Background/objectives:The Neonatal Assessment Manual scorE (NAME) model has emerged as a novel, structured, touch-based approach to evaluating neonates' general conditions, with growing evidence supporting its validity and reliability in NICU settings. However, there is a critical need to integrate this method into clinical workflows and explore its translational potential in improving neonatal care. This paper aims to consolidate the body of evidence surrounding the NAME model and propose a clinically implementable strategy to enhance neonatal assessment, early detection of complications, and overall health outcomes in NICU settings. Methods:We critically appraised key NAME studies encompassing theoretical rationale, construct and content validity, inter-rater reliability, and clinical correlations in NICU populations. Drawing from these findings, we developed a stepwise clinical framework for NAME integration, aligning it with existing neonatal care protocols. Results:Evidence demonstrates that NAME scores correlate significantly with infants' gestational age, birth weight, and complexity indices (p < 0.001), providing a rapid and non-invasive method to stratify newborns' health conditions. Inter-rater reliability is moderate-to-good, particularly for "Marginal" classifications, and professionals across NICU disciplines found the method to have high content validity (CVI ≥ 0.9). A structured roadmap for clinical integration is proposed, including operator training guidelines, NAME score interpretation algorithms, and embedding NAME within multidisciplinary rounds. Conclusions:The NAME model, grounded in physiological and clinical evidence, represents a promising paradigm shift in neonatal assessment. Its systematic adoption may facilitate early risk detection, personalized care planning, and improved outcomes in NICU populations. Future implementation studies are needed to validate its operational impact across diverse care settings and age groups.

Australian and New Zealand osteopaths predominantly manage musculoskeletal complaints using a variety of modalities including manual therapy, exercise and lifestyle and occupational advice. There appears to be a small percentage of patients who seek osteopathy care for non-musculoskeletal issues such as conditions affecting the gastrointestinal tract. The evidence base for osteopathic treatment as part of the management of such conditions is equivocal. The aim of this study was to describe the practice of Australian and New Zealand osteopaths who report often treating patients with non-musculoskeletal complaints. This study is a secondary analysis of data from the Australian and New Zealand osteopathy practice-based research networks (PBRNs) collected in Australia from July to December 2016 and in New Zealand from August to December 2018. Respondents to the PBRN baseline surveys were asked to provide information about their demographic, patient and clinical management characteristics. One of these characteristics was the frequency of treating patients presenting with non-musculoskeletal complaints. Descriptive and inferential statistics were used to inform regression modelling of significant predictors of often managing non-musculoskeletal complaints. Of the 1254 osteopath participants from Australia and NZ, 13.5

Osteopathic manipulative treatment (OMT) has shown efficacy in various clinical conditions and age groups. Understanding its neurobiological, particularly autonomic, mechanisms of action remain limited. Preliminary studies suggested a parasympathetic effect of OMT, evidenced by heart-rate-variability analysis. A cross-over RCT on healthy adults was conducted to compare OMT with sham therapy. Thirty-seven participants underwent two sessions (OMT and sham), comprising baseline, tactile treatment, and post-touch. Novel thermal imaging data analyses in combination with seed correlation analyses (SCA) were employed to explore the OMT effects on autonomic parameters. Particularly, the sham group exhibited an elevated warming effect on the cheeks, nose, and chin. Inversely, for the OMT group a conspicuous cooling trend in the nose, but not in the cheeks and chin was observed. Considering SCA maps, the intensity of the correlation for nose tip, glabella and GSR seeds showed higher values in the OMT compared to the sham group. The comparative analysis of thermal maps and SCA results represents a significant advancement in our understanding of the physiological mechanisms underlying OMT’s effects on autonomic functions. By elucidating specific patterns of temperature change, correlation intensity and specific clusters, this research provides valuable insights for optimizing clinical practice and refining theoretical models of manual therapy.

