Therapeutic touch occupies a central place in osteopathic practice, yet its epistemological foundations remain insufficiently clarified. It is typically framed either as a technical intervention explicable through biomechanical or neurophysiological mechanisms, or as a vector of non-specific relational and contextual effects. While these perspectives provide valuable insights, neither fully accounts for the complexity of touch in osteopathic care. This article proposes a pluralistic epistemological framework that integrates scientific, experiential and operational dimensions of osteopathic touch. Evidence-based approaches to manual therapy have contributed to the scientific understanding of osteopathic interventions by identifying measurable mechanisms and therapeutic effects. However, there is a tendency to objectify, detaching it from the lived, perceptual and relational dynamics through which it actually unfolds in practice. Drawing on embodied and phenomenological approaches to care, this article argues that osteopathic touch emerges at the intersection of neurophysiological processes, lived experience, perceptual attunement, and situated clinical action. Rather than proposing a unified theory of touch, the framework clarifies how multiple epistemological perspectives may coexist within osteopathic practice without being reduced to a single explanatory model. This framework has concrete implications for osteopathic clinical reasoning, education, and reflexive practice: it provides practitioners and educators with a clearer conceptual foundation for navigating the biological, experiential, relational, and ecological dimensions of therapeutic touch. Implications for practice -Moving beyond the usual reductions of osteopathic touch: neither a simple technique, nor a simple « contextual effect », nor an ineffable experience.-This framework integrates different types of knowledge: scientific, pragmatic, and operational knowledge without reducing them to a single explanatory model. This may help reduce ontological, epistemological and pedagogical ambiguities, supporting clearer clinical reasoning, teaching and research practices.-It supports a stable professional identity grounded not in doctrinal adherence, but in the practitioner's capacity to adapt their actions to a situated bodily experience and a reflexive therapeutic relationship.-Osteopathic touch is not limited to correcting local dysfunctions or biomechanical problems. It also involves a relational and perceptual process through which patients can discover new ways of experiencing their bodies and regulating themselves.-The focus should shift towards the cultivating attentional and adaptive clinical skills, rather than merely reproducing manual techniques. Touch should be taught as a perceptual and interactive clinical skill, emphasising how practitioners perceive bodily responses, adapt their touch accordingly, and respond to patient feedback in real time.

PURPOSE:Recent technological advances offer new perspectives for the assessment and management of low back pain (LBP). Due to the multidimensional nature of pain, assessment methods must continuously evolve. Although some studies have analyzed the impact of LBP on gait under real-world conditions, their clinical applicability remains limited by methodological constraints. Technology-based interventions with different levels of immersion (TBILI) are therefore being explored as an alternative, since locomotor behaviors appear to be largely preserved in simulated environments. The objective of this scoping review is to identify the potential contribution of TBILI to the assessment of LBP. MATERIALS AND METHODS:In accordance with JBI recommendations and PRISMA-ScR guidelines, studies meeting the PCC criteria were selected. These included a population with low back pain, a concept using TBILI assessment, and a context focusing on the mechanisms of action of TBILI. RESULTS:Thirty-nine studies (2547 patients; mean age: 46.8 ± 10.4 years) were analyzed. Pain intensity (n = 31) and physical function (n = 28) were the most reported assessment outcomes. Feedback (n = 18) and motivation (n = 16) were the most identified mechanisms among a broad range of TBILI action mechanisms. Immersive technology seems used for bodily awareness or biopsychosocial approach while non-immersive technology seems used for motivation and sensory modulation. However, methodological heterogeneity and a lack of standardization limit the clinical applicability of TBILI. CONCLUSION:TBILI demonstrate strong potential for the assessment and management of LBP. Standardization of protocols and better integration of biopsychosocial dimensions are required to fully realize this potential.

