The enigmatic case of cranial osteopathy: Evidence vs clinical practice.
Editorial in the International Journal of Osteopathic Medicine (2016) 21, 1-4.
The editorial reported that a recent study requested by the French Physiotherapy Council (FPC) decided that cranial osteopathic techniques should be avoided for lack of evidence. The lack of evidence for ‘cranial’ techniques has long been an issue and yet it remains popular with patients and trials show osteopathy in the cranial field (OCF) to be harmless. The editorial says that while an evidence based approach may be impossible an ‘evidence informed’ approach – combining research with personal experience – should be used. It acknowledges that the pharmacological paradigm does not apply well when working with complex interventions such as osteopathy.
The editorial proposes a simpler ‘traffic light’ system, asking three questions to decide whether an intervention can be used:
- Are there objectively tested facts to support the concept?
- Are the concepts that form the basis of for this clinical act based on scientifically acceptable concepts?
- Is the concept based on long-term and widely accepted experience?
Only the last question can be answered positively and the editorial suggests that this implies that OCF should not be used, except that the patient may demand it. The editor laments the lack of the patient voice in evidence based medicine.
Response to this editorial by the Board of Trustees of the SCCO (IJOM in press).
Free access to this article is via the GOsC website. Login to the oZone, click on “news and resources”, then “research”, then “research journals” and click on the cover of the IJOM and then “articles in press” and you’ll see it.
We don’t want French Physiotherapists or other professions using the techniques of OCF with no understanding of the underlying system of medicine.
We take issue with the report to the FPC as its analysis has been criticised by researchers whose work was quoted in it.
Randomised controlled trials are not suited to osteopathy and if we did do some RCTs we would probably be accused of funding bias.
The traffic light system assumes that what is “scientifically acceptable” is fixed and unchanging.
We recognise the value of scientific and patient experience research and suggest that a wider net is cast to capture outcomes beyond the patient’s presenting complaint.
The McNamara Fallacy is discussed, stating that complex systems must not, however, be reduced to what is measurable if they are to be properly understood. We work with humans, the ultimate in complex systems, and adopt the Goethean scientific method:
- Thinking – exact sensory perception, precise observation without judgment (as per orthodox science);
- Feeling – exact sensory imagination, images from the edges of our perception;
- Seeing – opening to a sense of wonder, to forces greater than ourselves;
- Knowing – being one with the object.
Our thinking, feeling, seeing and knowing fingers and mind give us a far richer appreciation of the phenomena under our hands than ‘thinking’ alone ever could.
We discuss the complexities of water and touch – key concepts in our approach that are very poorly understood or understandable by orthodox science.
Finally, we quote Andrew Cotton’s defence of osteopathic principles (IJOM 2013, 16, 1, 17-24): “Formally shared principles encourages community, helping to foster the perpetration of expert practice toward known, valued ends”. This is the very raison d’êtreof the SCCO, to “share knowledge, learning and practice”.