Ibrahim Npochinto Moumeni, Ibrahim Npochinto Moumeni, Ibrahim Npochinto Moumeni
et al.
BackgroundPoststroke spastic paresis represents a dual pathology combining neurological impairment and secondary muscle contracture, often perpetuated by learned non-use. Current rehabilitation approaches frequently address these components separately, limiting functional recovery potential.MethodsThis perspective synthesizes over 10 years of clinical experience treating poststroke spastic paresis across European and sub-Saharan African settings, integrating constraint-induced movement therapy with progressive muscle-lengthening protocols. Clinical insights are drawn from over 300 patients treated in both resource-rich and resource-limited environments.ResultsThe integrated approach demonstrates superior outcomes compared with conventional therapy, with patients showing functional improvements even years after stroke. Key success factors include intensive training protocols, systematic antagonist muscle stretching, and patient-centered motivation strategies adapted to diverse cultural contexts. European validation and African implementation confirm universal applicability.ConclusionCombining neuroplasticity-based interventions with muscle-targeted therapies offers a paradigm shift in poststroke rehabilitation. This approach proves effective across diverse healthcare settings, from high-technology European centers to resource-limited African hospitals, relying on intensive human intervention and evidence-based protocols.
Sebastián Eustaquio Martín Pérez, Carmen Pérez Canosa, Iván Pérez Aguiar
et al.
<b>Background/Objectives</b>: Cruciate ligament injuries, particularly those involving the anterior cruciate ligament and posterior cruciate ligament, are common among active individuals and often require surgical reconstruction followed by intensive rehabilitation to restore knee stability, movement, and strength. Virtual reality exposure therapy has emerged as a potentially beneficial adjunct to traditional rehabilitation, offering immersive, interactive environments that may aid in pain relief, balance, proprioception, and functional recovery. This meta-analysis aimed to evaluate the efficacy of VRET compared to conventional rehabilitation for postoperative cruciate ligament reconstruction, focusing on outcomes in pain, balance, proprioception, and the knee flexion range of motion. <b>Methods</b>: A systematic review and meta-analysis were conducted following the PRISMA guidelines and registered in PROSPERO (CRD42024604706). A comprehensive search across databases including MEDLINE (<i>PubMed</i>), SPORTDiscus, ScienceDirect, Web of Science (<i>WOS</i>), Cochrane Library, Scopus, and EBSCOhost included studies from inception until the date of search, using terms such as “cruciate ligament”, “virtual reality”, “rehabilitation”, “pain”, and “balance”, combined with Booleans “AND” and “OR”. Methodological quality, risk of bias, and recommendation strength were assessed using <i>PEDro</i> Scale, Cochrane Risk of Bias Tool (<i>RoB 2.0</i>), and <i>GRADE</i>, respectively. <b>Results</b>: Eleven studies (n = 387) met the inclusion criteria, involving patients who had undergone ACL or PCL reconstruction. Virtual reality exposure therapy showed significant benefits in reducing pain intensity [SMD = −2.33, 95% CI: −4.24 to −0.42, Z = 2.40, <i>p</i> = 0.02], improving proprioception, and enhancing the knee flexion range of motion. However, the results for static balance [SMD = −0.37, 95% CI: −1.62 to 0.88, Z = 0.58, <i>p</i> = 0.56] and dynamic balance [SMD = −0.37, 95% CI: −1.83 to 1.09, Z = 0.50, <i>p</i> = 0.62] were mixed and not statistically significant. <b>Conclusions</b>: Virtual reality exposure therapy is an effective adjunct therapy to postoperative rehabilitation for cruciate ligament reconstruction, particularly in reducing pain and enhancing proprioception. However, the small sample sizes and variability across studies underscore the need for further research with larger cohorts to validate these benefits in diverse patient populations.
<b>Background/Objectives:</b> Mechanical, physiological, and biochemical changes contribute to post-traumatic osteoarthritis (PTOA). Specific mouse models that are highly reproducible, less invasive, and easy to use are lacking. This limitation hinders the progress of PTOA-related studies on therapeutic applications. The goal of the study was to establish a methodologically innovative, efficient, and less technically challenging surgical model for PTOA. <b>Methods</b>: We developed a modified medial meniscectomy (MMM) model demonstrating high reproducibility and applicability. The MMM model features distinct differences in the execution of transection of the medial meniscus on the lateral side and includes a smaller incision, which enhances reproducibility and is beneficial for studying pain, structure, and function. <b>Results</b>: One month after the MMM surgery, the mice showed increased sensitivity to pain and decreased biomechanical abilities, such as shorter running times and distances. This was further supported by higher Osteoarthritis Research Society International (OARSI) histology scores, a standardized system for determining the severity and extent of OA in cartilage. Additionally, transcriptomic analysis showed an elevated enrichment of immune activity and bone tissue formation gene sets in the knee joint. <b>Conclusions</b>: Overall, functional studies and transcriptomic analyses suggested that the MMM model can be utilized for future biomechanistic and therapeutic applications and could serve as a new resource for studying PTOA.
