CONTEXT:Migraine is a highly prevalent and disabling neurological condition affecting approximately 12 % of adults in the United States, with substantial personal and economic burdens. Nonpharmacologic therapies, including osteopathic manipulative treatment (OMT), are increasingly utilized as adjunctive or alternative management strategies, yet the evidence base for OMT efficacy in migraine remains variable and incompletely synthesized. OBJECTIVES:The objective of this study was to evaluate the efficacy of OMT in reducing monthly migraine days compared to control interventions in adult patients through a systematic review and meta-analysis of randomized controlled trials. METHODS:A comprehensive literature search was conducted across PubMed, Scopus, NIH Library, and Wiley Library through December 2024. Studies were included if they enrolled adult migraine patients, evaluated OMT for a minimum of 5 weeks, included a control group, and reported monthly migraine day outcomes. Five randomized controlled trials (n=258) met all of the inclusion criteria. Effect sizes were standardized to the mean difference in monthly migraine days; a fixed-effect model was applied to pool the results across studies. RESULTS:Pooled analysis demonstrated a statistically significant overall reduction of -0.38 monthly migraine days (95 % CI, -0.43 to -0.32) with OMT compared to the control interventions. Individual study effects ranged from -0.23 to -21.06 migraine days. Heterogeneity was extreme (I2=99.8 %), reflecting substantial differences in patient populations, OMT techniques, treatment duration, and outcome assessment methodology. CONCLUSIONS:OMT is associated with a statistically significant reduction in monthly migraine days and may serve as a clinically meaningful adjunct to standard pharmacologic migraine management. The extreme heterogeneity across trials limits the generalizability of pooled estimates and underscores the need for standardized protocols, rigorous blinding, and harmonized outcome definitions in future research.
CONTEXT:Concussions are some of the most common sports-related injuries in US high school athletes, yet concussions have a wide range of symptoms and stigma that lead to underreporting of symptoms to healthcare professionals and coaches. Sustaining multiple concussions has been linked to neurological issues in both the short term and long term. It has also been proven that adequate sleep is essential for a variety of activities and cognitive functions. Previous studies have linked sleep disturbances to increased head injury risk in collegiate athletes, but less is known about this relationship in younger populations. OBJECTIVES:With thousands of high school athletes sustaining concussions annually, this study aimed to explore associations between sleep quantity/quality and concussion history in high school athletes and if these vary by sex or other sociodemographic factors. METHODS:We conducted a cross-sectional analysis utilizing 2019-2021 Youth Risk Behavior Surveillance System (YRBSS) data. Participants included high school students who reported playing at least one sport and answered questions regarding sleep and concussions. Additional variables such as age, sex, race, and ethnicity were analyzed. We utilized binary and multivariable regression models to examine associations between sleep duration and concussion history. RESULTS:High school athletes averaged 6.56 h of sleep per night (95 % CI: 6.5 to 6.6). Each sociodemographic factor was independently associated with sleep duration. In adjusted regression models, athletes with one concussion slept less than those with none (-0.12 h; 95 % CI: -0.23 to -0.01). Those with two or more concussions reported even shorter sleep durations (-0.24 h; 95 % CI: -0.43 to -0.05). CONCLUSIONS:A dose-response association was observed between the self-reported concussion history and the shorter self-reported sleep duration among high school athletes. The long-term clinical implications of these modest differences in sleep duration remain uncertain and warrant further investigation. Future longitudinal studies utilizing objective sleep and validated concussion assessments are needed to assess the long-term effects of concussion-related sleep disruption from adolescence into adulthood and to investigate potential causality in this relationship.