OBJECTIVE:Chronic non-specific low back pain (cNSLBP) is a leading cause of disability, influenced by bio-psycho-social factors. However, its impact on everyday activities such as navigating streets and interacting with other pedestrians remains underexplored. This study aimed to assess the effect of cNSLBP on perceptual-motor processes in a pedestrian crossing task, focusing on 1) collision avoidance behaviours, 2) the walker's role in avoiding collisions, and 3) the influence of pain perception. METHODS:Seventeen asymptomatic adults (AA, 11 females, 46.4 ± 12.8 years) and seventeen cNSLBP participants (10 females, 47.9 ± 12.7 years) performed a task involving crossing paths at a 90° angle with another walker. Participants interacted in three groups pairings: AA-AA, AA-cNSLBP, and cNSLBP-cNSLBP. Key metrics included crossing order inversion, collision risk threshold informing movement adaptation, crossing distance, and the walker's contribution (speed/orientation). RESULTS AND DISCUSSION:No significant differences were observed between groups for the collision risk threshold (≈0.93 m) or crossing distance (≈0.8 m). However, cNSLBP participants exhibited distinct avoidance strategies, especially in cNSLBP-cNSLBP interactions, which showed more frequent inversions. When crossing first, cNSLBP participants contributed less, whereas when crossing second, they contributed more, primarily by adjusting their speed. A significant negative correlation emerged between depression scores and the level of contribution when cNSLBP participants crossed second. CONCLUSION:These findings suggest that pain perception may influence collision avoidance behaviours. Further research, potentially incorporating virtual reality, is needed to control environmental factors and deepen our understanding of these interactions.

Background: Artificial intelligence (AI) is increasingly being integrated into healthcare education and research, yet little is known about how AI is perceived within osteopathy. To the best of our knowledge, this is the first cross-sectional study to examine AI perspectives specifically among osteopathic educators and researchers, providing fresh insights into technology adoption within this healthcare discipline. Methods: A cross-sectional survey was conducted between December 2023 and February 2024 among osteopathic educators and/or researchers through snowball sampling. The survey collected data on AI-related knowledge, usage in educational and research contexts, attitudes toward AI, perceived risks, and necessities challenges. Principal Component Analysis (PCA) was used to validate the structure of the survey. Demographic factors such as age, gender, occupation, and academic qualifications were analysed in relation to scores. Results: 190 respondents from 18 countries completed the survey. Participants demonstrated positive attitudes toward the role of AI in education and research, but acknowledged limited proficiency in its use. Usage of AI was higher among younger, male participants, with AI primarily used for personal organisation and research. Concerns about AI included risks of bias, over-reliance on technology, and potential replacement of human judgment. Participants with educational roles expressed fewer concerns about AI's risks compared to those outside of education. Knowledge of AI was not correlated with demographic factors, but attitudes and concerns about risks varied with age. Conclusion: Osteopathic educators and researchers view AI as a beneficial tool for teaching and research, but face challenges in its effective implementation due to concerns about technology replacing human expertise and biases. Training, institutional support, and ethical guidelines are essential to foster the responsible integration of AI in osteopathy. Implications for practice: AI is underutilised in osteopathic education and research despite positive attitudes towards its potential. Educators are less concerned about AI risks, positioning them as key facilitators of responsible assimilation. Institutional policies should provide clear AI usage guidelines while addressing ethical and validity concerns. AI should support, not replace, human expertise, ensuring critical thinking remains central in education and research.