Introduction Chronic low back pain (CLBP) and depressive symptoms (DS) are highly prevalent, burdensome, costly and comorbid health conditions. Osteopathic manipulative treatment (OMT) was shown to improve pain and disability in patients with CLBP; however, the effect on comorbid DS remains less certain. Interestingly, CLBP and DS seem to be associated with changes in interoception, which may be reversed by OMT.Methods and analysis The study protocol proposes a single-blinded, parallel-group, randomised controlled trial to investigate the effect of OMT on clinical symptoms (depression, pain and disability) and interoceptive functions (interoceptive accuracy, sensibility and awareness) in patients with CLBP and comorbid DS. A sample of 60 adult subjects with CLBP and comorbid DS shall be recruited from osteopathic, orthopaedic and physiotherapeutic practices and educational institutes for osteopathy, sports science, psychology and medicine in Hamburg, Germany. Participants will be randomly allocated (1:1 ratio) to receive six 45 min treatment sessions of either OMT (standard-OMT group) or sham treatment imitating OMT (sham-OMT group). Primarily, symptoms of depression, pain and disability will be assessed with the Beck’s Depression Inventory, Second Edition (BDI-II), Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI). Secondarily, interoceptive accuracy, sensibility and awareness will be evaluated using the Heartbeat Tracking Task (HTT), Multidimensional Assessment of Interoceptive Awareness (MAIA-2) and confidence-accuracy correspondence (CAC). Ancillary, the therapeutic alliance will be investigated with the Helping Alliance Questionnaire. Data will be collected at baseline (t0), the first, third and sixth treatment sessions (t1, t3, t6) and at 3 months follow-up (t7). The findings will be analysed for between-group differences using descriptive (mean and SD) and inductive statistics (mixed analysis of variance). It is hypothesised that standard-OMT, compared with sham-OMT, will reduce depression, pain and disability (BDI-II, NRS, ODI) and increase interoceptive accuracy, sensibility and awareness (HTT, MAIA-2, CAC) in patients with CLBP and comorbid DS.Ethics and dissemination The study was approved by the ethics committee of the Medical School Hamburg (MSH-2023/288). The anonymised dataset will be published in an online repository, and the results will be published in peer-reviewed scientific journals.Trial registration number DRKS00031694.

Introduction Improving the quality of life for preterm children is a global health priority, given their vulnerability to neurocognitive impairments and adverse health consequences. Lack of posthospital care further exacerbates these risks, necessitating effective interventions during the neonatal period. This protocol for a pilot study aims to investigate the effects of touch interventions, including physiotherapy and osteopathic manipulative treatment, on brain activity in moderately preterm infants using brain functional MRI (fMRI), computerised EEG and metabolomics.Methods and analysis A 3-arm randomised sham-controlled trial will be conducted with 15 infants per experimental group. The study will include stable preterm infants born between 32.0 and 33.6 weeks of gestational age who do not require any intensive care treatments.The study aims to assess the impact of touch interventions on brain activity and metabolic sequelae. Using fMRI will primarily examine the pre-post changes between groups in blood oxygenation level dependent levels among different brain areas, specifically the anterior insula and the medial prefrontal cortex. Secondarily, we will explore the preterm brain’s neural effects on EEG slow delta wave band. Metabolomics will provide data on the effects among the three groups on metabolic changes associated with touch interventions.Ethics and dissemination Ethical approval has been obtained from the Ethics Committee of the local health agency in Milan (CET 449-2024). Understanding the effects of touch interventions on brain activity in moderately preterm infants, without needs of intensive care, can contribute to improving their clinical outcomes and promoting their growth, development and social behaviour. Findings from this pilot study will pave the way for future research, enabling the development of evidence-based interventions to enhance preterm infants’ well-being and long-term outcomes.Trial registration number NCT05853991.

