) and 3-months (p = 0.001) post-injection. The difference in SPADI scores at the3-month follow-up between those participants who returned to a rehabilitation provider and those who did not was not.

OBJECTIVE: To examine and identify the breadth of definitions and measures of objective and subjective spinal stiffness in the literature, with a focus on clinical implications and research opportunities. DATA SOURCES: Eligible peer-reviewed studies were identified using PubMed, Ebsco health, and Scopus electronic databases. DATA EXTRACTION: Following the 6-step framework by Arksey and O’Malley1 and based on the eligibility criteria, studies that reported definitions and measures of spinal stiffness were collected using a data abstraction form and classified into four themes; biomechanical, surgical, pathophysiological and segmental spinal assessment. Fifteen categories to identify similarities and differences between studies were generated. DATA SYNTHESIS: Among 2121 records that were identified, 333 met the eligibility criteria. There were 299 subjective and objective measures (124 subjective;175 objective measures) and 60 indicators of spinal stiffness. The majority of studies (n = 72%) did not define stiffness and there is no consensus regarding a standardised definition of stiffness in the reviewed literature. CONCLUSION: This review highlights the breadth of objective and subjective measures that are both clinically and methodologically diverse. There was marked variation in the definitions reported in studies. There were no definitions of stiffness provided alongside self-reported or patient-reported outcome measures. Stiffness is a clinically important symptom that may indicate the presence of underlying pathophysiology/disease which has implications for patients’ health outcomes. An important distinction should be made between the patient’s subjective reports of stiffness and this may differ from objective clinical assessments.

A key distinction of Doctors of Osteopathic Medicine (D.O.s) is their recognition of each patient as a whole person rather than just addressing his ailment. This focus previously highlighted physical manipulation over medications; however, the osteopathic profession has evolved significantly over the years. As this field is no longer identified by its original rejection of pharmaceuticals, other original principles of osteopathic medicine have impacted the growth of the field. The data collected from surveyed patients indicated that many osteopathic patients and physicians have religious backgrounds, and there is a widespread emphasis on psychological integration. The increased number of patients is largely due to the increased prevalence of osteopathic physicians, with growth of the field supplemented by good experiences and recommendations.

Bone has several crucial functions including mechanical support of movement, hematopoiesis, maintenance of mineral homeostasis, and energy regulation. Bone also undergoes continuous remodeling to maintain its structural integrity, which suggests it has strong respiration and energy consumption capability. It has been shown that during development, bones, in particular, osteoblasts, rely on glucose uptake for proper skeletal development. However, the effect of energy utilization on osteocytes’ function is currently unknown. Osteocytes are terminally differentiated osteoblasts and are deeply embedded into the mineralized matrix of bone. Previous studies have shown that PTH promotes bone anabolism, in part, by stimulating osteoblasts anaerobic glycolysis while suppressing glucose oxidation through the TCA cycle. In osteocytes, PTH suppresses Sost expression (the gene encoding a potent inhibitor of bone formation) by inducing HDAC4/5 nuclear translocation and MEF2C inhibition. Recently, Scriptaid, an HDAC complex inhibitor, has been shown to induce Mef2 expression and exercise-like adaptation in mouse muscles. In myocytes, Scriptaid disrupts the HDACs co-repressor complex and induces nuclear export of HDAC4/5 with MEF2 activation. This will subsequently increase the expressions of several genes related to energy utilization such as Glut4 and Pdk4. Thus we hypothesized that Scriptaid might regulate Sost and Glut4 expression in osteocytes. To investigate the effect of Scriptaid on osteocytes, we treated a mouse osteocytic cell line, Ocy454-12H, with Scriptaid. Unexpectedly, Scriptaid potently suppressed Sost, whereas it increased Glut4 expression. Scriptaid stimulated osteocyte respiration and glucose consumption rate. Mechanistically, Scriptaid treatment of Ocy454-12H induced nuclear translocation of Hdac5 whereas it did not affect Hdac4. Silencing of Hdac5 expression with shRNA increased Sost basal expression and blocked Sost suppression induced by Scriptaid. However, Glut4 up-regulation by Scriptaid was independent of the HDAC4/5-MEF2C pathway. Glut4 luciferase reporter assays demonstrated that two additional transcription factors binding sites, O/E&NF1 and C/EBPα, may mediate Scriptaid-induced Glut4 up-regulation. Taken together, these data demonstrate that in osteocytes Scriptaid suppresses Sost expression through regulating HDAC5-MEF2C signaling. However, Scriptaid increases Glut4 expression through Hdac5-independent mechanisms, and dependent on O/E&NF1 and C/EBPα.

