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Get to know the projects and researchers whose work has earned AOA funding.
The AOA has funded myriad research projects designed to evaluate the effectiveness of osteopathic medicine in two key areas. Learn more about grant opportunities for physicians, fellows, residents and osteopathic medical students and new investigators.
Grants supported three designated focus areas:
Grant periods range from six to 18 months. Recipients are strongly encouraged to submit their research for publication in The Journal of Osteopathic Medicine.
2024 Research Grant Recipients
Fluid Dynamics of Concussion in Mixed Martial Arts in a Pilot Randomized Controlled Trial of OMM | Jayme Mancini, DO, PhD, FAWM, graduated from Michigan State University College of Osteopathic Medicine’s (MSUCOM’s) DO/ PhD program in Neuroscience in 2008. She became board-certified in family practice and NMM/OMM and a Fellow of the Academy of Wilderness and Environmental Medicine. She has been a professor at the New York Institute of Technology College of Osteopathic Medicine since 2013, where she teaches osteopathic manipulative medicine (OMM) and has gained 10+ years of clinical practice experience.
She has been using OMM and cognitive neuropsychological assessments to help manage head injuries since 2002 as a DO/PhD student. Her clinical research interest has focused on clinical applications of OMM for neurological and connective tissue health problems. She has authored nine original clinical research articles plus abstracts and review articles about utilizing OMM for concussion, focal dystonia, Parkinson’s disease, essential tremor, restless leg syndrome, Ehlers Danlos syndrome/hypermobility spectrum disorders, prolotherapy and evaluating links between biomarkers and benefits of OMM.
A Molecular Approach to Examining the Immune Stimulatory Impact of Lymphatic Pump Technique | Stephen Andrew DiGiuseppe, PhD, is a virologist who graduated from Louisiana State University Health in Shreveport, Louisiana. He completed his postdoc training at Northwestern University Feinberg School of Medicine in Chicago, Illinois. Dr. DiGiuseppe is an assistant professor at Edward Via Osteopathic Medical School (VCOM) in Monroe, Louisiana. He teaches courses in medical microbiology and shares his passion for pathogenic microbes with students. Dr. DiGiuseppe oversees several research projects focusing on understanding how viruses hijack protein synthesis while subverting the innate immune response and evolutionary adaptations in the transmission of coronaviruses. He has expanded his research focus areas to include collaborations with osteopathic physicians to investigate how osteopathic manipulation can be used to stimulate the immune system to protect against or expedite the clearance of viral infections.
Dr. DiGiuseppe is very enthusiastic about research and encourages his students to participate. His students have gone on to be selected for Researcher of the Year and Student Doctor of the Year, winning poster awards and co-authoring several publications.
2023 Research Grant Recipients
Somatic Dysfunction Characterization Following Acute Cerebrovascular Disease (SOMADC-AC Study) | Alan Yee, DO, is a vascular neurologist and associate professor of neurology at the University of California Davis School of Medicine. He received his osteopathic medical degree from Kansas City University College of Osteopathic Medicine. Dr. Yee completed residencies in internal medicine and neurology at the Cleveland Clinic and Mayo Clinic, respectively, followed by fellowship training in neurocritical care and stroke at the University of California San Francisco. He serves as the associate program director for the neurology residency and vascular neurology fellowship programs. As a core medical educator, he developed interprofessional and post-graduate training curricula to improve neurological care among health professionals. Dr. Yee’s previous research focused on neurologic prognostication in patients with critical brain disease. His current research efforts focus on neurologic medical education, osteopathic examination rater reliability and the association between somatic dysfunction and stroke-related outcomes. In addition to providing acute and critical cerebrovascular care at UC Davis, he established a novel OMM clinic for stroke survivors with chronic physical disability.
Effectiveness of the Osteopathic Pedal Pump in Reducing Lower Limb Volume in Older Adults with Chronic Leg Lymphedema | Donald Noll, DO, graduated from the A.T. Still University Kirksville College of Osteopathic Medicine in 1987. He completed this internal medicine residency training from the Philadelphia College of Osteopathic Medicine in 1990 and a fellowship in geriatric medicine at the University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine (now a part of Rowan-Virtua School of Osteopathic Medicine) in 1992. His academic research interest has focused on clinical applications of osteopathic manipulations for common health problems in the elderly. He has authored 20 original peer-reviewed papers relating to the use of osteopathic manipulation for pneumonia, chronic obstructive lung disease, influenza vaccine, improving immune function, applications of osteopathic philosophy, falls prevention, leg length discrepancies and, most recently, leg edema. Chronic leg edema and related lymphedema is a common chronic problem in the elderly refractory to conventional treatments that leads to significant morbidity. The osteopathic pedal lymphatic pump is a novel technique that is easy to apply and shows great promise for treating this condition.