Background and Rationale: Visceral disorders, both functional and organic, significantly impact health-related quality of life and pose a challenge for healthcare systems. Osteopathy offers manual, systemic, and patient-centered approaches for their management, yet these remain controversial due to limited scientific support and methodological inconsistencies. In the evolving landscape of healthcare regulation in Europe, and particularly in Italy, exploring clinical reasoning and operational models in visceral osteopathy is essential. This study aimed to explore the beliefs, clinical reasoning, and management strategies of experienced Italian osteopaths in the treatment of visceral disorders using a Constructivist Grounded Theory approach. Methods: This qualitative study applied a Constructivist Grounded Theory approach to explore the beliefs and clinical practices of 10 experienced Italian osteopaths. Semi-structured interviews were transcribed, coded, and thematically analyzed, integrating literature comparisons to support theory generation. Results: Four core themes emerged: (1) education and professional development, (2) definition and identification of visceral disorders, (3) clinical management strategies, and (4) multidisciplinary collaboration. The findings reveal marked heterogeneity in diagnostic frameworks and treatment rationales, often driven by tradition and subjective interpretation rather than empirical evidence. Palpatory assessments were frequently prioritized over patient-reported outcomes. Conclusion: The study highlights substantial fragmentation in Italian visceral osteopathic practice, echoing challenges across Europe. Promoting a shift towards critical thinking, evidence-based models, shared terminology, and interprofessional integration is essential for contextualising osteopathic contributions to the care of individuals presenting with visceral-related problems. These findings provide insights into the fragmented clinical practices of Italian osteopaths and may contribute to shaping a more critical and evidence-informed approach within Italian osteopathic practice and professional development, which is now more relevant than ever, given the recent integration of osteopathy into the Italian higher education system.

OBJECTIVES:To describe the prevalence and profile of NZ osteopaths treating people experiencing headaches and migraines. This study is the first to describe this practice. BACKGROUND:Manual and manipulative therapy interventions are commonly sought by individuals experiencing headaches or migraines. Evidence supports the use of manual therapy as part of the management of headache and migraine disorders. Osteopaths are health professionals who provide care for individuals experiencing headaches and migraines. However, there is a lack of data concerning the profile of osteopaths treating these conditions, in addition to their diagnostic and management strategies. METHODS:The Osteopathy Research Connect-New Zealand (ORC-NZ), a practice-based research network for the New Zealand osteopathy profession, was established, and recruitment occurred between August to December 2018. RESULTS:Two hundred and seventy-seven respondents provided responses to the headache and migraine items on the ORC-NZ practice questionnaire. Of these respondents, 235 (84.8 %) indicated treating headaches often, and 107 (38.6 %) indicated treating migraines often. Osteopaths who reported often treating patients with migraines and headaches were more likely to report clinically supervising associates and be co-located with a general practitioner. In terms of management, they tend to use HVLA, are likely to treat TMJ in the case of migraines, and the thoracic spine for patients with headaches. Further, NZ osteopaths frequently refer patients with migraines and/or headaches to other practitioners. CONCLUSIONS:NZ osteopaths treat patients with migraines and/or headaches and frequently refer them to other practitioners. NZ osteopaths are aware of the inter-professional approach required for this patient population.

Background:Persistent physical symptoms (PPS), including functional neurological disorders (FND), chronic pain, and other neurological conditions [e.g., Parkinson's disease (PD), Huntington's disease (HD), autism spectrum disorder (ASD), and psychosis], present substantial challenges for healthcare systems due to their complex and multifaceted nature. These disorders often involve maladaptive sensory processing and heightened sensory perception, contributing to disability and psychological distress. Sensory attenuation (SA) is a neurophysiological mechanism that helps differentiate self-generated from external sensory stimuli, filtering irrelevant sensory input. Altered SA has been implicated in the pathophysiology of FND, chronic pain, and PPS, where impaired sensory modulation contributes to symptom persistence. Aims:This scoping review aimed to explore the role of SA in healthy individuals and those with FND, neurological disorders, and chronic pain. A secondary objective was to examine SA measurement techniques and their clinical relevance. Methods:Following the Joanna Briggs Institute (JBI) methodology and PRISMA-ScR guidelines, a comprehensive search of PubMed, ScienceDirect, and Google Scholar identified studies published between 2013 and 2023. Inclusion criteria encompassed investigations of SA in both symptomatic and healthy populations, focusing on FND, neurological disorders, and chronic pain. Data extraction highlighted SA mechanisms, assessment methods, and clinical implications for manual therapy and musculoskeletal (MSK) care. Results:A total of 62 studies involving 3,344 participants were included. Findings indicated that SA is essential for sensorimotor integration and the sense of agency in healthy individuals. However, disruptions in SA were consistently observed in FND, chronic pain, and neurological disorders, leading to sensory hypersensitivity, impaired motor control, and a distorted sense of agency. SA was assessed using methods such as the force-matching paradigm, electroencephalography (EEG), event-related potentials (ERPs), and functional magnetic resonance imaging (fMRI), providing insights into neurophysiological alterations. Conclusion:This review highlights the critical role of SA in adaptive sensory processing and its disruption in conditions like FND and chronic pain. Integrating SA-based interventions, such as sensorimotor retraining and affective touch, into manual therapy and MSK care may help recalibrate sensory processing and improve patient outcomes. Future research should focus on standardizing SA assessments and exploring its modulation in clinical settings to enhance person-centered therapeutic approaches.