Bone Morphogenetic Proteins (BMPs) belong to the Transforming Growth Factor Beta superfamily of growth factors. While BMP signaling has been shown to induce skeletogenic differentiation of mesenchymal stem cells and be involved in the formation of ectopic bone and ossification, BMPs also are involved in the differentiation of many other tissues including neurogenic tissues. Prior studies from our laboratory showed that BMP-2 induction of chondrogenic differentiation of the C3H10T1/2 murine mesenchymal stem cell line was associated with increased oxidative metabolism. This study was performed to test the hypothesis that BMP-2 promotes increased oxidative metabolism during the differentiation of other types of cells. Using the neurogenic cell line, SH-SY5Y, this study examined whether cellular differentiation induced by BMP-2 also was associated with increased oxidative phosphorylation in non-mesenchymal stem cells. SH-SY5Y cells were grown in growth medium (DMEM/F12 with 10% FBS, 1% Penicillin/Streptomycin, L-glutamine, and non-essential amino acids). Cells were plated appropriately at differing seeding densities (Day 0), treated one time with ± 200ng/mL BMP-2 two days after plating and analyzed on Day 4. Oxidative metabolism was measured using a Seahorse XF Analyzer that measures oxygen consumption rate (OCR) and extracellular acidification rate (ECAR). BMP-2 induction of neural cell differentiation was assayed by quantifying dendrite communication between neurons and decreased proliferative capacity as assessed by overall culture DNA contents. Mitochondrial density after BMP-2 treatment was examined using vital mitochondrial labeling. Groups treated with BMP-2 contained significantly less DNA content than control groups (p=0.006). BMP-2 treated cells had on average more dendritic interactions with one or two and more processes than control groups (p=0.396; p=0.872), while there were a larger percentage of cells not treated with BMP-2 that had zero dendritic interactions (p=0.470). All parameters of oxidative metabolism were increased in cells treated with BMP-2. More specifically, basal respiration and ATP production were significantly increased in BMP-2 treated cells (p=0.031; p=0.010). SH-SY5Y cells were significantly affected by BMP-2 treatment in both DNA content and oxidative phosphorylation. The diminished DNA content with BMP-2 treatment is consistent with the known decrease in cellular proliferation that is associated with neural cell differentiation. While there were small increases in dendritic interactions these were not significant and are inclusive for demonstrating BMP-2’s effect on neural differentiation. Upregulation of oxidative phosphorylation indicated after BMP-2 treatment was validated by the substantial increases in metabolic parameters associated with BMP-2 treatment. Through the utilization of the neural cell line, SH-SY5Y, this research suggests a more generalized functionality of BMP-2 in upregulation of oxidative metabolism as well as differentiation non-specific to bone and chondrocyte cell lineage.

In New Zealand, osteopaths can lodge Accident Compensation Corporation (ACC) claims, on behalf of patients, for accidental injury. ACC provides treatment and rehabilitation services for patients following injury. Postgraduate osteopathy students practice and develop their skills under supervision at teaching clinics. Anecdotal evidence suggested that a number of potentially eligible ACC claims were not being lodged. This study involved a clinical audit exploring this issue, and possible reasons for misinterpretation of ACC injury claims. AIM: To investigate the extent to which new patient files in the osteopathy teaching clinic satisfy ACC’s criteria for an injury claim. Methods: A clinical audit was performed on 290 new patient records randomly sampled from clinical records between 1st January 2016 to 31st December 2016 and 1st January 2017 to 31st December 2017.Each record was systematically processed and categorised into contingency tables to address each of the objectives. METHODS: A clinical audit was performed on 290 newpatient records randomly sampled from clinical records between 1st January 2016 to 31st December 2016 and 1st January 2017 to 31st December 2017. Each record was systematically processed and categorised into contingency tables to address each of the objectives. FINDINGS: 29.7% of possible claims were not made when they appeared to meet ACC criteria for an injury claim. The overall accuracy was 70.3% (95%CI 64.7-75.5%). Between years 2016 and 2017, the results supported instances of underclaiming for ACC injury. When following the same cohort of students from Year 1 to Year 2 there was no difference in the level of observed accuracy (95%CI for Accuracy in Year 1 = 57.4-81.5% and 64.5-86.9% in the same cohort in their second year). No significant difference in accuracy was identified over time (R2 = 0.03). CONCLUSION: A significant proportion (~30%) of the sample meet ACC criteria for an injury claim when no claim was submitted. There were no instances of submitting a claim when the clinical history appeared not to meet ACC criteria.

PURPOSE OF THE STUDY: At present, more than 3% of women and girls in New Zealand (NZ) experience symptoms of endometriosis. The purpose of this study was to investigate the experience of a sample NZ women who considered osteopathy to be effective in dealing with their symptoms of endometriosis and to relate the findings to the literature regarding the success of complementary and alternative medicine for the management of endometriosis. This study sought first-hand responses from participants in order to help provide insight into how to improve the management and support available to women as they manage this highly complex condition. The study also sought to establish a case for further research into osteopathy as supplementary management. The thesis presents the findings of the study and suggests implications for osteopaths and other health professionals who provide treatment and advice for women with endometriosis. It concludes with providing suggestions for future research regarding the direct effects of osteopathic treatment on symptoms of the disease. METHODS: Using a qualitative descriptive approach this thesis explored the experiences of a convenience sample of NZ women diagnosed with endometriosis who had each experienced osteopathy as part of their management for the condition. Interviews were conducted with four women aged 30-50 years, who had a laparoscopy-confirmed diagnosis of endometriosis. All of the women had included osteopathy as a strategy for managing the symptoms of endometriosis. The interviews were recorded and transcribed verbatim. Data analysis followed the steps of the thematic analysis described by Braun and Clarke (2006) FINDINGS: The main themes that emerged from the interviews included: the value of osteopathic treatment for increased quality of life by empowering participants and encouraging self-management; the importance of osteopathic characteristics such as understanding the significance of patient-centred care and having compassion, building trust, making time, and encouraging relaxation; and the positive impact of osteopathy on the physical self through touch, treatment being a positive experience, and the holistic method of both assessment and treatment. DISCUSSION: The participants expressed their past and current ‘battle’ with the physical and psychological symptoms associated with endometriosis and how these impacted on quality of life. All participants had accepted that they would not find a cure for their endometriosis, instead, they each sought support and guidance to manage the associated symptoms rather than relying solely on pain medication. The findings suggest that the contributing factors to a successful treatment outcome are multifactorial and do not solely depend on the technical skill of the practitioner. Rather, a successful treatment includes a complex and dynamic relationship between the patient and practitioner which is built on trust and compassion. CONCLUSION: The findings of this study justify further research examining the role of osteopathy as an option for the management of endometriosis including both physiological and psychological symptoms associated with endometriosis