Assessment of the Therapeutic Efficacy of OMT on Chronic Low Back Pain: An Integrated Sonographic and Machine Learning Analysis of Thoracolumbar Fascia Glide Impairment | Albert Kozar, DO, is a primary care sports medicine/NMM-OMM specialist with 20+ years of clinical practice and 15 years of collegiate team physician experience. He is board certified in NMM-OMM, sports medicine and family practice. He has studied MSK ultrasound since 2005 and became nationally certified in 2012 as part of the first pioneering group in the country to take the American Registry of Diagnostic Medical Sonographers (ARDMS) certification exam. Dr. Kozar works with MSKUS, which internationally teaches musculoskeletal ultrasound courses, master classes and cadaver dissection. His primary research projects have been utilizing various modes of ultrasound, grey-scale, doppler and shear-wave elastography, to study patellar tendons in athletes and the thoracolumbar fascia in individuals with low back pain, as well as assess visceral organ function or motion before and after OMT. He has been a national lecturer for the last several years on diagnostic and guided interventions with musculoskeletal ultrasound, OMT, motor control rehabilitation and regenerative medicine. In 2014, Dr. Kozar co-authored a DVD entitled “Fundamentals of Diagnostic Musculoskeletal Ultrasound: An Anatomical Approach to Upper and Lower Extremity, Pelvis, Abdomen and Groin.”
Chronic Pain Management Provided by Osteopathic vs. Allopathic Physicians: Comparison of Patient-Reported Outcomes Over 36 Months | John C. Licciardone, DO, MS, MBA, is the first recipient of a Regents Professorship awarded by University of North Texas Health Science Center/Texas College of Osteopathic Medicine and holds the Osteopathic Heritage Foundation Distinguished Chair in Clinical Research. He directs the Osteopathic Research Center and its national pain research registry, PRECISION. He received a Midcareer Investigator Award from the National Institutes of Health (NIH) and later served as an NIH expert panelist and on its National Advisory Council for Complementary and Integrative Health. He directed the OSTEOPATHIC Trial funded by NIH that showed OMT efficacy. He served to help develop NIH’s Federal Pain Research Strategy and is a co-investigator in the $14 million PACBACK Trial sponsored by NIH. He served as a World Health Organization consultant on international regulatory and safety issues relating to osteopathy. He gave the keynote address at Advancing Osteopathy 2008 to celebrate recognition of osteopaths in the UK’s National Health Service, including a reception with His Royal Highness, then-Prince of Wales, King Charles III. He advised two U.S. Surgeons General on the role of osteopathic physicians in American health care. The American Osteopathic Foundation honored Dr. Licciardone with its Gutensohn-Denslow Award for devoted lifetime service and contributions to research and education.
Pilot Study Evaluating the Elasticity and Shear Wave Modulus (Stiffness) of the Median Nerve in Patients with Mild to Moderate Idiopathic Carpal Tunnel Syndrome Receiving OMT and Conservative Therapy | Roland E. Gazaille, III, DO is a board-certified diagnostic radiologist with an interest in musculoskeletal imaging, including MRI and MSK ultrasound. He received his medical degree from the University of New England College of Osteopathic Medicine in 2005 and completed his diagnostic radiology residency at Grandview Medical Center in Dayton, Ohio in 2010 and a musculoskeletal radiology fellowship at Henry Ford Hospital in Detroit, Michigan in 2011. Dr. Gazaille has served as the program director of the Kettering Health Diagnostic Radiology Residency Program since 2014. He is a member of the Society of Skeletal Radiology (SSR), the Radiological Society of North America (RSNA), the American Roentgen Ray Society (ARRS) and the Association of Program Directors in Radiology (APDR). Dr. Gazaille is also a member and sits on the Board of Directors of the American Osteopathic College of Radiology (AOCR). Dr. Gazaille has been with Kettering Network Radiologists, Inc. since 2005.