Giulia Dalla Serra, Cliona Skelly, Olga Amorós Carafí
Metaphyseal osteopathy (MO) is a rare systemic disease primarily affecting young large-breed dogs. Diagnosis of MO is usually based on a combination of signalment, presenting clinical signs, and imaging findings. While radiographic features of MO are well documented, reports describing Computed Tomography (CT) findings are limited. Clinical records of a veterinary teaching hospital were searched for dogs with a presumed diagnosis of MO that underwent CT imaging. CT and available radiographic studies were retrospectively reviewed. Four dogs met the inclusion criteria. All presented with pyrexia, often associated with other clinical signs. CT lesions were bilateral and symmetric in all cases, characterised by an irregular metaphyseal band of lysis parallel to the physis with associated signs of bone sclerosis. Multiple long bones were affected, and mandibular involvement was suspected in two cases. Comparison with a radiographic study was available in two cases, and follow-up CT imaging was performed in one. Although radiographs remain the primary diagnostic tool for MO, understanding the CT features of the disease is valuable and may contribute to prompt diagnosis, particularly when evaluating young dogs with pyrexia and non-specific clinical signs.
An analysis of the stages in the development of scientific research on the use of evidence-based medicine in osteopathy is presented. A search was conducted for scientific publications in the entire Medline database of the US National Center for Biotechnology Information (NCBI), starting in 1984. The main directions aimed at improving the quality and reliability of scientific research in osteopathy are described. As a discussion, it is proposed to use an assessment method that allows you to record three types of body reactions to the treatment — immediate, fast and delayed.
Abstract Osteoporosis affects more than 200 million women worldwide, with postmenopausal women being particularly susceptible to this condition and its severe sequelae disproportionately, such as osteoporotic fractures. To date, the current focus has been more on symptomatic treatment, rather than preventive measures. To address this, we performed a meta-analysis aiming to identify potential predictors of osteoporotic fractures in postmenopausal women, with the ultimate goal of identifying high-risk patients and exploring potential therapeutic approaches. We searched Embase, MEDLINE and Cochrane with search terms (postmenopausal AND fracture) AND (“risk factor” OR “predictive factor”) in May 2022 for cohort and case–control studies on the predictors of osteoporotic fracture in postmenopausal women. Ten studies with 1,287,021 postmenopausal women were found eligible for analyses, in which the sample size ranged from 311 to 1,272,115. The surveyed date spanned from 1993 to 2021. Our results suggested that age, BMI, senior high school and above, parity ≥ 3, history of hypertension, history of diabetes mellitus, history of alcohol intake, age at menarche ≥ 15, age at menopause < 40, age at menopause > 50, estrogen use and vitamin D supplements were significantly associated with osteoporotic fracture in postmenopausal women. Our findings facilitate the early prediction of osteoporotic fracture in postmenopausal women and may contribute to potential therapeutic approaches. By focusing on preventive strategies and identifying high-risk individuals, we can work toward reducing the burden of osteoporosis-related fractures in this vulnerable population.
Orthopedic surgery, Diseases of the musculoskeletal system
There is presented a review of the literature on the concepts of «osteopathic damage», «somatic dysfunction», «trauma», «damage». The similarities and differences of these terms in osteopathy, traumatology and forensic medicine are shown. In order to achieve an interdisciplinary understanding in osteopathy, along with the original and new terminology, the use of the historically established terminology of classification of external damaging factors is proposed.
The article discusses the application of the International Classification of Functioning, Disabilities and Health (ICF) in the diagnostic practice of an osteopathic physician. The ICF is an internationally recognized classification of health constituents and health-related factors. ICF allows the osteopathic physician to formulate the goals of the patient′s treatment, to determine the terms of treatment. A clinical example reveals the possibilities of using ICF in osteopathy.