Background Chronic low back pain (CLBP) presents a significant challenge for manual therapists. Recent advancements in pain research have highlighted the limitations of the traditional biomedical and biopsychosocial models, prompting the exploration of alternatives. The biopsychosocial-enactive (BPS-E) model has emerged as a promising alternative. This study aims to explore the application of the BPS-E model by manual therapists in managing CLBP and to initiate a meaningful dialogue about its use. Methods This study adhered to the Standards for Reporting Qualitative Research. Guided by constructivist grounded theory, we conducted semi-structured interviews with ten manual therapists who are experts in the BPS-E model. Data collection, conceptualization, and analysis were systematically carried out to identify key themes and insights. Results The core theme identified was “The person-centred approach,” with three subthemes: “Opportunities in implementing the model”, “Utilizing and Integrating Diverse Skills for Holistic Care”, and “Challenges in implementing the model”. Conclusion This study provides insights into how manual therapists incorporate the BPS-E model in their practice, demonstrating its advantages over the traditional biopsychosocial model. The findings highlight the need for further research and training to effectively implement the BPS-E model in clinical settings. This research begins an essential discussion on the potential of the BPS-E model to enhance care for CLBP patients.

Background: Since more people age and live longer with chronic disease, it is important to develop complementary and adjunctive approaches to improve body homeostasis and ensure the highest possible level of well-being for people affected by neurological disorders, besides the known benefits related to neurorehabilitation. In this context, osteopathic manipulative treatment (OMT) should be considered a promising holistic treatment to manage better pain and symptoms related to the chronic stages of neurological diseases. Objective: The primary purpose of this review is to examine the existing literature to determine the role and effects of OMT in patients affected by neurological disorders, giving some clinical advice. Methods: This critical review followed the Preferred Reporting Items for Systematic and Meta-analyses extension for Scoping Review (PRISMA-ScR). To guarantee a comprehensive and up to date search of evidence, the following databases were consulted: PubMed, Google Scholar, OSTEOMED.DR, Scopus and Cochrane library. Results: After an accurate screening, we included 16 primary research articles about the use of OMT in patients affected by neurological disorders, such as Parkinson disease, multiple sclerosis, cerebral palsy, and spinal cord injury. Conclusion: This critical review supports the idea that OMT could be a useful complementary tool in neurorehabilitation. However, further research is needed to bridge the gap between research and clinical practice. Registration protocol: 10.17605/OSF.IO/HDSXC.

Research evidence has become the foundation of modern health services. Health professionals rely on sound research to provide safe and effective care for patients, for the development of innovative diagnostic and treatment practices and to develop policies supporting the provision of optimal healthcare. Osteopathy is an established profession with an emerging research evidence base. The Strengthening Osteopathic Leadership and Research (SOLAR) program is a recent international initiative aiming to further build the evidence base and research capacity of the osteopathy profession. The program was developed by The Australian Research Consortium in Complementary and Integrative Medicine (ARCCIM) at the University of Technology Sydney (Sydney, Australia) and funded primarily by Osteopathy Australia, with the support from the Osteopathic Foundation (UK), Osteopaths New Zealand (NZ), Unite Pour l'Osteopathie (France), and Svenska Osteopatforbundet (Sweden). This paper describes the origins, objectives and features of the SOLAR program and outlines the importance of the program for future research and practice in the osteopathy profession. From its beginnings in 2022, to date, the SOLAR program has been highly successful, producing a substantial collection of concrete research and presentations, while enhancing the Fellows' capacity and confidence as leaders, both in osteopathy and the broader healthcare environment.

