Please click here to view the full article on the Science Direct website. [Link active until 8 April 2017]
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:
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.
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:
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’être of the SCCO, to “share knowledge, learning and practice”.