OBJECTIVES:To systematically investigate trustworthiness (methodological rigor, transparency, good governance, research integrity, and absence of misconduct) in randomized controlled trials (RCTs) of osteopathic manual therapy. METHODS:This prospectively registered review (PROSPERO-ID: CRD42023457697) searched MEDLINE, EMBASE, CINAHL, AMED, PEDro, ostmed.dr, and Chiroindex for RCTs evaluating osteopathic treatments (January 2021-June 2024). Risk of bias (RoB) was assessed using Cochrane tool 2, while trustworthiness was assessed with the Cochrane Pregnancy and Childbirth Screening Tool and the REAPPRAISED checklist. Journal trustworthiness, misleading representations in abstracts ("spin"), and results plausibility (via meta-analysis) were also assessed. Findings were synthesized descriptively. RESULTS:Sixty-one RCTs were included (median sample size 45, interquartile range (IQR) 30-76), largely studying healthy volunteers (29%). Most had high RoB (74%), and only 7% acknowledged potential conflicts from authors' professional ties. No journals appeared on cautionary lists, although 23% of articles were published within 2 months of submission. Only 27% of contactable authors engaged with reviewers. Seven abstracts (12%) were free of spin. Methodological concerns included poor missing data handling (31%), selective analyses (38%), unacknowledged multiple testing (36%), and outcome switching (12%). Meta-analysis found two outliers and five further with very large effects, while 19% provided inadequate data for pooling. Limitations include incomplete reports and lack of validated trustworthiness assessment tools. CONCLUSION:Adherence to best practices in osteopathic RCTs needs improvement to enhance evidence-based decision-making, reduce research waste, and enhance reproducibility. Further research should explore whether these findings apply to other small, under-resourced fields. PLAIN LANGUAGE SUMMARY:Clinical trials are studies that test if medical treatments work. Doctors and others use these studies to decide how to care for patients or which treatments should be paid for. For clinical trials to be helpful, they need to follow rules to show they can be trusted. For example, researchers can build trust by sharing their plans before they start, reporting all their results honestly and answering questions about their work. In this project, we looked at 61 clinical trials from a 3.5-year period that tested a hands-on treatment called "osteopathic manual therapy." We checked how well these trials followed the rules for trustworthy research. We found that many trials had problems. For example, important research steps were skipped (such as properly registering the study on appropriate online platforms before starting, following the steps described in the registration documents, and correctly examining the collected data). Often, results were also made to look better than they really are, or it was not clearly explained what happened during the study. Only a few researchers answered questions when we asked them. This shows that some osteopathic trials need to do better so people can trust the results. We also suggest ways researchers can improve trustworthiness in the future.

Chronic non-specific low back pain (cNSLBP) is a leading cause of disability. However, its impact on daily activities (e.g., walking in public spaces) remains poorly understood. This study aimed to examine how cNSLBP individuals make navigation decisions when exposed to varying situational and social conditions. Eighteen cNSLBP (45.7 ± 9.2 years, 10 women) and eighteen asymptomatic adults (AA, 43.7 ± 9.5 years, 7 women) walked a 10-meter path to reach a goal and chose to pass between two apertures placed midway according to four conditions: (1) baseline: two large apertures, (2) situational: narrow and large apertures, (3) situational and social: human interferer facing the narrow or for (4) large aperture. Measures included switch point, walking speed, clearance distance, and pain perception. Results revealed that cNSLBP participants adopted more conservative decision-making strategies. Under situational and social conditions, they showed a marked preference for the larger aperture (switch points per conditions (1) 0.1; (2) 1.83; (3) 3.35, and (4) 3.34), with weaker modulation of their choices based on goal position (p < 0.01) than AA participants (switch points per conditions (1) 0.2; (2) 0.70; (3) 1.77, and (4) 2.15). While all individuals adapted their strategy in the presence of a human interferer, cNSLBP participants gave less consideration to social norms, with no difference between switch points for conditions 3 and 4. In terms of kinematics, cNSLBP participants walked significantly slower than AA, regardless of condition or goal position (p < 0.001). For both groups, clearance distance significantly increased for all trials involving a human interferer (p < 0.05). No significant differences were observed between groups or conditions in shoulder rotation or in trunk torsion (p > 0.05). This paradigm offers a promising approach to addressing cNSLBP-related functional impairments, though further research is needed to clarify the underlying mechanisms.

