The College of Osteopaths
Annual Conference 2018
17th November 2018 – Staffordshire Campus
Reflections by Bill Garland DO.
There were 4 speakers, and the occasion was curated by Julie Thompson, head of research and someone who has done a huge amount to encourage the student body to engage with the ideas around and the practical processes of research. With the coming of the new CPD obligations on all osteopaths more than ever we need to understand and enact our own objective activities and minor forays into data gathering audit and research projects.
Carol Fawkes from NCOR, was on hand to outline the great work that they do and the mainstream projects that they are coordinating. This is, in the main PROMS and PILARS. The former is a large and ongoing data gathering exercise, currently 10% of us are signed up; if all of the 5000 osteopaths were signed in and contributed perhaps 50 data sets a year, there would be a really significant body of data to demonstrate to a wider public what it is we are doing, and to whom. Anyone who regrets or feels disadvantaged by the lack of osteopathic research and isn’t signed in, get to it. Qualitative data of this kind is very much where we can show what patients think of what we do, and as Kathy Kinmond shows us later what patients think is what we need to know. PILARS helps osteopaths make sense of what we are doing in an internal professional environment, keeping us safe and sane in the uncertain world of clinical encounters. If we believe in patient centred care, and we believe ourselves to be open and reflective this is an opportunity to ‘unload’ when things are a little too hard to manage alone.
The first student to speak was Hannah Beard, a 5th year, who was delivering her findings from a review of papers concerning injuries to female runners. This was an interesting title in the first place as female runners are more likely to be injured, and yet their injuries seem less well studied. Food for thought right there. Hannah explored a plausible notion as to why there might be that likelihood and then spoke about the variety of injuries that might occur, focusing on the doubtless familiar to osteopaths; patella-femoral pain syndrome, ilio-tibial band syndrome, and tibial stress fractures, yet to be designated as having syndrome status.
There was not much agreement to be found within the 6 papers reviewed and this is again of as much interest perhaps as what they did concur on. There is talk within our profession as to the lack of credible research – and why that might be. The reality is, perhaps that we can explore and show the preponderance of certain presentations of symptoms, and in some cases offer credible treatment protocols, but people continue to be individuals and as long as one is a general practitioner of osteopathic treatment then generalities will persist. It was evident from Hannah’s collection of papers that a multitude of variables were in play and refining a truth from them was difficult. There did perhaps seem to be some consensus that there was a tendency to over adduction in the gait of those presenting with some of these injuries, but the cause of that adduction remains unclear.
Hannah’s style of presentation, and this was also true of her colleague Lily Prestwood who delivered later in the conference, was mature and very professional. This is a credit to them and the valuable work done by Julie in her leadership of the research parts of our course, to enable such confidant handling of complex data.
Lily, spoke about the importance of cervical muscle fatigue in relation to postural balance. She presented data from several papers and was convincing in her conclusions that there is a relationship between the capability of the cervical extensors and the ability to maintain balance. This is of interest surely for those of us on the ground who have the time to educate patients in the process of maximising their abilities and avoiding falls. There were diverting factoids: how many cans of beans does an average head weigh? (11) and how many additional cans are added in weight by flexing 15 degrees? (18!); this is surely a compelling case for postural awareness and reducing smart phone stare time. The extreme sensitivity of the sub occipital group, especially the obliquus capitus superior (extra marks for attachments and nerve supply) in terms of muscle spindle density suggest that the skull is cradled by a complex proprioceptive mechanism and perhaps as responsive in some ways as the eye to changes in position.
Lily also alluded to the cost of falls to the NHS in the elderly, and this was a theme which was also described by the final speaker Kathy Kinmond.
She is a lecturer and academic who spoke to the conference about a project she is involved with regarding COPD. The project, using the PPI (public patient involvement) principle has made an extremely encouraging difference to the initial group and a wider trial is going to be done. Essentially the PPI – part of the INVOLVE initiative- is where the actual recipients of care are invited to be involved in the evolution of the treatment pathway. This should not be too revolutionary an idea, asking patients to be on board from the beginning, in a systematic engagement with their needs as people who are patients surely help devise the best ways to both study and intervene in the conditions they present with. Kathy was at pains to point out that now, more than ever, the health service is in a place which is willing to recognise that patients are people, people have complex lives which encompass both their minds and bodies and interventions, and those who intervene, would do well to recognise that. Something we can all get on board with as osteopaths.