2023 AOA OMM Observational & Explorative Focused Hypotheses Research Grant Recipient
Role of OMT in the Management of Persistent Post-COVID-19 Symptoms – A Pilot Prospective Cohort Study | Brian F. Degenhardt, DO, is a 1989 graduate of the Des Moines University College of Osteopathic Medicine. He completed his residency in osteopathic manipulative medicine (OMM) at Northeast Regional Medical Center and is board certified in neuromusculoskeletal medicine/osteopathic manipulative medicine. Dr. Degenhardt is the assistant vice president for osteopathic research at A.T. Still University Kirksville College of Osteopathic Medicine, co-director of the Center for Research in OMM at the A.T. Still Research Institute, an Osteopathic Heritage Foundation Endowed Chair and the director of DO-Touch.NET, an international practice-based research network assessing the clinical usefulness and safety of OMM. He oversees numerous areas of research with a primary focus on directing research in the areas of palpatory diagnosis and OMT. His published work demonstrates a broad scope of research, evaluating the reliability of palpatory diagnostic tests, objectifying somatic dysfunction, evaluating the association of biomarkers and pain with OMT, health benefits of wellness programs, the impact of OMT on a variety of conditions such as otitis media, pneumonia in the elderly, chronic obstructive pulmonary disease and the use of raster-stereography in assessing posture.
2023 AOA Physician In Training Research Grant Recipient
Urological National Surgical and Trauma Quality Improvement Projects | Young Son, DO, is currently a PGY-3 urology resident in Jefferson, New Jersey. He attended Pennsylvania State University for undergraduate studies in biology and completed medical school at Philadelphia College of Osteopathic Medicine. Currently, he is investigating machine learning and its utilization with large national databases. The objectivity of random forest models or neural networks allows to rid investigator bias for postoperative outcomes. He is also currently working with patients that underwent prostatectomy, nephrectomy or cystectomy.
2022 Research Grant Recipients
Changes in Pain, Spasticity, and Quality of Life after use of Counterstrain Osteopathic Manipulative Treatment in Individuals with Spinal Cord Injury | David Dolbow, DPT, PhD, RKT has over 33 years of experience working in rehabilitation medicine with the Veterans Affairs Medical System as a Kinesiotherapist, Exercise Physiologist, Physical Therapist and Physical Therapist Research Specialist. Dr. Dolbow has treated individuals with various physical conditions and has a Certification in Neurologic Clinic Practice. Dr. Dolbow has taught at the university level for eight and a half years (University of Southern Mississippi – four and a half years) and at William Carey University – four years). Over the past decade, Dr. Dolbow has been investigating the effects of spinal cord injury on functional mobility, body composition and the risk of secondary comorbidities. Dr. Dolbow’s research interests include improving the quality of life in those with spinal cord injuries and other paralytic conditions by improving functional mobility and decreasing secondary morbidities such as obesity and cardiometabolic diseases. Recently, Dr. Dolbow and Ajay Sharma, DO, have teamed up with students from the College of Osteopathic Medicine and Physical Therapy Department at William Carey University to study the effectiveness of osteopathic manual techniques in decreasing neurogenic pain after spinal cord injury.
Treating Chronic Cervicogenic Head and Neck Pain with Osteopathic Manipulation and Exercise Therapy | Richard Hallgren, PhD, received a PhD degree in Biomedical and Electrical Engineering from Iowa State University in 1974. His long-term research goal is to implement cost-effective treatment protocols to improve patient outcomes. His research team will test the combined effectiveness of OMT and focused exercise therapy to decrease headache measures of frequency, intensity and duration in a cohort of female patients diagnosed with chronic cervicogenic headaches.
Professor Hallgren has previously reported that fatty infiltration of RCPm muscles is associated with chronic cervicogenic headaches. Weakened RCPm muscles would be expected to compromise the functional relationship between these muscles and the pain-sensitive spinal dura, resulting in referred headache pain. Positive outcomes from this study will not definitively prove that the dura is the source of headache pain. However, considering the present opioid crisis, the use of OMT and exercise therapy to reduce head and neck pain in a population of female patients presents a particularly attractive approach to health care.
Serological Assessment of the Effect of Osteopathic Manipulative Treatments in Conjunction with COVID-19 Booster Shots | Sebastien Fuchs, MD, PhD, is an Associate Professor of Pharmacology at the College of Osteopathic Medicine of the Pacific (COMP) of Western University of Health Sciences in Pomona, California. Dr. Fuchs’ research focus has been the renin-angiotensin system for over two decades, which includes ACE-2, the receptor for the SARS-COV-2 virus.