As osteopaths, many of us ideally endeavour to minimise biased interpretations when evaluating the pain and distress expressed by individuals seeking treatment. However, as a product of the society we live in, we acknowledge that various unconscious biases, including racial bias, may unintentionally and spontaneously influence our view of a patient's condition and perception of pain. This paper explores the intersection of Person-Centred Care (PCC) and racial biases through critical theory in the context of osteopathic practice. It emphasises the ethical duty of healthcare professionals to deliver PCC that recognizes individual experiences, values, needs, and abilities. Racial biases within healthcare settings are identified as contributors to disparities in access, quality, and outcomes. They can also lead to bias in the clinical decision-making process requiring attention in osteopathic clinical practice.The critical theory framework allows for the identification of opportunities and barriers to implementing PCC and equity in osteopathic practice, highlighting factors such as the impact of implicit bias and structural barriers.As a result, osteopaths are recommended to take a proactive approach through self-awareness, challenging personal beliefs and actively engaging in cultural humility to minimise racial biases. Osteopathic education could contribute to the cultivation of cultural humility and awareness in training programmes, fostering a passion for fair healthcare among future osteopathic professionals. Ultimately, the integration of critical theory and PCC through cultural humility is presented as an approach to promoting equitable healthcare that empowers individuals.

Objective To identify the evaluation criteria and measurement tools that are used in Randomised Controlled Trials to assess the effects of manual therapy on pain in adults living with PNSLBP. Methods RCT were included if: participants were adults (18-65 years old) with PNSLBP, experimental group received manual therapies (osteopathy, physiotherapy and chiropractic) and they had been published in English or French since 2010. The search was conducted between May 2021 and April 2023, using the Cochrane Library, Ebscohost, EMBASE, MEDLINE Pubmed, PEDro, ScienceDirect and Scopus databases. Three independent reviewers have checked eligibility. The PEDro scale have been used for quality appraisal. Results In the 29 studies included, 131 measurement tools were identified in three main areas: 76% of the measurement tools were related to life impact (which 24% related to pain intensity and 23% to functional difficulties) and 24% were related to pathophysiological manifestations (which 8% related to Range of motion). Conclusion Most measurement tools focus on pain intensity and physical functioning using scales and questionnaires. Two perspectives must be considered: responding to current recommendations by standardizing the measurement tools relating to life impact and physiopathological manifestations, and using biomechanical markers making it possible to evaluate patients in daily life situations.

Background Game-based simulation education is becoming an integral component in healthcare programs. It is defined as any educational activity implying simulation procedures to recreate clinical scenarios. Previous studies have shown that simulation can improve patient safety by enhancing healthcare providers' competencies. However, few studies have investigated students' perceptions of simulation within osteopathic programs. Aim This study aimed to measure and compare Year three osteopathy students’ perceptions of a game-based simulation versus traditional clinical training. Methods Year three students at the end of their 12 weeks clinical training were asked to participate in this research project. This included filling out a Likert-based survey and semi-structured interviews. Three clinical training modalities were implemented and evaluated: a demonstration clinic, a video-streamed demonstration clinic, and a game-based simulation, the clinical battle. Results Sixty-seven Year three osteopathy students completed the surveys, and eight students were interviewed. The clinical battle was significantly felt as the most engaging, most useful to gain feedback, and least stressful of the three training proposed (p<0.05). The clinical battle was also perceived as similar to a demonstration clinic to formulate a diagnosis and for reflective practice (p>0.05). The semi-structured interviews offered deep structured explanatory narratives depicted from thematic analyses. Five themes were identified: engagement, clinical reasoning improvement, stress, ideas for improving clinical training, and reflective practice and self-assessment. Conclusion The simulation-based training implemented in this study was positively perceived by students for their clinical education. Future research could focus on the effectiveness of game-based simulation versus traditional training on clinical competencies acquisition.