CONTEXT:Osteopathic manipulative treatment (OMT) utilizes manual techniques to address somatic dysfunctions (SDs) and promote physiologic function. Although SDs commonly develop following traumatic injury, the role of OMT in postinjury remains incompletely characterized. Patients recovering from trauma frequently experience persistent pain and functional limitations requiring ongoing healthcare utilization. To address this need, we established a novel OMT for trauma program (OTP) to complement interventions for patients with subacute and chronic postinjury pain and mobility impairments. OBJECTIVES:This study aims to evaluate the growth and effectiveness of the novel OTP over its first 3 years. METHODS:We retrospectively analyzed data for all patients treated at the OTP between January 1, 2021 and December 31, 2023. The outcomes included patient volume, relative value units (RVUs), and referral patterns as well as changes in pain, mobility, and other subjective improvement patients attributed to OMT. We performed subgroup analyses of patients who reported a mechanism of injury (MOI, "Injured") and those who did not ("No MOI"). Data are presented as percentages or medians (interquartile range [IQR]). RESULTS:During its first 3 years, the OTP provided 279 OMT sessions for 95 patients (41 [43.16 %] male and 54 [56.84 %] female; median 52 [41.50-64.50] years-old), applying a trauma-informed biomechanical OMT model. Quarterly patient encounters, RVUs generated, and new patient referrals increased per calendar-year quarter (CYQ; r=0.74, 0.62 and 0.56 with p=0.0028, 0.028, and 0.016, respectively). Referral patterns shifted from trauma/acute care surgery (T/ACS) and Physical Medicine and Rehabilitation (PM&R; 51.85 to 25.0 % and 33.33 to 2.78 %) toward OTP patient referrals and Primary Care referrals (0-19.44 % and 11.11-47.22 %). Median pain scores decreased immediately following the first OMT session (3 [2-5] on a 10-point pain scale). OTP patients whose first follow-up was within the study period (61, 64.21 %) reported a similar decrease between OMT sessions #1 and #2 (4 [3-6]). All patients reported improved mobility immediately after OMT. Additional benefits that patients attributed to the OTP included improvements in daily activity level (75.41 %), mood (60.66 %), sleep quality (36.07 %), and pain-free periods (36.07 %). The rate of immediate post-OMT complications (universally described as musculoskeletal discomfort or pain) was 2.87 %. We detected no significant differences during subgroup analyses. Median pain scores improved similarly between Injured and No MOI subgroups immediately after OMT session #1 (3 [2-5] vs. 3.5 [1.5-4.25], p=0.337) and between OMT sessions #1 and 2 (4 [3-6] vs. 4 [1.5-6], p=0.363). CONCLUSIONS:Our data demonstrate that not only is it possible to integrate a novel OTP into a level 1 trauma center but also that such a program is likely to grow significantly over time and consistently provide potentially beneficial OMT services for patients who do and do not identify a MOI. Programs like the OTP may provide a distinct modality to help improve postinjury pain and mobility limitations, among other potential benefits, although further analysis is necessary to assess causality. The present data informed updates to OTP operations, including the implementation of prospective, higher-fidelity data collection to enable more detailed and accurate analyses. Further research, including comparative studies, is warranted to explore the potential benefits of OMT for the trauma population.
Medical society membership is declining as physician employment, specialization, and changing professional priorities reduce reliance on traditional organizations. At the same time, interest in holistic, individualized care is growing, reflected in the expansion of fields centered on well-being, natural approaches to healing, and the relationship between lifestyle and disease, as well as in the rapid growth of osteopathic manipulative treatment research. Contemporary healthcare is increasingly embracing principles long associated with osteopathic medicine. This convergence presents an opportunity for osteopathic organizations to redefine themselves as leaders in integrating holistic approaches with established standards of care. The New York State Osteopathic Medical Society is advancing a three-pillar strategy focused on rebuilding professional community and public awareness, strengthening career development and integrative continuing medical education, and expanding advocacy for patient-centered policy and contemporary medical careers. The future of osteopathic institutions depends not on preserving traditional structures, but on adapting while clearly articulating the profession's distinct value. Osteopathic medicine combines whole-person principles, prevention, and care tailored to individual patient needs. As these principles increasingly enter mainstream healthcare, osteopathic institutions must decide whether to lead that transformation or be left behind.
CONTEXT:Team physicians (TPs) play a critical role in professional sports, providing medical care for athletes under high-pressure conditions. These positions are highly competitive, influenced by previous affiliations, training pedigree, and institutional connections, with fellowship training increasingly essential. Although the number of osteopathic (Doctor of Osteopathic Medicine [DO]) physicians in the United States has grown substantially, TPs in professional sports remain predominantly filled by allopathic (Doctor of Medicine [MD]) physicians, and the training pathways of DO TPs are not well characterized. OBJECTIVES:The objective of this study is to compare the training and demographic characteristics of DO and MD TPs in professional sports leagues. METHODS:Publicly available sources were utilized to identify all DO and MD physicians serving as head team physicians (HTPs), TPs, or consulting physicians across seven major US professional sports leagues (National Football League [NFL], Major League Baseball [MLB], National Basketball Association [NBA], Women's National Basketball Association [WNBA], National Hockey League [NHL], Major League Soccer [MLS], and National Women's Soccer League [NWSL]). Data on gender, specialty, medical education, residency and fellowship training, years in practice, clinical practice type, practice setting, and research productivity were collected across the leagues for both osteopathic and allopathic training backgrounds. RESULTS:Among 676 TPs and consultants, most were MDs (93.3 %) and male (91.3 %), with DOs more often being female (22.2 % vs. 7.8 %) and in early-career stages (p<0.05). Specialty distribution differed by degree, with DOs overrepresented in Family Medicine (15.6 %) and underrepresented in orthopedic surgery (1.2 %) (p<0.001). Training locations partially aligned with current team affiliation, particularly for residency, but research productivity did not differ by degree. The majority practiced in urban settings within private or academic institutions, although DOs were less frequently urban-based (5.0 %) than MDs (p=0.028). CONCLUSIONS:US professional sports team physicians (PSTPs) are predominantly MD-trained and male, with DO physicians and women underrepresented, especially in orthopedic surgery. Career stage, research productivity, and practice settings were generally similar across degree types, highlighting potential external factors, such as the presence of longstanding institutional affiliations and informal referral networks, that may influence access to these roles.
