CAROLINE STONE INSTITUTE
EDUCATIONAL AND PROFESSIONAL SERVICES
Excellence in Global Osteopathic and Functional Manual Medicine Education
© Caroline Stone 22 January 2018. Please do not use graphics or text without permission.
An Idea Is Born
PROPOSAL BY CAROLINE STONE D.O.(Hons), MSc(Ost), MEd, MClinEd. 22nd. January, 2018.
“EVIDENCE AND COMPETENCE INFORMATION SERVICE.”
Public discussion and illustration of osteopathic scope of practice and fields of interest.
To develop a web based visual and text graphic and platform, an interactive device which allows a display of areas of research and practice interest and their current evidence framework.
Who is it for?
For patients, public, third parties, critical analysis by anyone, and of course, osteopaths. UK, EUROPEAN AND WORLDWIDE OSTEOPATHIC AUTHORITIES, EDUCATION INSTITUTIONS, RESEARCH BODIES AND ASSOCIATIONS COULD FIND SUCH A TOOL VERY USEFUL FOR THEIR MEMBERS, ALUMNI, FELLOWS AND SO FORTH.
TO MAKE NO CLAIMS FOR ‘TREATMENT’ OR EFFICACY – but to help observers easily clarify when research is far away from a certain bar or threshold, or whether it is close; how much of the evidence base is hypothesis and how much emergent research, and a traffic light system or similar, to help illustrate the sliding scale of that evidence.
Academic analysis, systemic reviews and meta-analysis are important tools, but are not penetrable by many interested parties in a ready and quick manner.
A user-friendly interface of properly collated and collaboratively focused information will help lift a cloud on things in practice which are of long standing (historical interest or extant practice), emergent and common fields of interest by osteopaths, and which osteopaths consider could be of public interest.
A promotionally neutral dynamic, which declares when current evidence is below an advertising standard or is either anecdotal / individual practitioner based, or low-quality studies, or reasonable studies, or RCT / gold standard.
If osteopaths have a field of interest in practice, these are often disease oriented, or relating to a patient group etc.
Format will be condition or disease orientation – for clearer searching of terms and presentations by patients, other service providers and healthcare parties of interest.
For example – plagiocephaly, or glue ear, or carpal tunnel or sacro-iliac pain in pregnancy, or chronic joint strain and repetitive injury. Orienting from a condition basis does not detract from an osteopathic aim to treat the whole person.
The tool can then identify the range of ways osteopaths might help:
Is the osteopath aiming to help improve biomechanics, are they aiming for changed quality of life, are they aiming for functionality, are they aiming for emotional support, are they aiming for pain reduction, what other symptoms or physiological process are they aiming at that might be relevant to that condition / presentation?
Makes use of: QUALITY OF LIFE MEASURES, FUNCTIONALITY / MOVEMENT MEASURES, REDUCTION OF PAIN MEASURES, BETTER OBSTETRIC OUTCOMES MEASURES, HEARING AND SPEECH FUNCTION MEASURES AND SO FORTH – PROM FIELDS WHICH ARE RECOGNISED AND HELP DISPLAY FOCUS OF OSTEOPATHIC RANGE OF INTERVENTIONS.
There are likely several common groups of possible beneficial aims of management that can be framed around each condition – much like five circles around a central circle / condition, and within each circle a subset of smaller circles about physiological basis and biomechanical hypothesis, about current evidence and so forth.
Benefits: Can also be for special interest groups, specialist credentialing, CPD frameworks to aid collaboration and communication about what evidence is there or otherwise.
The same tool can be used to identify research needs, can be adapted and updated, and is a quick reference guide to scope and practice interest.
Additional possibilities with the tool:
Illustrating scope through competence – and (possibly) helping people identify practitioners with the relevant skills set for a particular-desired outcome in a particular field of interest – as it can identify special interest groups or fellows of a college or similar who have been credentialed to deliver that service in those circumstances perhaps.
Scope of practice is defined by two main things – a field of interest and an evidence base – so that a role can be identified (credentialing indicates currency of capability within that scope).
A role in that scope is then necessarily defined by the level of clinical input – maybe this is supportive like occupational therapy, or interventionalist like pharmacology or surgery. Each of those fields of practice are the same, but the scope is determined by the outcome aimed at by the intervention, which defines the performance characteristics of the professional role(s) in question, which speaks to competence and capability (and how to credential them / ensure competence to perform their role-tasks in that scope in that field.
For example – if the field of interest is paediatrics and the condition in question is deformational plagiocephaly, and a researched contributory factor is identified as ‘reduced or asymmetrical cervical mobility’, then osteopaths can say that management of uncomplicated cervical asymmetry caused by myofascial or biomechanical factors is within the general scope of osteopathic practice – and it can be indicated that there would be a high level of competence in registered osteopaths (without the need for further training) to perform this role, as the evidence emerges that this is advised or in guidelines etc.
This does not advocate that osteopaths ‘treat’ plagiocephaly, but it illustrates that osteopaths have skills and competence on which to draw; and have a role to play to a certain level of clinical engagement, in the management of that condition.
It allows a simple visual / graphic tool to help discussion about whether that competence does in fact exist in general post registration osteopaths without further training, or whether that management would require additional upskilling (and the areas of upskilling can be debated of course).
POSSIBLE FUNDING REQUIREMENTS – keep a watch for a possible crowdfunding request near you!
Full time or semi full-time project manager.
Funds for supportive network of working parties / groups, promotion of project and recruitment.
Funds for research and library searches and literature reviews, collation and data analysis
Funding, web design and interface testing funding, dissemination and final promotion of platform in public arena.