BACKGROUND:Chronic Non-Specific Low Back Pain (cNSLBP) has been identified as one of the leading global causes of disability and is characterized by symptoms without clear patho-anatomical origin. The majority of clinical trials assess cNSLBP using scales or questionnaires, reporting an influence of cognitive, emotional and behavioral factors. However, few studies have explored the effect of chronic pain in daily life tasks such as walking and avoiding obstacles, which involves perceptual-motor processes to interact with the environment.RESEARCH QUESTION:Are action strategies in a horizontal aperture crossing paradigm affected by cNSLBP and which factors influence these decisions ?METHODS:15 asymptomatic adults (AA) and 15 cNSLBP participants walked along a 14 m long path, crossing through apertures ranging from 0.9 to 1.8 times their shoulder width. Their movement was measured using the Qualisys system, and pain perception was evaluated by self-administered questionnaires.RESULTS:The cNSLBP participants stopped rotating their shoulders for a smaller aperture relative to their shoulder width (1.18) than the AA participants (1.33). In addition, these participants walked slower, which gave them more time to make the movement adaptations necessary to cross the aperture. No correlation was found between the variables related to pain perception and the critical point but the levels of pain were low with a small variability.SIGNIFICANCE:This study shows that during a horizontal aperture crossing task requiring shoulder rotation to pass through small apertures, cNSLBP participants appear to exhibit a riskier adaptive strategy than AA participants by minimizing rotations that could induce pain. This task thus makes it possible to discriminate between cNSLBP participants and pain-free participants without measuring the level of pain. The identification number registered in the clinical trials is NCT05337995.

L'évaluation clinique de la lombalgie chronique non spécifique (LCNS) est généralement réalisée au moyen d'échelles ou de questionnaires faisant état d'une influence des facteurs cognitifs, émotionnels et comportementaux [1]. Une autre approche consiste à recourir à une analyse biomécanique, cependant peu d'études ont proposé une analyse dans des conditions se rapprochant de situations de la vie quotidienne, comme adapter sa locomotion à l'environnement [2]. C'est le cas du passage par une ouverture étroite, qui oblige à tourner les épaules tout en marchant [3]. Dans ce contexte, en utilisant la tâche de marche à travers une ouverture horizontale [4], cette étude vise à (1) comprendre l'effet de la LCNS sur les stratégies d'action en identifiant les valeurs de seuil critique (i.e., ratio largeur d'ouverture/largeur d'épaules correspondant à un changement du comportement moteur) et (2) caractériser les facteurs qui peuvent influencer ces décisions. Au total, 15 adultes asymptomatiques (AA) et 15 LCNS ont réalisé 3 séries de 19 essais randomisés de marche à travers des ouvertures allant de 0,9 à 1,8 fois la largeur de leurs épaules. Les paramètres cinématiques suivants ont été calculés : rotation des épaules, vitesse de marche, stabilité du tronc. Le seuil critique est significativement plus grand dans le groupe AA (1,34) que dans le groupe LCNS (1,2) (p = 0,003). Aussi, les participants LCNS marchent moins vite que les participants AA sans pour autant adopter des profils de vitesse différents. Les ouvertures de portes pour lesquelles les sujets LCNS commencent à adapter leur mouvement sont plus petites que les sujets asymptomatiques suggérant un comportement plus risqué, mais qui pourrait prendre son sens dans la minimisation des variables en lien avec la douleur. Des travaux futurs sont nécessaires pour mettre en relation ces données cinématiques avec les variables pouvant influencer la perception douloureuse (e.g., intensité, durée, kinésiophobie). Cette nouvelle approche offre la possibilité de mieux comprendre les stratégies d'action des patients LCNS dans le but de développer de nouveaux outils de suivi et de prise en charge clinique.