BACKGROUND: Anterior cruciate ligament (ACL) reconstruction is one of the most frequent orthopaedic surgeries in young, active people. Secondary graft rupture is common and there is insufficient long-term evidence supporting the application of different surgical techniques to reduce its risk. OBJECTIVE: To investigate and compare outcomes of three primary ACL hamstring graft reconstruction surgeries. METHODS: Retrospective analysis of primary ACL reconstructions undertaken by one surgeon between 2006 and 2012 using three techniques of different graft placements and anchors were compared: (1) Single bundle graft at the site of the antero-medial bundle (SB), (2) a double-bundle graft with proximal and distal endobutton fixation, (EB), and (3) a double-bundle graft attached in a continuous loop with minimal fixation (MF). The primary measure was ACL graft rupture post-operatively. Secondary outcomes included recurrent rotatory instability, return to sport incidence and time-frame, and patient reported outcome measures (PROMs). RESULTS: A total of 216 participants were included (51, 77 and 88 in SB, EB and MF, respectively), 145 (67.1%) male, and aged 30.38 ± 11.63 (mean ± SD). Patient gender between the three groups was significantly different: 37 (72.5%) for SB, 58 (75.3%) for EB and 50 (56.8%) for MF (p = 0.026). There were 151 (69.9%) cases of concomitant injuries (meniscal or chondral), with meniscal injuries making up 65.7% of these injuries. The rates of meniscal injuries were significantly different between the three surgical groups (72.5%, 67.5% and 53.4% for SB, EB and MF, respectively (p = 0.046). Graft failure occurred in 17 (7.9%) surgeries and did not differ statistically between the three surgical groups (p = 0.284) at 8.4 years (SD ± 2.2) follow-up. At a follow up of 9 years (IQR = 7 – 10), 79.3% of participants felt stable with pivoting movements, with no significant difference between groups (p = 0.353). Levels of pre- and post-injury activity were not significantly different between groups when using Marx and Tegner scores (p=0.055, p=0.481), with 56.6% of all participants returning to their previous level of sport at median time of 26.00 (IQR = 12.00-42.50) weeks. CONCLUSION: There were no differences in ACL graft rupture rates or patient-perceived stability after more than 8 years follow-up between three primary ACL reconstruction hamstring graft techniques.

OBJECTIVES; Chronic shoulder injuries are prevalent amongst surfers and one potential underlying cause may be a lack of mobility in the thoracic spine. The objective of this cross-sectional study was to investigate the relationship between shoulder pain and thoracic mobility in surfers. METHODS: Surfers were recruited using emailed invitations to an existing database of surfers, and notices posted to surfing related social media sites. Auckland based surfers participated in a 30-minute measuring session where thoracic mobility was assessed using an electrogoniometer. Participants identified their level of shoulder pain and disability using a modified version of the Sports/Performing Arts Module in the Disability of the Arm, Shoulder and Hand (DASH) questionnaire in addition to identifying descriptive details such as age, height, surfing skill (Hutt Scale), and surfing history. RESULTS: Forty-one participants were recruited (n=29 males, n=12 females; mean ± SD age = 38.7 ± 11.9y, range (19-68 years)). No correlation was found between thoracic mobility and DASH scores. Findings showed a positive relationship between age and shoulder pain (r=.324*(-0.008, 0.635) p=0.039); skill level of the surfer and frequency surfed during the previous summer were also found to be correlated (r =.490** (0.207, 0.775) , p=0.001). There was a positive relationship between height and seated mobility in the lumbar spine (r =.311* (-0.034, 0.573), p=0.048). Lower thoracic spine symmetry was positively correlated with upper thoracic seated mobility (r =.349* (-0.013, 0.612), p=0.025). Negative relationships included frequency of surf sessions and shoulder pain (r =-.374* (-0.653, -0.049), p=0.016), and age and upper thoracic seated mobility (r =-.355*(-0.603, -0.023), p=0.023). Upper and lower thoracic spine prone mobility was negatively correlated (r =.365* (-0.628, -0.051), p=-0.019), and this was the same for lumbar spine prone mobility and age (r =-.417**(-0.648, -0.137), p=0.007). Other relationships that correlated negatively were upper thoracic paddling symmetry and frequency surfed during the previous summer (r =-.311*(-0.561, -0.023), p=0.048), and lumbar spine and lower thoracic spine paddling symmetry (r =-.415** (-0.676, -0.133), p=0.007). CONCLUSION: The correlation between DASH scores and thoracic mobility in the seated or prone position in this sample of surfers was small. Further research, such as a prospective longitudinal study exploring risk factors for the development of shoulder symptoms associated with surfing would be beneficial.