With the emergence of the COVID-19 pandemic, Dr. Fuchs has initiated a clinical trial to establish a hypothesized role for osteopathic manipulative treatment in support of vaccine efficacy. Specifically, the trial aims to test whether a short series of lymphatic osteopathic manipulative pump procedures given in conjunction with COVID-19 vaccination and booster shots will stimulate the immune response and thus increase the anti-Spike protein immunoglobulin titers. The frequency of spontaneous breakthrough infections and their symptoms will be correlated with immunoglobulin titers in treatment and control groups. Dr. Fuchs is a strong advocate for the inclusion of osteopathic medical students in research projects. Because of his mentoring efforts, student enrollment in research at COMP has been ever-increasing, with over 50% of current students actively engaged in research projects.
Use of High-Precision Phase Contrast MRI Flow Technique to Assess Changes in Cerebral Blood Flow Before and After OMT in Mild Cognitive Impairment | Kendi Hensel, DO, received her DO from Oklahoma State University College of Osteopathic Medicine. After completing a traditional rotating internship, she moved to the University of New England in Biddeford, Maine, and was one of the first graduates from a combined Family Practice and Neuromusculoskeletal Medicine residency. She returned to her native Texas in 2004 to join the faculty of the Texas College of Osteopathic Medicine (TCOM) at the University of North Texas Health Science Center. She has been an investigator and treatment provider on several OMM research studies. In 2006, she became the first DO to receive a K23 Award from the NIH-NCCIH. This project studied the effects of OMM on pregnant women. She received her PhD in OMM Clinical Research and Education in 2009 from UNTHSC-Graduate School of Biomedical Sciences. She served as the 2019-2020 President of the American Academy of Osteopathy, and served for six years as a Section Editor of the Journal of Osteopathic Medicine. She is currently involved in clinical, educational and research activities at TCOM and in national efforts to improve the evidence base and utilization of OMM. Her research interests include mechanistic and clinical effectiveness studies of OMM.
Quantitative Ultrasound Biomarkers to Assess Upper Trapezius Muscles in Patients with Chronic Neck Pain | Jing Gao, MD, FAIUM, is the Director of ultrasound in Research and Education at Rocky Vista University and adjunct research faculty at Weill Cornell Medicine. She completed her education in Medicine, Chinese Traditional Medicine, and Radiology residency in 1976, 1980 and 1984, respectively. Before joining Rocky Vista University in 2017, she worked for New York-Presbyterian Hospital/Weill Cornell Medicine for almost three decades. She has strong experience leading clinical ultrasound research and teaching radiology residents and medical students. Her current research focuses on quantitative ultrasound to assess chronic pain, somatic dysfunction, OMT effect, cardiovascular function and NAFLD. She has presented research reports nationally and internationally. She has served as a member of RSNA/AIUM/QIBA committees of ultrasound volume blood flow (VBF) and pulse-echo quantitative ultrasound (PEQUS). She has also served as an editorial board member for 3 journals: Clinical Imaging (Elsevier), Journal of Ultrasound in Medicine (Wiley) and Ultrasound in Medicine and Biology (Elsevier). The list of her publications can be found online.
2021 Research Grant Recipients
Augmentation of Immune Response to COVID-19 mRNA Vaccination Through Osteopathic Manipulative Treatment Including Lymphatic Pumps | Jesus Sanchez Jr., DO, MSHPE, MA, is a dual board-certified family practice and neuromusculoskeletal medicine/osteopathic manipulative medicine physician. He graduated from Western University of Health Sciences/College of Osteopathic Medicine of the Pacific (WesternU/COMP) in 2004 and is currently serving as a professor in the department of osteopathic medicine/neuromusculoskeletal medicine and family medicine at the COMP. He has been involved in areas of clinical medicine, teaching and research since 2008, having served as both assistant DME, +1NMM/OMM plus one residency program director and vice-chair of the NMM/OMM department. He has served as both member and chair of the Institutional Research Board at WesternU and has been actively able to develop, lead and collaborate in both educational and clinical research at WesternU/COMP. He is currently the principal investigator and lead for the research study on Augmentation of Immune Response to COVID-19 mRNA Vaccination Through Osteopathic Manipulative Treatment Including Lymphatic Pumps.