BACKGROUND AND PURPOSE:Chronic back pain conditions are highly prevalent worldwide. Osteopathic treatment seems to improve pain and function in this population. However, the mechanisms underlying osteopathic diagnosis and treatment of the spine are mainly unknown. Arguably, both inflammatory and autonomic processes may be involved, which should entail changes in skin temperature. Primarily, the feasibility of the study protocol was evaluated by assessing the retention, adherence, acceptability, safety, and blinding concealment rates and carrying out a power analysis. Secondarily, we investigated diagnostic correlations between pain ratings, palpatory findings, and skin temperature in spinal segments and therapeutic effects of osteopathic and sham spine manipulations. MATERIALS AND METHODS:In this single-blinded, randomized, and sham-controlled pilot and feasibility study, participants with chronic back pain were randomly allocated (1:1 ratio) to receive a single session of osteopathic or sham spine manipulations. Manual diagnosis, pain assessment, and infrared imaging were performed before treatment (baseline) and one week after treatment (follow-up), whereas infrared imaging was additionally conducted shortly after treatment (post-intervention). RESULTS:Seventeen participants completed the trial with 89.5 % retention, 100 % adherence, 100 % acceptability, 6 % adverse events, 22 % (osteopathic) and 50 % (sham) blinding concealment. A power analysis estimated a sample of 40 subjects for future randomized controlled trials. At baseline, no significant correlations were detected between palpatory findings, pain ratings, and skin temperature. There were no significant between-group differences in palpatory findings at single time points and pain ratings across time points (p < 0.05), whereas skin temperature showed significant between-group differences across all time points (p < 0.01). At post-intervention, osteopathic spine manipulations increased the skin temperature with a medium effect (Cohen's d = 0.66). CONCLUSION:The study was feasible. Osteopathic diagnosis does not seem to correlate with pain ratings and skin temperature. However, the increase in skin temperature shortly after osteopathic treatment suggests an autonomic (hyper-parasympathetic) effect.

OBJECTIVE:Tension-type headache (TTH) is among the 20 leading causes of disability worldwide. Due to the difficulty in diagnosis and the variable association of other symptoms, the management of this clinical condition is often unsatisfactory. Osteopathic manipulative treatment combined with exercise, diet, and general relaxation therapies may be valid for TTH. This study investigated osteopaths' common attitudes, beliefs, and values when treating and managing individuals experiencing TTH. METHODS:This is a qualitative study using thematic analysis with elements of grounded theory. Osteopaths with expertise in treating patients with primary headache conditions were recruited through purposive sampling methods. Data were gathered from individual, semistructured interviews and transcribed verbatim and then analyzed through thematic analysis. Ten osteopaths who met the inclusion criteria were recruited. RESULTS:Four main themes were generated from data analysis: (1) osteopathy and its alternative perspective on patients' perception of osteopathic intervention; (2) osteopaths' clinical decision making regarding the selection of treatment approaches; (3) the person's management through an individualized case treatment model; (4) a person-centered approach, setting the treatment in a particular environment to achieve the fulfillment of an individual's potential. CONCLUSION:The present study highlights that this sample of osteopaths endorse a person-centered renewed approach. The participants regularly assess the clinical conditions and disabilities associated with TTH to tailor their treatment approach. These osteopaths consider that these tailored treatment approaches directed at improving and promoting the individual's wellbeing alongside a reduction of their symptoms should be the main aim of osteopathic treatment.