Keeping clinical records of patient interactions in the medical profession is a legal obligation for any practitioner. Each medical profession has their own guidelines and requirements for what needs to be written within each record, with importance being placed on maintaining good quality records due to the potential consequence of patient adverse events and legal retributions. In this study, 193 new patient clinical records from a two- year period were audited. The aim was to determine if osteopathic students were compliant with all relevant record keeping standards and requirements in New Zealand. This current study employed a new Modified Clinical Record Keeping Tool (M -RKAT), alongside an interpretation guideline for each of the 57 items within the tool. A numerical scoring system was applied (1-5) and two benchmarks for the records were set. One of a mandatory level of completion of 50%, and one of a satisfactory level of completion of 75% for all clinical records. Statistical Analyses was preformed using SPSS software to calculate descriptive statistics and test the data for normality. Whilst a one-way repeated ANOVA score was calculated to ascertain any change in record-keeping over time. Findings showed that over the 193 records, the M -RKAT mean score was 72.30% (SD 5.79) 95% CI (71.47, 73.12), which fell below the 75% benchmark of satisfaction for clinical record keeping. The level of quality for the student clinical records did not change over the two -year period. The study also found that 38 out of 57 items needed to be improved upon in terms of quality as all gained a score of 3 or below which fell below the standard for record keeping. This study provides evidence to support further research, encouraging a full audit process to be taken in the future to see if improvements can be made in student clinical record keeping following intervention.

BACKGROUND: Professional dancers almost invariably experience injury at some point in their dance careers. There is weak evidence to show that many dancers do not seek professional consultation to manage their injuries. Moreover, many dancers attempt to continue to practice and perform and this can negatively impact on their physical, mental and emotional wellbeing. When treatment is sought, manual therapists (such as osteopaths, physiotherapists) are most commonly consulted. Despite this, there is minimal research examining dancers’ experiences of manual therapy, and more specifically, their experiences of consulting osteopaths. AIM: To explore New Zealand dancers’ experiences of osteopathic care for dance-related injuries and their attitudes towards seeking help for dance injuries. METHOD: A descriptive phenomenological study of four New Zealand professional dancers. Dancers were interviewed using semi-structured and open-ended interview techniques. Transcripts were analysed using Braun and Clarkes’ approach to thematic analysis. RESULTS: Three essential themes were revealed which helped provide insight into dancers’ attitudes towards injuries and their experiences of osteopathy. The first theme ‘pushing through pain’ considered some of the reasons for dancers to continue to dance despite injury. The second theme, ‘deciding if and who’ explained some of the factors that dancers contemplated when deciding whether their pain or injury warranted treatment. The third essential theme, ‘experience of different treatment modalities’ provided an insight of what dancers found most helpful during consultations and treatments. CONCLUSION: Participants’ attitudes towards injuries were compelling with their decision-making being influenced by pressures within dance culture coupled with self-expectations. Dancers were often competitively driven and their hesitancy to seek treatment may be similar to those identified in other high-level athletes involved in other sports. The fear of disappointing their peers and colleagues appeared to be more dominant in the accounts of dancers than what has been reported for other athletes. Dancers found osteopathy to be beneficial, which was largely attributed to positive communication and the whole-body treatment approach used by osteopaths. It is important for osteopaths to be aware of the challenges dancers face surrounding their pain and injuries in order to produce the best possible outcome.

BACKGROUND: Bariatric surgery is an effective weight loss treatment modality for people with morbid obesity, however, there may be a negative impact on postoperative bone health. This review summarizes changes of different bone mineral density dual-energy x-ray absorptiometry measurements, with specific attention to the laparoscopic sleeve gastrectomy and the roux-en-y gastric bypass. METHODS: PubMed and the Cochrane Library searches yielded 156 articles published before November 2017. The articles were evaluated based on the following inclusion criteria: focus on laparoscopic sleeve gastrectomy or roux-en-y gastric bypass and bone health, written in English, full-length article, studied participants for one-to-two years, and included statistical measurements. RESULTS: Of the 156 studies that were initially screened, 16 full-length articles were included in the final analysis. The articles described a lower loss of bone density at the lumbar spine, femoral neck, forearm, and total hip after laparoscopic sleeve gastrectomy when compared to roux-en-y gastric bypass, however, these studies lack statistical power due to the small sample sizes of less than 10 participants. CONCLUSION: The number of bariatric surgeries continues to increase worldwide, however, the literature provides limited studies that evaluate the effects of bariatric surgery on bone health, more than two-years postoperative. Further study is necessary to determine the mechanisms of bone loss after bariatric surgery, with great attention to differences in bone health between sexes.

RESEARCH QUESTIONS: 1. What documentation exists regarding paediatric osteopathic competence? 2. What is the nature of, and the need for practical clinical skills in the osteopathic care of children? 3. What are stakeholders’ views regarding best practice for the acquisition of clinical skills for the osteopathic care of children? 4. What are stakeholders’ views as to the learning theories involved in the acquisition of clinical skills for the osteopathic care of children? ABSTRACT: Paediatric care is a popular and growing area of osteopathy. This area of practice is sparsely regulated and there are inconsistent educational standards. There is also a gap in the literature regarding competency and education in this field. This research aims to discover the opinions of key stakeholders regarding practical osteopathic skills for paediatric care. This study employed qualitative research methods using an interpretative approach by conducting three focus group interviews at an international osteopathic conference held in New Zealand. The select groups were separately comprised of regulators, educators and practitioners. Thematic coding was employed to analyse themes across the responses of the three stakeholder groups. The opinions of all three stakeholder groups were consistent in identifying a need for direct educational instruction for the acquisition of practical clinical skills in paediatric care. For a basic level of competence, that is especially important for clinical safety, the groups were in general agreement that this education should occur in the pre-registration period. The practitioners’ group was the least clear regarding training delivery. There was strong agreement across the educators’ and regulators’ groups that theoretical education, followed by clinical observation and then low-ratio supervised practice in paediatric focussed clinical time, is what is required. A significant consideration for further consultation and development of this area of practice is that the practitioners’ group expressed the least objectivity about conscious competency, the necessity of training and educational considerations. The regulators and educators identified the general absence of competencies for the care of children across the international profession. The key recommendation for all stakeholders is for an international approach to the development of more specific competency and accreditation standards for the osteopathic care of children.

