The study of the osteopathic diagnostics results′ coincidence frequency

Abstract

The quality of diagnostics in various branches of medicine including the use of complex and expensive equipment leaves much to be desired. In any case, the doctor evaluates the patient′s examination results and makes a diagnosis, which may be wrong. In manual medicine the main tool is the hands of the doctor and it makes the diagnostic process even more subjective. There are few studies confirming the reliability of manual diagnostic methods; the reproducibility estimates in the most cases do not satisfy the evidence based medicine requirements, and in some cases are simply absent. One of the indicators characterizing the diagnostics quality is the indicator of the diagnoses matches or discrepancies frequency. The goal of research — to determine the coincidence frequency of the osteopathic diagnostics results (osteopathic conclusions) formulated by the osteopathic doctors working as teachers of one osteopathic school. The cross-blind study involved 6 osteopaths-teachers of the Institute Osteopathy of Saint-Petersburg. Their experience as an osteopathic doctor was from 3 to 14 years (median 7.5 years). The osteopaths were randomly divided into two «triples». Each triple worked on the same day on the same contingent of subjects (students of the Osteopathy Institute). A total of 75 people aged 22 to 58 years (median 35 years) were examined, including 36 women and 39 men. Each person was examined by three osteopaths with completing a standard osteopathic conclusion. Osteopaths carried out only osteopathic diagnosis without taking a history and analysis of the additional examinations results. All subjects filled out an anamnestic questionnaire in which they noted the regions where there were operations or injuries, or the problem was identified by objective examination methods (there was a diagnosis). Statistical processing of the results was performed using nonparametric statistics by a specialist who did not know who specifically performed the osteopathic diagnosis. The following patterns were revealed after comparing the osteopathic conclusions made by three osteopathic doctors examining one group of patients. For 12 regions of the body (including variants of somatic (soma) and visceral (viscera) components), 8 regions showed agreement on the presence or absence of biomechanical somatic dysfunctions (SD) by the results of groups comparing according to the Friedman criterion p>0,05. In the head and chest (soma) regions in both triplets there was the greatest coincidence of diagnoses, and in the lower back (viscera) region — the least, perhaps the latter region is the most difficult for osteopathic examination. Regional neurodynamic SD was detected rarely, from 1 to 3 per group, and so there was almost complete negative consent among osteopathic doctors, perhaps these SD are very rare. Global SD either were not detected by the osteopaths, or the detected global SD did not match in most cases, perhaps the global SD identifications the most difficult part of the osteopathic examination. For the most cases (84 % in the first triple and 60 % in the second triples), 2 osteopaths out of 3 revealed the same dominant SD, and the original diagnoses were from 28,9 % to 53,3 %. In 73 % of the subjects the localization of the dominant SD coincided with the localization of the problems indicated in the questionnaire (a history of trauma or surgery; a diagnosis confirmed by objective examination methods). These results are very important for confirming the osteopathic diagnostics objectivity, since SD is likely to form at the site of an injury or operation (i. e. acute inflammation). The obtained results of osteopathic diagnostics can be regarded as quite good and acceptable, especially in comparison with the so-called objective methods (ultrasound, MRI, etc.).