Background: The practice of osteopathy differs around the world. However, the dominant practice is that of manual therapy interventions guided by assessment of the neuromusculoskeletal system. Patient populations treated by osteopaths vary across the lifespan and include groups with more-nuanced care requirements such as those who are pregnant. The volume of evidence for osteopathy care is increasing. Objectives: This umbrella review seeks to identify systematic reviews of osteopathic care with the purpose of highlighting current knowledge about the high-level evidence underpinning the profession. Methods: The umbrella review will be conducted consistent with the Joanna Briggs Institute umbrella review methodology. Articles will be limited to those describing osteopathic care. An initial search did not identify a similar study and nor is one registered. A search of MEDLINE and CINAHL informed the search syntax. A full search will be performed across MEDLINE (PubMed), CINAHL (EBSCO), Scopus, Web of Science, PEDro, Osteopathic Research Web, AMED, Index to Chiropractic Literature, Cochrane Database of Systematic Reviews, and the Osteopathic Medicine Digital Repository (OSTMED.DR). The reference lists of included articles will be reviewed to identify potentially relevant systematic reviews. Data will be extracted from each systematic review and presented in tabular format. Conclusion: The umbrella review will synthesise what is known about osteopathic care as described in systematic reviews. The review will inform stakeholders about the role of osteopathic care in the health system and provide recommendations for future research. The findings will be submitted for peer-review publication.

The polyvagal theory has led to the understanding of the functions of the autonomic nervous system in biological development in humans, since the vagal system, a key structure within the polyvagal theory, plays a significant role in addressing challenges of the mother-child dyad. This article aims to summarize the neurobiological aspects of the polyvagal theory, highlighting some of its strengths and limitations through the lens of new evidence emerging in several research fields-including comparative anatomy, embryology, epigenetics, psychology, and neuroscience-in the 25 years since the theory's inception. Rereading and incorporating the polyvagal idea in light of modern scientific findings helps to interpret the role of the vagus nerve through the temporal dimension (beginning with intrauterine life) and spatial dimension (due to the numerous connections of the vagus with various structures and systems) in the achievement and maintenance of biopsychosocial well-being, from the uterus to adulthood.

Background Chronic Low Back Pain (cLBP) poses a significant health challenge, leading to functional disability and reduced quality of life. Osteopathic Manipulative Treatment (OMT) is emerging as a therapeutic option for cLBP, but the brain mechanisms underlying its analgesic effect remain unclear. Materials and Methods Thirty cLBP patients were randomly exposed to either four weekly sessions of OMT (N=16) or Sham treatment (N=14). Resting-state Magnetic Resonance Imaging (rs-MRI) scans and pain perception questionnaires were collected before and after treatment. A voxel-wise, rs-fMRI data-driven analysis was conducted to identify changes in the intrinsic functional connectivity across the whole brain that were associated with the OMT. Spearman’s correlations were used to test for the association between changes in intrinsic connectivity and individual reports of pain perception. Results Compared to the Sham group, participants who received OMT showed significant alterations in the functional connectivity of several regions belonging to the pain matrix. Specifically, OMT was associated with decreased connectivity of a parietal cluster that includes the somatosensory cortex and an increase of connectivity of the right anterior insula and ventral and dorsal anterolateral prefrontal areas. Crucially, the change in connectivity strength observed in the ventral anterolateral prefrontal cortex, a putative region of the affective-reappraisive layer of the pain matrix, correlates with the reduction in pain perception caused by the OMT. Conclusions This study offers insights into the brain mechanisms underlying the analgesic effect of OMT. Our findings support a link between OMT-driven functional cortical architecture alterations and improved clinical outcomes.

Control interventions (often called "sham," "placebo," or "attention controls") are essential for studying the efficacy or mechanism of physical, psychological, and self-management interventions in clinical trials. This article presents core recommendations for designing, conducting, and reporting control interventions to establish a quality standard in non-pharmacological intervention research. A framework of additional considerations supports researchers' decision making in this context. We also provide a reporting checklist for control interventions to enhance research transparency, usefulness, and rigour.