RESEARCH QUESTION: What are the experiences of informed consent in a New Zealand clinical osteopathic consultation for six patients? ABSTRACT: Medical informed consent is described as permission to perform mutually agreed upon examination and treatment after understanding the risks and benefits of multiple options. The informed consent process is at the heart of patient centred care and ethical practice in all health professions, yet there is a limited research base about patients' lived experience of informed consent in an osteopathic context. Using semi-structured interviews, this study explored how six patients experience the informed consent process in a single New Zealand osteopathic clinical setting. Interpretative Phenomenological Analysis (IPA) was used to analyse these experiences. The results show that information exchange and active patient engagement play significant roles. The patients in this study have little recollection of an initial and explicit consent process but instead, describe the ongoing process of consent as their treatment progresses. Information from this research can be used to help osteopaths understand the patient experience of consent which could lead a greater collaboration between patient and practitioner.

BACKGROUND: There are complex expressions of gender and sex inherent within the three professions of chiropractic, osteopathy, and physiotherapy. These professions commonly use the body of the practitioner to provide treatment for the body of the patient (more so than most other regulated healthcare modalities), yet the application of a sex and gender lens in this context seems to have received scant attention within the literature. OBJECTIVES: To examine the nature, range and extent of research investigating the impacts of sex and/or gender on patients and practitioners within the professions of chiropractic, osteopathy and physiotherapy, to identify areas for further research. METHOD: A scoping review based on the Arksey and O’Malley (2005) framework was conducted. Sixteen online databases were searched, with no date or geographical restrictions. RESULTS: Forty-eight papers from eight countries, including peer reviewed publications and grey literature, were selected for inclusion. Thirty-five of the papers used related to physiotherapy, nine to chiropractic, one to osteopathy, and three to a combination of these professions. Ten themes were identified. Thirteen textbooks used to teach technique skills to student chiropractors, osteopaths and physiotherapists in New Zealand were also included. Technique textbooks used within these three professions in New Zealand demonstrate a significant under-representation of females as practitioners, compared to males. CONCLUSION: There are numerous opportunities to address significant gaps in research utilising various methodologies and covering a wide range of topics applying a sex and gender lens, relating to the professions of chiropractic, osteopathy and physiotherapy. It seems the proportions of males and females employed within chiropractic, osteopathy and physiotherapy have greatly influenced the volume and direction of research undertaken to date. This scoping review has also highlighted a need for a comprehensive audit of teaching resources for chiropractic, osteopathy and physiotherapy as there are currently few textbooks showing female practitioners demonstrating techniques, particularly high-velocity, low-amplitude thrusts (HVLATs).

BACKGROUND: Musculoskeletal ultrasound (MSK US) imaging provides visualisation of a large number of superficial anatomical structures including nerves, joints, ligaments, tendons and muscles. The utility of ultrasound has been compared to other common imaging techniques such as Magnetic Resonance Imaging (MRI,) and is proving to be of similar, or better accuracy, for some applications. In New Zealand, ultrasound is a secondary level service, requiring referral from a primary practitioner. Included in primary health services are musculoskeletal practitioners (physiotherapists, osteopaths, podiatrists and chiropractors). These professions often rely on palpation and physical examination to inform diagnostic reasoning. However, there are limitations related to accuracy of this approach. Diagnostic ultrasound is a tool that can be used to inform clinical practice by aiding diagnosis of musculoskeletal conditions. To date, there appears to be just one study investigating referral protocols for musculoskeletal ultrasound. AIM: The aim was to identify the descriptive characteristics of cases referred to one sonographer, working within a private MSK US practice located within an osteopathy tertiary teaching clinic in Auckland, New Zealand. Methods: A retrospective stratified random sample of 1000 cases was sampled from the total number of available records from one practice between 1 January 2016 and 31 December 2016. Two sources of information were available for each case: a single referral request (paper-based referral request), and the associated sonography imaging report (radiologist endorsed sonography report letter). Information extracted from these sources included patient demographic characteristics, referrer characteristics, descriptive referral request, and imaging report information. Systematized Nomenclature of Medicine – Clinical Terms coding was used to code referrer queries and sonographer’s diagnostic opinions. RESULTS: The most common body regions referred for scanning were shoulder (27%) followed by knee (16%) and ankle (15%). Clinical indications for sonography requests were investigated, referrers wrote a maximum of 5 clinical indications per referral. Clinical indications generally included ‘location of pain’, ‘mechanism of injury’, ‘positive orthopaedic tests’, and ‘history of injury’. Only 27% of referrals provided a time since injury while the majority included other specific information such as clinical signs (e.g. ‘positive orthopaedic tests’). Overall, 35% of referrals did not include a query (median number of queries per referral was 1 (IQR=2)). Excluding those who did not include a clinical query with their request (35%), those who gave a smaller number of queries generally had a higher level of agreement between their queries and the sonographer’s opinion. CONCLUSION: This project explored the characteristics of referral requests and sonography report. Further research is needed to explore the utility of referral for diagnostic ultrasound by musculoskeletal practitioners, and to determine whether referral protocols should be developed to increase efficacy of the referral process.