CONTEXT:Thoracic outlet syndrome (TOS) involves the compression of neural or vascular structures in or near the superior thoracic aperture, and osteopathic manipulative treatment (OMT) can be utilized to relieve associated symptoms. Ultrasonography may be useful for determining possible mechanisms by which OMT reduces symptoms, leading to an improved understanding of how to best implement OMT techniques for the treatment of TOS. OBJECTIVES:This study aims to develop a Doppler ultrasonography protocol to assess blood flow changes in the subclavian artery before and after OMT that was intended to address musculoskeletal dysfunction associated with vascular TOS. METHODS:We recruited adults with TOS symptoms and utilized a nonrandomized, crossover design to evaluate blood flow in the subclavian artery before and after OMT utilizing Doppler ultrasonography. Specifically, a fixed-sequence, 2-period crossover design was utilized to compare ultrasound measurements of blood flow at baseline (US1), after a 10-minute rest (US2), and after a physical examination and OMT (US3). The examination, OMT, and ultrasound were performed on both arms, and the participant arms with a positive vascular TOS maneuver were considered TOS-positive. Ultrasound measurements included vessel diameter, peak systolic velocity (PSV), end-diastolic velocity (EDV), and heart rate (HR). Mixed-effect models were utilized to determine the effect of OMT on blood flow, and changes in ultrasound measurements between study time points (US1 vs. US2, US2 vs. US3) and differences by TOS test results and by participant sex were also evaluated. RESULTS:Fourteen volunteers (6 men, 8 women) participated in the study. Nine (64.3 %) participants had at least 1 arm that was TOS-positive, and 14 (50.0 %) of the 28 arms were TOS-positive. No differences in measurements were found between US1 and US2 (all p≥0.08). When comparing US2 and US3 measurements, vessel diameter (p=0.02) and EDV (p=0.03) increased after OMT. After OMT, HR decreased (p=0.05), and the decrease was greater in TOS-positive arms than in TOS-negative arms (p=0.02). No differences were found between men and women between US1 and US2 (p=0.90) or between US2 and US3 (p=0.16). CONCLUSIONS:These preliminary results suggested that our ultrasonography protocol assessing subclavian artery flow was sensitive to the effects of OMT and identified significantly increased perfusion and decreased HR after OMT. Additionally, our results suggested that TOS-positive arms with compromised vasculature may have greater responsiveness to OMT. Therefore, more rigorous studies are needed to better assess the impact of OMT on TOS and to improve our understanding of the effects of OMT on impaired blood circulation. Such information about OMT would likely benefit patients by identifying effective, low-risk, and noninvasive management options for the treatment of TOS.
CONTEXT:The United States Medical Licensing Examination (USMLE) Step 1 and Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) Level 1 transitioned to a Pass/Fail (P/F) designation in 2022. While this change is meant to improve medical students' mental health during their first-level licensure examination period, it is also critical to consider how this may affect students during their second-level licensure examination period. Because this scoring transition is relatively recent, limited studies have investigated how this change has affected student quality of life (QoL). Even fewer studies have analyzed COMLEX-USA specifically. OBJECTIVES:This study aims to investigate the QoL of osteopathic medical students during their designated study periods (DSPs) for COMLEX-USA Level 1 and Level 2 after the transition of COMLEX-USA Level 1 to a P/F designation. METHODS:The study design consisted of an online survey distributed to fourth-year osteopathic medical students in the Class of 2024 via the Council of Osteopathic Student Government Presidents (COSGP), with a total of 253 participants. Participants were included in the study if they were members of the Class of 2024 and if they took COMLEX-USA Level 1 as P/F and Level 2 as numerically scored. The survey included identical questions for COMLEX-USA Level 1 vs. Level 2 regarding QoL parameters during DSPs on a Likert scale, and the sign test was utilized to analyze the results. RESULTS:During their DSP for COMLEX-USA Level 2, participants reported better mental health (p=0.0017), more time for hobbies (p=0.0072), more time spent with loved ones (p<0.0001), higher levels of physical activity (p=0.0199), higher overall QoL (p=0.004), and higher confidence in passing (p=0.0003) compared to during their DSP for COMLEX-USA Level 1. Although the QoL parameters were nearly all significantly better for participants during their DSP for COMLEX-USA Level 2, a total of 137 participants (54.1 %) reported that they felt greater perceived stress for the COMLEX-USA Level 2 examination. However, this proved to not be statistically significant (p=0.1852). CONCLUSIONS:The newly established P/F designation for first-level licensure examinations was implemented to improve student well-being. This study's results indicate an overall better QoL for survey participants from the Class of 2024 during their COMLEX-USA Level 2 DSP as compared to QoL during their COMLEX-USA Level 1 DSP. Still, there is some suggestion that the mental burden previously associated with first-level licensure examinations has potentially been deferred to second-level licensure examinations. Further studies would be required to clearly delineate the impact of COMLEX Level 1 having a P/F designation on medical student wellness and the residency application process.