In recent decades, an increasing number of studies on psychophysiology and, in general, on clinical medicine has employed the technique of facial thermal infrared imaging (IRI), which allows to obtain information about the emotional and physical states of the subjects in a completely non-invasive and contactless fashion. Several regions of interest (ROIs) have been reported in literature as salient areas for the psychophysiological characterization of a subject (i.e. nose tip and glabella ROIs). There is however a lack of studies focusing on the functional correlation among these ROIs and about the physiological basis of the relation existing between thermal IRI and vital signals, such as the electrodermal activity, i.e. the galvanic skin response (GSR). The present study offers a new methodology able to assess the functional connection between salient seed ROIs of thermal IRI and all the pixel of the face. The same approach was also applied considering as seed signal the GSR and its phasic and tonic components. Seed correlation analysis on 63 healthy volunteers demonstrated the presence of a common pathway regulating the facial thermal functionality and the electrodermal activity. The procedure was also tested on a pathological case study, finding a completely different pattern compared to the healthy cases. The method represents a promising tool in neurology, physiology and applied neurosciences.

BackgroundEnactivism and active inference are two important concepts in the field of osteopathy. While enactivism emphasizes the role of the body and the environment in shaping our experiences and understanding of the world, active inference emphasizes the role of action and perception in shaping our experiences and understanding of the world. Together, these frameworks provide a unique perspective on the practice of osteopathy, and how it can be used to facilitate positive change in patients. Since the neonatal period is a crucial time for development, osteopaths should aim to create a therapeutic relationship. Arguably, through participatory sense-making, osteopaths can help the baby build a generative model (with positive priors) to deal with stress and needs throughout their life.AimSince the literature considers that interactions with the environment, which enact the patients’ experiences, depending on contextual factors and communication between patient and caregiver, this research explored whether there is a correspondence between the indications in the literature and clinical practice in the management of the mother/parent–child dyad during osteopathic care on children aged 0 to 2 years old.MethodsSemi-structured interviews were conducted with a purposive sample of nine osteopaths with experience in the field of pediatrics. Interviews were transcribed verbatim, and constructivist grounded theory was used to conceptualize, collect and analyze data. Codes and categories were actively constructed through an interpretive/constructionist paradigm.ResultsThe core category was the idea of the pediatric osteopath as a support for the family, not only for the child. Four additional categories were identified: (1) Preparing a safe environment for both children and parents, (2) Communication, (3) Attachment and synchrony, and (4) Synchronization.ConclusionThrough participatory sense-making, osteopaths manage contextual factors to establish an effective therapeutic alliance through the osteopath-parent–child triad to facilitate the construction of the child’s internal generative model to promote healthy development. The therapeutic encounter is considered an encounter between embodied subjects, occurring within a field of affordances (ecological niche) that allows the interlocutors to actively participate in creating new meanings through interpersonal synchronization. Participatory sense-making and the establishment of a therapeutic alliance through the osteopath-parent–child triad are crucial to promote healthy development in the child.

Therapeutic affective touch has been recognized as essential for survival, nurturing supportive interpersonal interactions, accelerating recovery—including reducing hospitalisations, and promoting overall health and building robust therapeutic alliances. Through the lens of active inference, we present an integrative model, combining therapeutic touch and communication, to achieve biobehavioural synchrony. This model speaks to how the brain develops a generative model required for recovery, developing successful therapeutic alliances, and regulating allostasis within paediatric manual therapy. We apply active inference to explain the neurophysiological and behavioural mechanisms that underwrite the development and maintenance of synchronous relationships through touch. This paper foregrounds the crucial role of therapeutic touch in developing a solid therapeutic alliance, the clinical effectiveness of paediatric care, and triadic synchrony between health care practitioner, caregiver, and infant in a variety of clinical situations. We start by providing a brief overview of the significance and clinical role of touch in the development of social interactions in infants; facilitating a positive therapeutic alliance and restoring homeostasis through touch to allow a more efficient process of allostatic regulation. Moreover, we explain the role of CT tactile afferents in achieving positive clinical outcomes and updating prior beliefs. We then discuss how touch is implemented in treatment sessions to promote cooperative interactions in the clinic and facilitate theory of mind. This underwrites biobehavioural synchrony, epistemic trust, empathy, and the resolution of uncertainty. The ensuing framework is underpinned by a critical application of the active inference framework to the fields of pediatrics and neonatology.