BACKGROUND: Pain related complaints form one of the most common, and most costly, presentations of patients in healthcare in New Zealand and worldwide. Theories of pain such as the biopsychosocial and fear-avoidance models aim to provide a multidimensional framework from which pain can be approached, considering various aspects of how pain affects people. The most effective pain management approaches seem to be multimodal and patient-specific. The Reinforcement Sensitivity Theory proposes two neurophysiological systems that regulate impulsivity and anxiety in human behaviour: the behavioural activation system and the behavioural inhibition system. It has recently been suggested that sub-grouping individuals affected by pain based on their levels of activation and inhibition could facilitate the allocation of more effective management strategies. DESIGN Cross-sectional survey design. AIM: To establish which of the following best predicts average intensity and duration of musculoskeletal pain: fear avoidance beliefs, kinesiophobia, and levels of behavioural activation or inhibition system. METHODS: Surveys were made available online to adults in New Zealand with pain complaints, and to patients at the Unitec Osteopathic Clinic, Clinic 41. Data were gathered over a three month period and analysed using Spearman’s rho correlations, linear regressions and a between groups analysis assessing for differences between high and low intensity pain and levels of behavioural activation or inhibition. RESULTS: Correlational analyses showed significant positive relationships between pain intensity and fear-avoidance beliefs, kinesiophobia, and disability, as well as between pain duration and fear-avoidance, kinesiophobia and perceived disability. Regression analyses showed fear-avoidance beliefs, kinesiophobia and disability accounted for 31% of pain intensity variance. Disability alone accounted for 5% of the pain duration variance. Neither iv behavioural activation nor inhibition systems significantly related to or predicted pain intensity or duration. CONCLUSION: This study provides further support for the inter-relationships between fear avoidance beliefs, kinesiophobia, disability and pain duration and intensity. The results do not show explicit support for the behavioural activation or inhibition systems relating to pain intensity or duration. It is suggested that this may be due to the measurement instrument, which could be explored in further studies..

BACKGROUND: Chronic low back pain (LBP) is considered one of the most disabling health conditions worldwide. There is overwhelming evidence that psychosocial factors are important risk factors in the development and maintenance of chronic LBP. It appears that healthcare practitioners’ attitudes and beliefs regarding LBP can significantly influence the views of their patients. AIMS: To identify common LBP attitudes and belief orientations of New Zealand osteopathy students. The secondary aim was to investigate psychometric properties of the tool, the Back Pain Attitudes Questionnaire (Back-PAQ) which has had limited prior testing. Methods: An online cross-sectional survey was conducted that included basic demographic information, the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS) and the Back Pain Attitudes Questionnaire (Back-PAQ). Students marked on a Likert scale how strongly they agreed or disagreed with each item in the questionnaire. The convergent validity and internal consistency of the Back-PAQ was also evaluated against the HC-PAIRS. In total 83 students participated in this study. RESULTS: The median Back-PAQ and HC-PAIRS scores for students across all year levels were 6.5 and 46.0 respectively. Median Back-PAQ scores for Year 1 and 2 students were 10.0 and for Year 4 and 5 students’ 17.0. Third year students’ scored 11. Scores for the HC-PAIRS for Year 1 and 2 students were 54.0, Year 3 students scored 50 and for Year 4 and 5 students were 35.0. The Back-PAQ had ‘good’ internal consistency (α= 0.88) and acceptable convergent validity (Pearson’s r = - 0.77, P value

AIMS: It is not commonly known that osteopathy can be beneficial for children with otitis media (OM). The research aims of this study are twofold. Firstly, to explore the parents’ experience of having their child treated for otitis media by an osteopath. Secondly, to stimulate the discussion regarding adjunct treatments for otitis media. DESIGN: A qualitative study using interpretive description. Recruitment was via advertising material in osteopathic and allied health clinics in the greater Auckland region as well by as word of mouth. Data were collected via semi-structured audio-recorded interviews, analysed thematically and themes evolved through the process of interpretative description. FINDINGS: Irrespective of the outcome of the osteopathic treatment for otitis media, all participants continue to use osteopathy as a treatment option for themselves and their families. Three themes were identified, (1) first line treatment paths, (2) the emotional impact of parenting a child with otitis media (3) osteopathy for otitis media. An overarching theme ‘Do you hear me’ refers to the interpretation of the ever-present subtext of caring for a child with OM. CONCLUSIONS: Osteopathy offers a non-invasive, drug-free treatment approach for children with otitis media. Research suggests osteopathy could have a place in providing adjunct treatment to standard biomedical care for otitis media. Regardless of the chosen treatment, positive shared decision making between care giver and health professional plays a significant role in the outcome of a child’s illness narrative.

Despite the increasing emphasis on changing dietary practices to improve health, nutrition education is lacking in many healthcare training programs. Many health conditions and diseases can be minimized or managed with appropriate and adequate nutrition education. However, medical schools do not provide sufficient nutrition education to prepare future physicians to give specific dietary recommendations. This research study was designed to better understand the nutrition knowledge and attitudes towards nutrition counseling of osteopathic medical students, whose focus is on holistic medicine. The participants completed an online Qualtrics survey with a demographic questionnaire, a previous nutrition knowledge and nutrition experiences questionnaire, a nutrition knowledge multiple-choice quiz, and questions from two previously validated studies on nutrition in patient care and self-perceived proficiency in nutrition. A sample of 257 first and second year medical students (mean age = 24.8 ± 3.4 years, 53.0% female, and 79.0% white/Caucasian) completed the survey. The mean score on the nutrition knowledge quiz was 69.9% with a significant difference between first and second year students (66% vs. 74%, p < 0.001). 59% (n = 143) of students felt comfortable counseling patients on nutrition recommendations, but only 12% (n = 213) were aware of the current DRI nutrition guidelines. Qualitatively, most students noted the importance of nutrition in medical school, particularly in providing patient education, overall health and wellness, and preventing and treating disease. Despite the perceived importance of nutrition education and comfort level with counseling patients, most students lacked nutrition knowledge and information about dietary guidelines. These findings provide empirical support for the integration of more nutrition education into medical school curricula.