Abstract Background The biopsychosocial model is recommended in the management of non-specific low back pain but musculoskeletal practitioners can lack skills in assessing and managing patients using a biopsychosocial framework. Educational interventions have produced equivocal results. There is a need for an alternative educational tool to support practitioners’ development in the application of biopsychosocial model to manage low back pain. Methods A mixed methods study assessed the feasibility and acceptability of an e-learning programme on the biopsychosocial management of non-specific low back pain for osteopaths with more than 15 years’ experience. A sequential explanatory design was conducted, with a feasibility randomised controlled trial and semi-structured interviews explored with thematic analysis. Results A total of 45 participants participated in the RCT of which 9 also participated in the interview study. The a-priori sample size was not met (45 instead of 50). The recruitment strategies, randomisation, retention, data collection and outcome measures worked well and were found to be feasible for a main trial. The retention, satisfaction and participants’ views of the programme demonstrated a good acceptability of the programme. Data from the semi-structured interviews were organised in three themes, the first two were related to the feasibility and acceptability of the e-learning programme (practical experience of following the course and engagement with the content) and the third relates to the impact of the intervention (perception of the BPS model). Conclusion A main RCT is feasible and the intervention was received well by the participants. A main RCT is required to assess the effectiveness of the e-learning programme. This work also provided data on aspects so far unreported, including osteopaths’ views on continuing professional development, on e-learning as a form of continuing professional development and osteopaths’ perceptions and challenges concerning the implementation of the biopsychosocial model in practice.
Working on the diaphragm muscle and the connected diaphragms is part of the respiratory-circulatory osteopathic model. The breath allows the free movement of body fluids and according to the concept of this model, the patient's health is preserved thanks to the cleaning of the tissues by means of the movement of the fluids (blood, lymph). The respiratory muscle has several systemic connections and multiple functions. The founder of osteopathic medicine emphasized the importance of the thoracic diaphragm and body health. The five diaphragms (tentorium cerebelli, tongue, thoracic outlet, thoracic diaphragm and pelvic floor) represent an important tool for the osteopath to evaluate and find a treatment strategy with the ultimate goal of patient well-being. The two articles highlight the most up-to-date scientific information on the myofascial continuum for the first time. Knowledge of myofascial connections is the basis for understanding the importance of the five diaphragms in osteopathic medicine. In this first part, the article reviews the systemic myofascial posterolateral relationships of the respiratory diaphragm; in the second I will deal with the myofascial anterolateral myofascial connections.
Abstract Osteopathic manual practitioners in Canada use, and continue to be educated to use the term 'osteopathic lesion'. This term is either derived from or directly drawn from the biomedical model; the overarching framework through which most healthcare is delivered. Use of the term illustrates the adoption and misappropriation of a biomedical term and follows the same curative reasoning processes as in biomedicine. Manual osteopathic practitioners in Canada believe the osteopathic lesion to be a palpably detectable entity. Use of the term could arguably be capable of eliciting nocebo and iatrogenic symptom effects. The origin of, and potential iatrogenic consequences of using the term with patients appears to be largely invisible to osteopathic practitioners. Awareness of the origin and use of this term and potential problems for patient-centred osteopathic care are necessary before comprehensive transformation in education and practice standards at the association and educational levels can be adopted.
Sarah Elhamiani Khatat, Rosario Vallefuoco, Meryem El Mrini
et al.
Case summary A 10-year-old neutered male domestic shorthair cat was diagnosed with renal adenocarcinoma associated with hypertrophic osteopathy. The cat was referred for chronic ambulation difficulties. The physical examination showed a painful thickening of all four limbs, a right cranial abdominal mass and a conjunctival hyperaemia. Radiographic findings were consistent with extensive periosteal new bone formation involving not only the diaphyses of the fore- and hindlimbs, but also of the pelvis, tarsus and carpus. Abdominal ultrasonography and CT revealed a mass within the right kidney and a primary neoplasm was suspected. A ureteronephrectomy of the right kidney was performed and histopathology confirmed the diagnosis of renal adenocarcinoma. Although clinical improvement of the lameness occurred after surgery, no radiographic changes of hypertrophic osteopathy lesions were observed at the 9-month follow-up. Relevance and novel information Feline cases of hypertrophic osteopathy are rarely reported in the literature and only a few of them were associated with abdominal neoplastic diseases. To our knowledge, this is the first case of renal adenocarcinoma associated with hypertrophic osteopathy in a cat.