CONTEXT:The brain is highly vulnerable to circulatory disruptions, including cerebrovascular accident (CVA or stroke). Stroke survivors can benefit from cardiac rehabilitation (CR). OBJECTIVES:This systematic review evaluated the safety and efficacy of CR in stroke survivors. METHODS:PubMed and Embase databases were screened from 1993 to May 2025 for articles utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. We included randomized controlled trials (RCTs), nonrandomized clinical trials/studies, cohort studies (prospective or retrospective), case-control studies, and large case series (≥10 participants). Two independent researchers screened articles utilizing the Participant, Interventions, Comparisons, Outcomes, and Study design (PICOS) criteria for inclusion in the review, and a third person was utilized to resolve any conflicts. Data were abstracted from selected studies to a structured spreadsheet, which included information on study characteristics, adverse events, withdrawals, and functional outcomes. RESULTS:A total of 2,239 records were identified through database searching, including PubMed (n=2039) and Embase (n=200). After removal of duplicates (n=180), 2059 records underwent title and abstract screening. Of these, 1986 records were excluded, and 73 studies were sought for retrieval. Of the 73 studies, 9 were not retrieved. The remaining 64 full-text articles were assessed for eligibility, of which 52 were excluded due to incorrect study design (n=28), failure to report adverse events (n=15), incorrect intervention (n=6), or incorrect patient population (n=3). A total of 12 studies were included in the review. Out of the studies included, five studies reported adverse events in ranging severity. All events were considered unrelated to the use of CR, due to lower-graded events being expected occurrences of physical exertion, whereas severe and fatal events were attributed to pre-existing comorbidities, unrelated illnesses, or external factors. Withdrawal rates and events were reported in all 12 studies, which showed that withdrawal was unrelated to CR and based more on logistical and medical events present within the patient population. All studies reported improvement in functional outcomes; however, a mix of statistically significant and nonsignificant results were observed, contingent upon the specific outcome measure evaluated. CONCLUSIONS:Collectively, the data suggest that CR is a safe intervention for poststroke rehabilitation and has the potential to improve functional outcomes in patients. However, variability in functional outcomes highlights the need for individualized CR protocols.
CONTEXT:Quality mentorship for medical students and resident physicians throughout their medical education has been shown to be beneficial in supporting students in their academic and professional endeavors. There is no standardized approach for providing mentorship across institutions, and many students feel that they do not receive adequate mentorship. There is a paucity of literature about osteopathic mentorship, which is important to address due to the unique set of challenges faced by osteopathic medical students and residents. OBJECTIVES:This review aims to evaluate the quality and availability of osteopathic mentorship in medical education and to identify areas of improvement and barriers for implementing structured mentorship programs across institutions. METHODS:A comprehensive search of PubMed and ClinicalKey was conducted to explore current practices for mentorship within the training world of medicine, focusing on osteopathic mentorship throughout medical school and residency training. Recommendations for improving mentorship and developing standardized approaches were derived. RESULTS:Mentorship was strongly associated with improved specialty choice and residency match outcomes. Students prioritized honest feedback (75.4 %), responsiveness (70.8 %), and networking (60.8 %). Structured mentorship programs demonstrated high effectiveness, including a 100 % categorical surgery match rate in one cohort and significant perceived benefit (p<0.05). Osteopathic students reported limited mentorship (59.0 %) and significantly greater degree-based bias than allopathic peers (73.7 % vs. 16.0 %; p=0.001), with fewer research and mentorship opportunities. Targeted mentorship initiatives increased specialty interest (odds ratio [OR]=1.43; p=0.003) and improved match outcomes. CONCLUSIONS:Mentorship has been demonstrated to be beneficial in medicine for both medical students and residents. Mentorship is very valuable to help osteopathic medical students match competitive specialties for residency and to maximize their potential. Residents at training programs with established and well-structured mentorship programs demonstrated greater satisfaction and success.