Osteopathic vs. Allopathic Physician Opioid Prescribing for Chronic Pain: A Longitudinal Study of Long-Term Outcomes and the Role of Osteopathic Manipulative Treatment | John C. Licciardone, DO, MS, MBA’s research focuses on chronic pain. He was the first recipient of a Regents Professorship at the Texas College of Osteopathic Medicine and holds the Osteopathic Heritage Foundation Distinguished Chair in Clinical Research in honor of Drs. David Richards and Benjamin Cohen. He directs the Osteopathic Research Center, including its “first-in-the-nation” PRECISION Pain Research Registry. He received an NIH Midcareer Investigator Award to conduct the OSTEOPATHIC Trial and is now Co-Investigator in the $14 million PACBACK Trial sponsored by NIH. He served on the Work Group that developed the Federal Pain Research Strategy and as a consultant to the World Health Organization. He gave the keynote address at Advancing Osteopathy 2008 to celebrate the 10th anniversary of the recognition of osteopaths in the UK’s National Health Service, including a pre-conference reception with His Majesty, King Charles III. He has met and advised two United States Surgeons General on the role of osteopathic physicians. Dr. Licciardone has received the Gutensohn-Denslow Award for his devoted lifetime service and contributions to research and education within the osteopathic profession.
Executive summary: Osteopathic physicians are trained to treat patients with musculoskeletal symptoms and somatic dysfunction with osteopathic manipulative treatment (OMT) and to avoid unnecessarily prescribing such drugs as opioids. It is also generally believed that osteopathic physicians provide a unique patient-centered approach to medical care that involves effective communication and empathy. Such training and characteristics of osteopathic medical care (OMC) may enhance clinical outcomes among patients with chronic pain.
The objectives of this research were to measure and compare the process and longitudinal outcomes of chronic low back pain (CLBP) treatment provided by osteopathic and allopathic physicians and to identify mediators of the treatment effects of OMC.
A retrospective cohort study was conducted using adult participants with chronic low back pain within the Pain Registry for Epidemiological, Clinical and Interventional Studies and Innovation (PRECISION) from April 2016 through December 2022. Participants having an osteopathic or allopathic physician for at least 1 month prior to registry enrollment were included and followed at quarterly intervals for up to 12 months. Physician communication and physician empathy were measured at registry enrollment. Opioid prescribing and effectiveness and safety outcomes were measured at registry enrollment and for up to 12 months and analyzed to compare participants treated by osteopathic vs. allopathic physicians. Statistical models, including opioid prescribing, OMT, physician communication and physician empathy, were used to identify mediators of OMC treatment effects.
A total of 1,079 participants and 4,779 registry encounters were studied. The mean age of participants at enrollment was 52.9 years, 796 (73.8%) were female, and 167 (15.5%) reported having an osteopathic physician.
The mean physician communication score for osteopathic physicians was significantly greater than that for allopathic physicians (71.2 vs. 66.2). Similarly, the mean physician empathy score for osteopathic physicians was also greater than for allopathic physicians (41.6 vs. 38.3).
There was no significant difference in opioid prescribing for low back pain between osteopathic and allopathic physicians. Although participants treated by osteopathic physicians reported less severe nausea and vomiting as adverse events potentially attributable to opioids in a comprehensive statistical model, neither result was clinically meaningful.
The percentage of participants treated by osteopathic physicians who reported currently receiving OMT for low back pain ranged from 13% to 27% during each of their encounters over 12 months.
Osteopathic medical care was associated with significant and clinically meaningful outcomes pertaining to low back pain intensity, physical function and health-related quality of life over 12 months. Moreover, physician empathy was a significant mediator of OMC treatment effects in each of the three outcome domains. Physician communication, opioid prescribing and OMT were not mediators.
In conclusion, this study found that osteopathic physicians provided a patient-centered approach to chronic low back pain treatment, particularly involving empathy, that yielded significant and clinically meaningful outcomes pertaining to low back pain intensity, physical function and health-related quality of life over 12 months of follow-up.