OBJECTIVE The purpose of this study is to assess the variability in grading systems used by US allopathic and osteopathic medical schools across all 4 years of medical school coursework. DESIGN Transcripts were reviewed from all participating allopathic and osteopathic medical schools for all 4 years of coursework for grading system type, the presence or absence of a key or guide, the inclusion of grade distribution within class year, inclusion of a class rank, and summary statements or evaluation systems used by the institution within the Medical Student Performance Evaluation to evaluate overall performance. SETTING Loyola University Medical Center. Maywood, IL. PARTICIPANTS Transcripts were reviewed for 144 out of existing 147 allopathic medical schools (97.9%) and 37 out of 39 existing osteopathic medical schools (94.8%). RESULTS For allopathic schools, grading system distribution for preclinical years was-41.6% Pass/Fail, 40.3% Honors, 13.2% Letter; while grading system distribution for clinical years was-78.5% Honors, 15.9% Letter. Only 35.4% of allopathic medical schools used the same system for all 4 years, while the remaining schools used a different system for preclinical and clinical years. For osteopathic medical schools, grading system distribution for preclinical years was-45.9% Letter, 32.4% Honors, and 13.5% Pass/Fail; while grading system distribution for clinical years was-59.5% Honors and 29.7% Letter (Table 4). Overall, 56.7% of osteopathic programs used the same system for all 4 years, while the remaining schools used a different system for the preclinical years than the clinical years. Variability also existed within each of these broader grading system categories (Table 1, Table 3). CONCLUSIONS Our results highlight the variability in grading systems used by medical schools both among programs and between preclinical and clinical years. From the residency program perspective, the lack of consistent, objective comparisons between school transcripts makes comparing applicants from different institutions difficult.
Abstract Introduction Patient experience, satisfaction, perception and expectation are some related measures valued by patient-centered health care. Patient experience (PE) usually refers to objective, observable events or facts; while patient satisfaction, perception and expectation (PS) are measures which focus on a patient's subjective evaluation of the health care process. These concepts have been studied in osteopathic manipulative treatment (OMT), a therapeutic intervention practiced by osteopathic practitioners in many countries and by some medical doctors in USA and Canada. Objective To systematically review and summarize the primary research literature pertaining to PE and PS of OMT. Methods A comprehensive literature search was performed on seven databases: Ovid MEDLINE, Embase, Cochrane Central, Cinahl, AMED, Osteopathic Research Web, and OSTMED.DR to identify primary research that surveyed the PE or PS of OMT. Findings from relevant studies were summarized. Results The literature search identified 322 references, of which 16 were included in this review, including 7 qualitative, 8 quantitative and 1 dual-method study. The quantitative studies with various research instruments reported on a number of PE & PS aspects, with data showing mostly positive responses from patients. The qualitative studies revealed patients’ perception of OMT which may be summarized as being patient-centered, holistic, thorough, a treatment option that could be effective for certain conditions and one that offered good clinician-patient partnership but with possible adverse effects and futility. Conclusion The primary literature reported mainly positive PE and PS of OMT. OMT as a treatment was found to have many positive characteristics.
Andrea Buscemi, Vincenzo Pennisi, A. Rapisarda
et al.
Abstract Background This randomized controlled pilot study evaluated the efficacy of osteopathic treatment in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) assessed using spirometry, COPD Assessment Test (CAT) and six minutes walking test (6MWT). The main goals were to improve the quality of life of patients with stable moderate-to-severe COPD, and to revise the parameters of the assessment tests, such as spirometry and 6MWT. Methods The study comprised several phases and patients were divided into two groups: group A (controls) received conventional pharmacological treatment with Indacaterol–Glycopyrronium and, while group B (OMT group) received both traditional therapy and osteopathic manipulative treatment (OMT) at different stages of the study. The osteopathic approach focused on maxillary sinus, vertebral-pleural ligaments, phrenic nerves, ribs, pleura, lungs, bronchi, subclavian muscles, and trapezoid and conoid ligaments. Results Overall, 32 patients were randomized and treated. Patients of the OMT group got better improvements in all tests compared to the control group: spirometry: FVC (p<0.5411), total FEV1 (p<0.5061); CAT: OMT (p<0.0005) - controls (p<0.188) 6MWT OMT (p<0.0038) - controls (p<0.5326). The clinical results collected in phase (T3) confirm those obtained in the first sessions; the results of CAT questionnaire (p<0.0005) and 6MWT (p<O, OO38) highlighted score improvements of patients treated with osteopathy compared to patients in the other group. Conclusions The results showed that the patients with COPD who received the conventional pharmacological treatment in association with the OMT therapy demonstrated a good response to the osteopathic treatment, thus leading to significant improvements in their health and wellbeing, and a better daily functioning.