CONTEXT:Breast cancer is the second leading cause of cancer death among women in the United States. Screening mammograms reduce mortality overall, but they present unique challenges in patients with cognitive impairments. Harms such as psychological distress and financial burden may outweigh benefits provided by screening mammograms. Those with subjective cognitive decline (SCD), defined as self-perceived cognitive decline without measurable cognitive impairment, are a population lacking clear recommendations, and SCD remains understudied regarding mammogram utilization. OBJECTIVES:The objective of this study was to investigate the relationship between SCD and adherence to mammogram screening recommendations. METHODS:To examine the relationship between SCD and mammogram utilization, we conducted a cross-sectional analysis utilizing the 2022 Behavioral Risk Factor Surveillance System (BRFSS) data set. Sociodemographic factors associated with screening rates within the SCD population were assessed. Logistic regression models were utilized to evaluate associations between mammogram screenings within the past 2 years, income levels, and other sociodemographic variables. RESULTS:A total of 18,344 of the 22,442 (81.2 %) women aged 50-74 in the BRFSS reported having a mammogram in the past 2 years. A total of 1,360 (6.75 %) respondents reported a level of SCD that only affects memory, whereas 1,230 (5.38 %) reported having SCD that impacts memory and ADLs. Although mammogram screening rates decreased in individuals reporting SCD, the rate of decline was only statistically significant if ADLs were affected (AOR: 0.63, 95 % CI: 0.46-0.86; p=0.004). Furthermore, all groups' odds are significantly increased when income is >$50,000, except those in which ADLs are affected by SCD. CONCLUSIONS:Our data indicate similar mammogram screening rates between women with and without SCD as long as ADLs are not affected; however, once SCD impacts ADLs, screening rates for women drop significantly. Interestingly, we found that the women with the highest rates of screening are those with income greater than $50,000 with SCD but no impacts to ADLs and that screening disparities between rural and urban were nonsignificant. Given these contextual differences, additional screening guidelines for mammograms among women with SCD are warranted.
CONTEXT:Since its inception, osteopathic medicine has included pediatric patients within its clinical scope, addressing a wide range of congenital, postural, respiratory, neurological, and musculoskeletal conditions. OBJECTIVES:This study aimed to review historical osteopathic literature for the analysis of osteopathic manipulative treatment (OMT) utilized for the management of pediatric patients. METHODS:This structured historical literature review, conducted between June and October 2025, examined osteopathic literature published from 1874 to 1950, with a focus on pediatric OMT. Online archive searches were conducted utilizing Medical Subject Headings (MeSH)-derived keywords. Articles were screened for relevance to OMT in pediatric patients and caregiver guidance, excluding those that did not provide details on manipulative interventions. The assessed outcomes encompassed reported health conditions, the use of OMT, the duration of osteopathic interventions, guidance provided to caregivers, and the outcomes reported. Data were analyzed utilizing a reflective brainstorming model, with findings organized into key themes relevant to contemporary osteopathic practice. Articles lacking descriptions of manipulative interventions were excluded. RESULTS:The initial literature search identified 227 articles, of which 126 were excluded for not meeting the inclusion criteria. A total of 28 articles were deemed eligible and included in this review. The extracted data are structured into five thematic areas: health issues reported, OMT, time frame of. OMT, caregiver guidance and behavioral approaches, and reported outcomes. These data are presented through integrated narrative and tabular syntheses. CONCLUSIONS:This review highlights the evolution of osteopathic medicine in pediatrics, emphasizing its role in managing various pediatric conditions with gentle, individualized treatments. Osteopathic medicine focuses on improving health, restoring function, and preventing invasive interventions. Its child- and family-centered approach aligns with modern healthcare models that prioritize prevention and well-being. Given its safety and effectiveness, particularly in musculoskeletal and developmental disorders, osteopathic medicine remains a valuable tool in pediatric care. Further research is needed to validate these findings and to expand osteopathic medicine's role in child health, fostering a more integrated healthcare model.