Background: Osteopathy is not a health profession in France but it was regulated in 2007. However, the profession is very popular, and the number of osteopaths is the largest in Europe. Since there is limited published data on the profile and characteristics of osteopaths practising in France, this study aimed to survey the current situation of osteopathic practitioners in France.Methods: A voluntary online-based survey was distributed to French osteopaths between March and July 2022. This survey consisted of 52 questions adapted from the original French version of the validated Benelux Osteosurvey.Results: A total of 1461 osteopaths responded to the study, of which 785 (53.73%) were female. The majority of respondents were aged between 30 and 39 years (50.65%), had full-time training (89.73%), during 5 years (67.15%), were self-employed (99.59%), advertised themselves exclusively as osteopaths (90.35%) and showed a solid professional identity. The median number of consultations per week was 21-25, and nearly one-third of respondents (31.42%) reported having other professional activities outside their clinical practice as an osteopath. Osteopaths in France manage acute and chronic complaints in all body areas but mainly in the spine.Conclusions: This study provides a first overview of the current profile of osteopathic practitioners in France since 2012. At present, it constitutes a new informative report of their characteristics and provides several perspectives on the profession's development in terms of status and training.

Purpose: Postural control impairment has been identified as a potential extrarespiratory manifestation in patients with chronic obstructive pulmonary disease (COPD). The aims of this study were to identify clinical factors that characterize patients with reduced postural control, to examine the correlation between clinical factors and postural control and to determine predictors of an impaired postural control among COPD participants enrolled in a pulmonary rehabilitation (PR) program. Methods: This study is a secondary analysis of an observational study (PARACHUTE). The baseline assessment of the PR program was used for the analysis. Postural control impairment was defined using the Brief BESTest score (BBT). Results: Participants (n = 73) were included in the analysis, 43 of them were classified in the reduced postural control group. The between-group comparison (non-reduced vs reduced postural control) identified differences for partial pressure in oxygen (Pa O 2 ), Saint George Respiratory Questionnaire (SGRQ) total score and subscores (SGRQ-Symptoms, SGRQ-Activities, and SGRQ-Impact), COPD assessment test (CAT), and anxiety score of the Hospital Anxiety and Depression Scale. The BBT score was significantly correlated with maximal inspiratory pressure (MIP), SGRQ, SGRQ-Symptoms, SGRQ-Impact, Falls Efficacy Scale, modified Medical Research Council Scale, 6-min walk test, and Pa O 2 . Logistic regression identified SGRQ-Symptoms, Pa O 2 , MIP, and body mass index (BMI) as predictors of the presence of reduced postural control. Conclusion: Low quality of life (QoL) and Pa O 2 and high anxiety seem to be discriminative characteristics of patients with COPD with reduced postural control. Furthermore, QoL, Pa O 2 , inspiratory muscle strength, and BMI seem to be acceptable predictors of the presence of postural control impairment.

Background: Observing how individuals actively adapt to their environment may provide additional insights into traditional clinical tests. Rather than using tests that only identify joint mobility limitations, it seems relevant to use clinical motion tests that assess global biomechanical functions more generally and identify functional behaviours.Objectives: This study explores whether different functional kinematic behaviour patterns appear when executing a new complex motor task and whether those observations are consistent over multiple executions.Methods: Marker-based kinematic analyses of the lumbo-pelvic complex were conducted on 29 asymptomatic athletes during two active self-induced motion tests: the one-sided tilt test and a modified version of this test limiting the trunk axial rotation. Marker data served as an input for a full musculoskeletal model to compute the lumbar and lower limb joint angles. Latent class analysis and intraclass correlation coefficients were calculated to identify different classes of functional kinematic behaviour and assess the reliability between measurements.Results: The methodology allowed us to identify four distinctive classes of possible movement combinations based on these two functional tests: standard movement, low knee and lumbar engagement, high pelvis engagement and high lumbar flexion. All ICCs for the lumbo-pelvic complex degrees of freedom were higher than 0.6, suggesting a moderate to good reliability for the overall test.Conclusion: It remains unknown whether the observed reproducible patterns emerging from the motion test relate to motivation and prior experiences. Further exploration is required to investigate whether these behaviours can be correlated to empirical clinical observations, past experiences, and future vulnerabilities for musculoskeletal conditions.