Use of Real-Time Physiologic Parameter Assessment to Augment Osteopathic Manipulative Treatment Training for First-Year Osteopathic Medical Students

摘要

Context: The first 2 years of osteopathic medical school involve training in osteopathic principles and practice, including understanding the tenets of osteopathic medicine and developing palpatory skills for clinical application. Although this training emphasizes the link between somatic dysfunction and physiologic function, it does not include the opportunity for students to quantitatively assess the physiologic effect of osteopathic manipulative treatment (OMT) using physiologic measurements. Objective: To evaluate an approach for integrated OMT training coupled with physiologic measurements of relevant parameters, whereby first-year osteopathic medical students assess the quantitative, real-time changes in specific physiologic signals during instruction. Methods: During mandatory musculoskeletal and cardiovascular demonstration laboratories at a single osteopathic medical school, students were divided into small groups and performed OMT on each other while recording real-time measurements of physiologic functions such as maximum clench force, time to fatigue for the forearm flexor muscles, heart rate, and peripheral vascular flow. After data were collected, students analyzed pre- and post-OMT measurements and discussed underlying physiologic principles in a large group format. At the end of the sessions, students completed a brief survey on the usefulness of the integrated laboratories. Results: Overall, 13 of 28 student groups (46.4%) measured a pre- to post-OMT increase in maximum clench force, and 16 (57.1%) observed an increase in time to fatigue for the forearm flexor muscles. Twenty-three of 27 student groups (85.2%) observed a reduction in heart rate and 19 (70.4%) measured an increase in peripheral vascular flow after OMT. Student satisfaction was generally favorable, with overall mean (SD) ratings of 6.38 (1.86) for the musculoskeletal laboratory and 7.81 (1.69) for the cardiovascular laboratory out of a maximum of 10 points. In open-ended comments, students deemed the combined laboratories as clinically applicable but desired more time for completing the laboratories. Conclusion: Measurement of specific physiologic musculoskeletal and cardiovascular parameters before and after OMT enabled quantification of physiologic responses to OMT. Students' favorable feedback indicated that the quality of learning in the laboratories was enhanced by the addition of physiologic measurements. J Am Osteopath Assoc.2014;114(12):918-929 doi:10.7556/jaoa.2014.179