Vaginismus is a condition characterized by involuntary vaginal muscle contraction leading to pain and distress that significantly impacts sexual health, psychological well-being, and quality of life. While conventional treatments, including behavioral therapy, physical therapy, and vaginal dilators, remain the cornerstone of management, their efficacy is often limited, and barriers such as stigma and access persist. Advancements such as botulinum toxin injections and topical agents show promise in reducing pain and muscle hypertonicity. Technological innovations, including laser and radiofrequency (RF) therapy, as well as neurostimulation techniques, aim to enhance muscle relaxation and modulate nerve activity. Additionally, psychological and integrative interventions, such as virtual reality-based exposure therapy and mind-body practices, address the emotional and psychological dimensions of the condition. Advances in personalized medicine, including biomarker research, offer the potential to tailor treatments to individual patient needs. Despite these developments, challenges remain in ensuring accessibility, overcoming stigma, and conducting robust clinical trials to establish efficacy and safety. Osteopathic physicians may contribute to multidisciplinary management by addressing musculoskeletal dysfunction associated with pelvic floor disorders through osteopathic manipulative medicine (OMM). This review highlights the importance of a multidisciplinary, patient-centered approach to managing vaginismus and underscores the need for further research to refine and expand therapeutic options. A comprehensive literature search of the PubMed, JSTOR (Journal Storage), and EBSCO databases was conducted between December 2024 and August 2025, and articles were selected based on accessibility and relevance. The majority of the studies evaluated multimodal approaches, including pelvic floor physical therapy (PFPT), cognitive behavioral therapy (CBT), pharmacologic interventions, and combined strategies. Reported success rates varied widely (71-100 %). Newer technological advances such as laser and RF therapies, photobiomodulation (PBM), and virtual-reality therapies all found significance (p<0.05) in treatment protocols and outcome definitions. Limited data were available regarding long-term outcomes, recurrence rates, and cultural/ethnic variations. Current evidence supports a multimodal approach as the most effective strategy for managing vaginismus. However, heterogeneity in study design, diagnostic criteria, and outcome measures limits the generalizability. Standardized protocols and larger, high-quality trials are needed to improve diagnosis and optimize care for patients with vaginismus.
CONTEXT:Early detection of colon cancer through screening is critical for improving long-term survival outcomes; however, only 54 % of the United States (U.S.) population that is eligible to have a colon cancer screening receive one. Previous research found that people who participate in physical activity (PA) are less likely to get screened due perception of having low risk. However, health organizations have lowered the age to initiate screening as more cases are being reported among younger U.S. residents. OBJECTIVES:This study aimed to examine the association between colon cancer screening and self-reported health status for individuals meeting aerobic PA guidelines among individuals aged 45-54. METHODS:We conducted a cross-sectional analysis of the 2023 Behavioral Risk Factor Surveillance System (BRFSS) data. We included all participants between the ages of 45 and 54 who responded to the questionnaire regarding colonoscopy and sigmoidoscopy examinations, and the supplementary module that features PA and sedentary behaviors. RESULTS:Among 1118 respondents, 503 (45.5 %) reported having undergone colon cancer screening via colonoscopy or sigmoidoscopy, whereas 615 (54.5 %) had not. Screening prevalence differed by insurance status (p=0.002), with higher rates among insured individuals (483/1034; 47.2 %) compared with uninsured individuals (11/65; 19.2 %). Screening also varied by race/ethnicity (p=0.022); rates were highest among White respondents (353/732; 49.9 %) and lowest among Asian respondents (16/60; 27.3 %). Screening did not significantly differ by education, sex, overweight/obesity status, transportation access, place of residence, or PA status (all p>0.05). Among respondents meeting aerobic PA guidelines (n=1048), 489 (47.0 %) reported screening. Neither cardiovascular disease (CVD) risk (adjusted odds ratio [AOR]=1.22, 95 % confidence interval [CI]: 0.87-1.70) nor self-reported good health (AOR=0.89, 95 % CI: 0.52-1.51) was associated with screening. Among those meeting both aerobic and strength training guidelines (n=541), 255 (48.8 %) reported screening. In this group, reporting good or better health was associated with lower odds of screening (AOR=0.37, 95 % CI: 0.15-0.90), while CVD risk remained nonsignificant (AOR=1.33, 95 % CI: 0.80-2.23). CONCLUSIONS:Our analysis found no link between colon cancer screening and self-reported health status for those meeting aerobic guidelines, but those who met both aerobic and strength training guidelines were less likely to get screened. Uninsured individuals and Asian Americans also had lower screening rates. These findings highlight the need for targeted public health campaigns to address screening disparities, particularly among active individuals and underserved communities.