Lower body training to improve jump height for sport performance has been extensively researched. However, no research has investigated improving shoulder range of motion through osteopathic techniques in order to achieve optimal overhead jump reach. The aim of this study was to investigate the effects of an osteopathic intervention for shoulder and thoracic range of motion in female athletes on overhead reach during vertical jumping. Participants were 17 healthy, active women (aged 18– 37 years) who were involved in basketball (n=9), netball (n=7) or volleyball (n=1). In a crossover design, they received an upper and lower body osteopathic intervention, in randomised order, 1 week apart. Jump reach and maximum ground reaction force (GRF) with and without arm swing were recorded prior to and immediately following each intervention using a Swift YardstickTM Vertical Jump Tester and force plate. There was no meaningful difference between interventions in the change in jump height following each intervention (P=0.96). However, there was a significant change in standing reach height following the upper body intervention (P=0.04), from 211.0±6.5 cm to 214.0±6.4 cm (mean±SD). An arm swing increased GRF during jumping from 1473 N [95% confidence interval 1328 to 1619 N] to 1660 N [1466 to 1854 N]. Overhead jump reach did not improve with osteopathic techniques for shoulder mobility in young, active women. Despite this, a significant increase in standing reach height was observed, suggesting that osteopathic techniques may be beneficial when used to improve joint ROM.

BACKGROUND: The clinical approach used in the following case series is a newly emergent treatment concept (Performance Therapy) in manual therapy that combines active exercise with passive manual therapy in sporting participants. Performance therapy fits into the coach, athlete and practitioner triad whereby the practitioner attempts to address dysfunctional movements in an attempt to improve athletic performance and prevent injury. Golfers may receive benefit in this new clinical approach by being guided through tailored intervention programs that are targeting dysfunctional movements affecting golf specific physiological characteristics. AIM: To demonstrate the use of combining active therapy (corrective exercise) with passive therapy approaches (osteopathic manual therapy/management) for the purpose of improving golfing performance (club head speed and Driving distance (DD)) over an 8-week period. METHODS: Five prospective case studies were undertaken. Each participant underwent a needs assessment in order to develop a tailored intervention program combining corrective exercise and osteopathic manual therapy for the purpose of improving club head speed and DD. A Selective Functional Movement Assessment was measured every week. FlightScope® analysis of golfing performance was assessed for both 5- iron and driver pre and post-intervention (club head speed, ball speed, carry distance, total distance, launch angle, flight time and SMASH factor). RESULTS: One participant withdrew from the study. Two participants showed improvement for club head speed for 5-iron (Cohen’s d= 3.52, d= 1.43). One participant showed significant improvements in total DD for 5-iron (d = 1.2) and Driver (d = 2.1), while one showed improvements in carry distance for driver only (d = 1.09) and one showed improvements in total DD (d = 0.52). One participant showed no changes in DD for the 5-iron (d = -0.43) and driver (d = 0.11). No golf related injuries occurred during the course of the study. CONCLUSION: The clinical approach demonstrated in this study (combined osteopathic manual therapy and corrective exercise) has shown potential for improving golfing performance. Golfers who are searching for improvements in golfing performance should assess their balance abilities and squat biomechanics. Golfers can receive benefits from receiving tailored management programs from a manual therapist in order to improve dysfunctional movements that may be restricting their golf swing. Further clinical and research development of the Performance Therapy concept in golf is necessary.

The under-recognised and often misdiagnosed condition of dysfunctional breathing (DB) requires urgent critical investigation of the practices, experiences, and perspectives that underlie current clinical practice. The objective was to explore current clinical practices, experiences, and perspectives of healthcare practitioners currently attending to DB. This qualitative exploratory study employed interpretive description.Referral and snowball sampling recruited six participants. Data collection methods involved semi-structured in-depth interviews with three osteopaths and three physiotherapists. Interviews were deconstructed and analysed, and themes were developed. The complex journey to optimal breathing emerged as the overarching theme in narratives of the participants’ own experiences. Three sub-themes were developed highlighting the complex nature of DB: 1) missed by both patient and practitioner, 2) re-establishing a mind-body connection, and 3) a multifaceted approach is key. Findings suggest that there is a general lack of awareness surrounding DB by the general population and possibly by many healthcare practitioners. A lack of identification impacts patient quality of life and can lead to chronic musculoskeletal adaptations. Establishing a mind-body connection allows patients to establish a level of body awareness that allows a change in their breathing pattern back to an efficient and relaxed state that impacts presenting symptoms. A multifaceted approach to treatment is critical to making maximum changes and optimising clinical outcomes.

