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• W2071836701 abstract "As practitioners we all know and frequently experience the feeling of being ‘right’. An insightful hunch, a correct diagnosis, a successful treatment, and an appropriate referral are all good examples. We are also all familiar with human explanations of the way the ‘world works’ that have been demonstrated to be wrong. This demonstrates that humans can be wrong and their interpretation of the world mistaken. We see research as a way of helping us to be less wrong. The information and knowledge gained through research forms an essential component of the way osteopathy can be practised. Factors that affect the way we all practice osteopathy include the underlying framework with which we approach patients and make decisions, which is more formally described as ‘clinical reasoning’, and our attitudes and opinions regarding research and the information and knowledge it generates. Each of these issues are specifically addressed in this edition, starting with a study reporting on clinical reasoning in osteopathy, followed by a study on our attitudes and opinions about research and evidence based medicine. We also publish a paper about how it can be determined if a test is reliable and we publish an example of such a study that investigates the reliability of diagnostic tests for sacroiliac dysfunction. Lastly, we publish a review of the breastfeeding literature relevant for osteopaths. So, just how do osteopaths reason their way through a clinical situation? This is a question that Thomson, Petty and Moore have grappled with and reviewed for our benefit in their paper on clinical reasoning in osteopathy. They make a succinct presentation of the background to clinical reasoning as it applies to osteopathy, pointing out what we do and don’t know about how osteopaths think. To shed further light on the way osteopaths judge information in terms of it being incorporated into a clinical reasoning process, Humpage reports a thematic analysis of public documents from the UK osteopathy media in the mid to late 2000s. The published letters, online forum posts and various articles published in industry magazines and newsletters serve as artefacts for investigators to systematically draw together evidence. Humpage’s findings reflect our personal experience working as osteopaths in practice, education and research, and we encourage you to read through the verbatim quotes in Table 2 to quickly get up to speed on the many and varied views of research and evidence based medicine expressed by members of our profession. To get at the heart of the way research information is generated, Lucas and Bogduk provide a masterclass on diagnostic reliability in osteopathic medicine. They provide the rational for the importance of diagnostic research and then provide a detailed discussion of the methodology of conducting reliability studies. In line with the masterclass, we also publish a primary study of diagnostic reliability by Rajendran and Gallagher who report on the inter-rater reliability of 4 tests used to assess sacroiliac joint dysfunction. We note that the findings of their study are not unique, and that a number of other studies evaluating these tests have been published and demonstrate similar findings. We also note that, as with some other studies, Rajendran and Gallagher studied the reliability of students in a small sample. What is of particular interest is that once again the results of this study demonstrate the poor reliability of these tests, and once again the authors question why these tests continue to be routinely taught in a professional degree. Perhaps the reason for poor reliability in this and other similar studies is simply because the examiners are senior students and not experienced practitioners? Perhaps not. It’s clear that practitioners with years of clinical experience are also unable to reliably identify positive or negative findings with these tests and we draw your attention to a systematic review by Seffinger et al. (2004)1Seffinger M.A. Najm W.I. Mishra S.I. Adams A. Dickerson V.M. Murphy L.S. et al.Reliability of spinal palpation for diagnosis of back and neck pain: a systematic review of the literature.Spine. 2004; 29: E413-E425Crossref PubMed Google Scholar an osteopathic physician and researcher from the USA, who along with his colleagues report the poor reliability of these tests from the results of multiple studies. It seems that in the case of sacroiliac joint dysfunction, the profession is for the most part ignoring the research evidence and continuing to teach and use these tests to make clinical decisions. This is a fascinating behaviour and one worthy of study in and of itself, for in order to ignore this research a decision has to be made in the mind of the practitioner (or teaching instructor) that judges the research to be untrustworthy, and that existing practices are worth maintaining. Lastly in this issue, Cornall provides a review of breastfeeding literature relevant to osteopathic practise, which includes a review of the benefits of breastfeeding, difficulties associated with breastfeeding, social and cultural factors, and interventions to promote breastfeeding. There is also an interesting presentation of the role of manual therapy to support breastfeeding. All in all, this is an interesting edition of the journal. An edition which we feel is representative of the growing depth of experience and collaboration within our profession. Enjoy." @default.
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• W2071836701 title "Research: A way of helping us be less wrong" @default.
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• W2071836701 doi "https://doi.org/10.1016/j.ijosm.2011.05.003" @default.
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