CONTEXT:Osteopathic medical care has been associated with better long-term outcomes in an intention-to-treat analysis of data from a retrospective cohort study involving chronic low back pain (CLBP). The beneficial outcomes attributable to osteopathic medical care were mediated by physician empathy and osteopathic manipulative treatment (OMT) in the subset of patients who consistently utilized osteopathic physicians compared with those who utilized allopathic physicians. OBJECTIVES:This study utilized data from the previously reported study to conduct a per-protocol analysis to determine the outcomes of osteopathic medical care utilizing a pragmatic research design in which patients consistently received osteopathic or allopathic medical care during long-term follow-up. METHODS:A retrospective cohort study was conducted utilizing patients with CLBP selected from the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION) from September 2016 through August 2024. Patients were followed at quarterly encounters after enrollment to determine whether they consistently received care for low back pain from either osteopathic or allopathic physicians. Data pertaining to pain, function, pain impact, health-related quality of life (HRQOL), and the frequency of chronic widespread pain (CWP) and CLBP recovery were measured at quarterly encounters for up to 36 months. Both unadjusted and adjusted results were measured over time. The latter were computed utilizing generalized estimating equations (GEEs) with covariates including sociodemographic and clinical characteristics. The clinical relevance of treatment-group differences was measured utilizing Cohen's d statistic. RESULTS:There were 1,078 patients in the study, including 132 (12.2 %) and 946 (87.8 %) treated by osteopathic and allopathic physicians, respectively. A total of 5,836 encounters were completed over 36 months, including 818 (14.0 %) and 5,018 (86.0 %) in the osteopathic and allopathic medical care groups, respectively. The adjusted means (95 % confidence intervals [CIs]) for patients treated by osteopathic vs. allopathic physicians were 6.0 (5.6-6.3) vs. 6.4 (6.2-6.7) for low back pain intensity (p=0.002); 13.5 (12.2-14.9) vs. 15.3 (14.4-16.2) for back-related disability (p<0.001); 30.2 (28.3-32.0) vs. 31.8 (30.7-33.0) for pain impact (p=0.03); 38.6 (37.3-40.0) vs. 37.2 (36.4-38.0) for physical function (p=0.01); 52.7 (50.9-54.5) vs. 54.3 (53.1-55.6) for depression (p=0.02); and 56.4 (54.9-58.0) vs. 58.0 (56.9-59.1) for sleep disturbance (p=0.01). These results all favored osteopathic medical care and the results for low back pain intensity (Cohen's d=0.23), back-related disability (Cohen's d=0.27), and physical function (Cohen's d=0.21) exceeded the threshold for clinical relevance. Osteopathic medical care was also associated with greater CLBP recovery (odds ratio [OR], 2.07; 95 % CI, 1.28-3.35; p=0.003), although recovery was infrequently reported during follow-up. CONCLUSIONS:This per-protocol analysis found better outcomes in pain, function, pain impact, and HRQOL, including physical function, depression, and sleep disturbance, among patients treated by osteopathic physicians compared with allopathic physicians over 36 months of follow-up after adjusting for sociodemographic and clinical characteristics. The findings for low back pain intensity, back-related disability, and physical function were also clinically relevant. Osteopathic medical care was associated with greater recovery from CLBP, although recovery was infrequently reported.
CONTEXT:Nonpharmacologic treatments are recommended for the treatment of pain including osteopathic manipulative treatment (OMT). It has been shown there is low utilization of OMT and disparities in access in patient with pain conditions. OBJECTIVES:The objective of this study is to describe the current landscape of OMT receipt as an adjunct in adult patients prescribed opioids. Through the exploration of a national outpatient database, this study will discern if there are disparities to receiving OMT. METHODS:Through a deidentified, national health record database, patients with seven categories of pain-provoking conditions who receive ≥3 opioid prescriptions were queried for receipt of OMT. Demographics, pain conditions, prescribed opioid morphine milliequivalent dose, and insurance data were analyzed. RESULTS:Of 98,892 patients meeting the inclusion criteria, 1,371 (1.4 %) received OMT. Patients under 60 years, female, White race, and having multiple pain-provoking conditions were more likely to receive OMT. Medicaid was the most common payer type for those who received OMT. Hispanic and Black patients received less OMT than non-Hispanic White patients. CONCLUSIONS:Despite recommendations for nonpharmacologic therapies to treat pain, OMT use remains low among patients on long-term opioid therapy for pain-provoking conditions. In this study, there were racial and ethnic differences with White patients receiving OMT more often than others. Further work is needed to assure access to OMT as part of a patient's pain treatment plan across all populations.