The purposes of the study were to determine the acute effects of upper body manual therapy when performing vertical jump and reach in basketball players, and to quantify the contribution of arm swing to ground reaction force during a counter-movement jump. Thirteen semi-professional to professional basketball players received two 15- minute standardized osteopathic manual therapy protocols one week apart, one implemented to the upper extremity and thoracic spine and a control implemented to the lower extremities, in a balanced, randomized cross-over design. Vertical jump and reach height and peak ground reaction forces with and without arm swinging were measured before and immediately following both protocols. Vertical jump and reach height (mean ± SD) was improved in the group receiving upper body manual therapy (59.3 ± 10.3 cm to 62.1 ± 9.8 cm) compared to the control group (59.3 ± 9.7 cm to 58.3 ± 9.7 cm; p < 0.001 for Time x Protocol interaction). The between-protocol differences were retained when adjusting for changes in peak ground reaction forces. Arm swing increased peak ground reaction force from 2187 ± 357 N without arms to 2330 ± 337 N (p = 0.005 for effect of arm swing). It appears that applying brief upper body manual therapy treatment improved overhead jump and reach height in high level basketball players. The application of these osteopathic techniques could be beneficial for immediate in-game enhancements of vertical jump performance.

BACKGROUND: Low levels of salivary SIgA have been associated with upper respiratory tract infection, oral ulceration and systemic diseases. Osteopathic Manipulative Treatment has been shown to have a positive effect on salivary SIgA levels. OBJECTIVE: This single case study aimed to determine changes in salivary SIgA concentration and secretion rate in response to a single 7-minute intervention of the osteopathic thoracic lymphatic pump in four male subjects who indicated suppressed mucosal immunity identified by recurrent upper respiratory tract infection and oral ulceration. METHODS: On a single day a total of nine saliva samples were collected per participant via oral swab, including four samples pre-, one peri- and four post-intervention. Participant results were analysed individually with group statistics reported. RESULTS: At baseline all participants showed suppressed levels of salivary SIgA concentrations with an average of 58.03 μg/mL (

BACKGROUND: Temporomandibular Disorder (TMD) will be experienced by many of the population with symptoms ranging from mild to severe. The management of chronic TMD can be challenging as well as costly. Manual therapies like osteopathy may offer an effective intervention for TMD. OBJECTIVE: This single system research design aimed to investigate the effectiveness of specific intra-oral osteopathic techniques in improving pain quality, intensity, mouth opening range and disability in TMD. METHODS: Ten participants (7 female) aged 16 to 43 (mean 29.2 years) with TMD pain from 1–12 years duration (mean 3.23 years) completed this 12-week study. Data was collected bi-weekly over 3-week baseline, 6-week intervention, and 3-week follow up phases. RESULTS: Improvements from baseline to end of intervention and follow up were noted for McGill Pain Questionnaire (MPQSF) sensory pain (pre 10.9±5.98 and post 5.2±6; P< 0.0001), Visual Analogue Scale at rest (VAS-R; 2.9±1.5 and 1.2±1.4; P

Background: Unsettled, fussy and irritable infant behaviour is a common complaint causing significant stress for parents. A lack of support during this time has been linked to negative effects on both infant and maternal health. Despite reports of anecdotal success, limited academic literature explores mothers’ first hand experiences with osteopathy during this time. Objective: The aim of this study was to determine mothers’ perspectives on the effectiveness of osteopathic treatment in the management of unsettled, fussy and irritable infants during their first year of life to enhance clinical understanding and inform future practice. Methods: Both qualitative and quantitative data were collected from each of 7 mother-infant dyads (2 primiparous women and 5 multiparous women) over a 3 month period, between February 2015 and July 2015. Interpretive description formed the theoretical framework used to analyse the main interview data. Supplementary mother notebooks and osteopathic treatment summaries were reviewed and summarised. The Infant Behaviour Questionnaire –Revised was also used as an objective tool to accompany subjective findings. Results: Key findings revealed 3 central themes with 9 sub themes to express the mothers’ journeys over time. Firstly ‘this can’t go on’ (retrospective, prior to osteopathic intervention), secondly ‘realising it will be okay’ (reflecting both infant and maternal maturation evident between interviews) and lastly ‘a happy baby is a happy mother’ (improvements promoting a happier relationship between mother and infant. Conclusions: Professional understanding and support is crucial in the management of unsettled, fussy and irritable infants to minimise the negative effects on both infant and maternal health. Osteopathy appears beneficial in infant). enhancing quality of life for both infant and mother during a difficult, yet self limiting period of time.

BACKGROUND: Sleep bruxism occurs in 8 to 20% of the population and can result in jaw and head pain, tooth destruction and diminished quality of sleep for bruxers and their partners. OBJECTIVE: To explore whether osteopathic manual therapy (OMT) could alter bruxing activity, pain and psychological wellbeing in self‐diagnosed sleep bruxers. METHODS: Six sleep‐bruxing participants received four weekly osteopathic treatments. Electromyographic activity of bruxing and head and jaw pain, via the Numeric Rating Scale (NRS), were monitored for a pre-treatment period, after each treatment and for a follow‐up period. The 21 Question Depression Anxiety and Stress Scale (DASS21) was assessed at study onset and conclusion. RESULTS: Six participants showed clinically significant decreases in NRS score from pre‐treatment to immediately following the third treatment. Group changes approached statistical significance from pre‐to post‐treatment despite a reduced sample size. (Effect Size = ‐0.71; P = 0.06). Five participants experienced a reduction of one or more DASS21 severity ratings for stress by the end of the study. Bruxing activity showed a trend towards improvement in two participants and increased in one participant. CONCLUSIONS: These results suggest that osteopathic treatment may help sleep bruxers by reducing their perceived pain and stress levels. The results are inconclusive as to the effectiveness of OMT for reducing nocturnal bruxing activity. Additional controlled studies with more detailed inclusion criteria and higher numbers of participants are suggested.