CONTEXT:Ehlers-Danlos syndrome (EDS) and hypermobility spectrum disorder (HSD) are connective tissue disorders associated with musculoskeletal manifestations and significant psychiatric comorbidities. Psychoactive medications commonly utilized in these populations raise concerns regarding potential cardiac effects. OBJECTIVES:This study explores associations between psychoactive medication utilization and electrocardiogram (ECG) parameters in patients with hypermobile Ehlers-Danlos syndrome (hEDS) and HSD to provide insight into potential cardiac considerations in this population. METHODS:This retrospective analysis included de-identified data from patients referred for cardiac evaluation at the Long Island Heart Rhythm Center between January 2019 and June 2023. Diagnosis of EDS and HSD were made utilizing the 2017 International Classification criteria. Psychiatric diagnoses were classified per DSM-5 criteria, and psychoactive medications were categorized utilizing NIH guidelines. ECG parameters, psychiatric diagnoses, and psychoactive medication use were compared between groups. Statistical analyses included Student's t-tests for continuous variables, chi-square or Fisher's exact tests for categorical variables, and odds ratio (OR) calculations. RESULTS:Among 109 patients (hEDS: n=75; HSD: n=34), psychiatric diagnoses were more prevalent in hEDS patients (72 vs. 38.2 %; p=0.008), with significant differences in trauma- and stressor-related disorders (p=0.009) and ADHD (p=0.006). hEDS patients had a higher mean psychoactive medication use (1.8 vs. 1.1; p=0.019) and greater anticonvulsant use (33.3 vs. 8.8 %; p=0.008). In a subset with ECG data (n=62), QTc intervals were significantly shorter in hEDS patients (421.62 ± 22.47 ms vs. 436.73 ± 18.74 ms; p=0.022), yet within normal ranges. QTc prolongation was more frequent in HSD patients (26.7 vs. 6.4 %; OR 5.33; 95 % confidence interval (CI) [1.04-27.39]; p=0.045). CONCLUSIONS:hEDS patients had a higher psychiatric burden and psychoactive medication use than HSD patients, but ECG parameters largely remained within normal limits. The increased QTc prolongation in HSD patients highlights potential cardiovascular risks, requiring further investigation. Routine cardiovascular monitoring and interdisciplinary care are recommended for hypermobile patients on psychoactive medications.
Access to mobile recording devices and the prevalence of telehealth encounters have increased dramatically in recent years. These circumstances create opportunities for patients to record their clinical encounters, and some states do not require permission from the physician to do so. State laws that define requirements to record conversations vary significantly, and clinicians may be unaware of their own states' policies. Furthermore, institutions may not have official guidelines addressing recording procedures in the clinical setting. Although research suggests that there are opportunities for consensual recordings to benefit healthcare delivery, covert recording of clinicians without their knowledge or consent has received less attention. This review explores the legislation governing recording laws, describes several cases involving recorded healthcare information, and reviews studies examining the risks and benefits of recording encounters. Finally, practical recommendations for healthcare providers and institutions are addressed, acknowledging the need for proactive transparency, trust, and therapeutic alliance in a rapidly changing healthcare landscape.
CONTEXT:The postacute sequelae of SARS-CoV-2 (PASC) are unexpected consequences of COVID-19 infections. Many patients continue to have PASC-related symptoms weeks to months after an infection, experiencing morbidity that affects daily living. Historically, many symptoms associated with PASC have been responsive to osteopathic manipulative medicine (OMM). OBJECTIVES:To develop and disseminate a standardized clinical protocol for evaluating the efficacy of osteopathic manipulative treatment (OMT) in managing PASC. This study will assess OMT's impact on symptoms and functional outcomes while systematically monitoring for adverse events (AEs) within this patient population. METHODS:The protocol is a prospective, single-arm, pre-post treatment cohort study involving patients seeking OMT with PASC-related symptoms. Standardized outcome measures have been selected to assess PASC-related symptoms and lifestyle impact over a 6-month longitudinal period. Data collection will occur at enrollment (baseline), at every second OMT session, and at a final follow-up. This final assessment will be conducted either 6 months postenrollment or 2 months after the cessation of treatment, whichever occurs first. Pragmatic, personalized OMT based on the physicians' clinical findings and judgment is recommended to provide a realistic assessment of real-world OMT practice vs. a protocol-based intervention. The design developers recommend utilizing a web-based, HIPAA-compliant platform such as Research Electronic Data Capture (REDCap) to facilitate informed consent procedures, disperse and collect surveys, provide reminders for completing surveys, and store and manage data. RESULTS:At baseline, participants will provide demographic and clinical data, including age, sex, race, smoking and employment status, pre-COVID-19 health status, and comorbidities. We will also document symptoms and treatments associated with their acute COVID-19 illness. Descriptive statistics will summarize baseline characteristics. Longitudinal outcomes - encompassing neurocognitive function, physical symptoms, quality of life, and work status - will be analyzed utilizing generalized linear mixed models (GLMMs). This approach accounts for clinician-level clustering and adjusts for potential confounding variables while monitoring for adverse effects. CONCLUSIONS:This protocol provides a standardized, pragmatic framework to evaluate the impact of OMT on the multifaceted symptoms of PASC. By utilizing a longitudinal, real-world design and robust statistical modeling (GLMM), the study aims to establish evidence-based insights into how osteopathic intervention can improve functional outcomes and quality of life for PASC patients. Furthermore, this standardized approach facilitates multi-site collaboration, ensuring that findings are reproducible and scalable within the broader medical community.