Soft Tissue Manipulative Therapy in Bone Anabolism | Jonathan Lowery, PhD, is a founding faculty member of the Marian University College of Osteopathic Medicine (MU-COM) in Indianapolis, Indiana. He completed a PhD in cell and developmental biology at Vanderbilt University and postdoctoral studies in developmental biology at Harvard University. At MU-COM, Dr. Lowery serves as the Director of Research Labs and teaches hypothalamic-pituitary endocrinology and skeletal physiology in the DO program. He also directs the Bone & Muscle Research Group (BMRG), a highly collaborative research collective with three other faculty members. They have trained more than sixty DO or MS students and produced more than thirty research publications since 2014. Dr. Lowery’s research interests center on understanding the mechanisms controlling bone remodeling with the goal of advancing potential strategies for reversing bone loss. He and his students collaborate with researchers at numerous US and international institutions. They are active in the American Society for Bone & Mineral Research, where Dr. Lowery serves as a committee chairperson.
Osteopathic Philosophy and Patient Experience of Care Program | Rebecca Malouin, PhD, MPH, MS, is an associate professor in the Department of Family and Community Medicine and serves as Director of the Global Health Studies Program at Michigan State University. Dr. Malouin is a health services researcher with a specific interest in the experience of care within primary care. She has authored two books, published by the American Academy of Pediatrics, on the measurement of family and patient-centered care within primary care. She has received K01 and R01 funding from the Agency for Healthcare Research and Quality for research on patient-centered primary care and served as an evaluator for several primary care demonstration projects, both federally and privately funded. She has also served on study sections for the Agency for Healthcare Research and Quality, the National Institutes of Health, the Health Resources and Services Administration, the PatientCentered Outcomes Research Institute, the American Association of University Women International Fellowships, and the governments of Israel and New Zealand. Dr. Malouin served as an epidemiologist in the Michigan Department of Community Health and the Maryland Department of Health and Mental Hygiene and as a United States Peace Corps volunteer in Niger. Dr. Malouin received her PhD and MPH in international health from the Johns Hopkins Bloomberg School of Public Health. She also completed an MS in epidemiology from Michigan State University.
Executive summary: As the United States struggles to control healthcare costs and achieve the quadruple aim, defined as improved patient experience of care, improved physician experience of care, improved quality of care and reduced or controlled costs, identifying successful care models, or components of care models, is of increasing interest to health systems, payers, employers, and increasingly, patients. The research study aims to assess whether the patient experience of care differs between osteopathic and allopathic primary care physicians as reported by patients. The study’s objective is to assess whether differences exist in how patients rate care provided by osteopathic and allopathic physicians. To achieve the objective, investigators conducted a cross-sectional study of patient data collected using the validated Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group Survey. As one of the Centers for Medicare and Medicaid Services (CMS) Multipayer Advanced Primary Care Practice (MAPCP) demonstration sites, the Michigan Primary Care Transformation (MiPCT) is the largest multipayer PCMH initiative in the country with five participating payers. The participating provider base includes 1900 physicians, physician assistants, and nurse practitioners in 350 primary care practices statewide. The MiPCT patient population totals over 1.2M patients, or 12% of the state’s population. Stratified random sampling was utilized with an oversample of patients with high medical risk. Data were analyzed to assess outcomes related to access, communication, coordination, office staff, provider rating, and a summative score of all domains. The main analysis was conducted by employing the general linear model (CSGLM) procedure with post hoc comparisons to assess differences among osteopathic and allopathic physicians after adjusting for race, educational level, payer group, health risk, practice size, hospital ownership, and geography. Consistent with previous studies, patients of osteopathic physicians reported higher communication scores than patients of allopathic physicians in primary care practices. No other significant differences were identified in patient scores. The project is significant because it is the first study to identify differences in the patient-reported experience of care between osteopathic and allopathic physicians using the CAHPS survey, the most widely utilized patient experience of care survey in the United States.
The Short and Long-Term Effect of OMT On Pain, Opioid Usage, Cost, and Psychosocial Factors in Adults with Chronic Low Back Pain | Clarence Nicodemus, DO, PhD, is a Professor, clinician, and Director of Clinical Research in the Department of Neuromusculoskeletal Medicine/OMM at Michigan State University College of Osteopathic Medicine (MSUCOM) and Director of the MSU Center for Neuromusculoskeletal Clinical Research (CNCR). Dr. Nicodemus graduated from MSUCOM in 2004 and completed his residency in Neuromusculoskeletal Medicine in 2007 with ABONMM board certification in 2010. He established a private, solo practice in Monterey, California, in 2008-2016. He was also on the Osteopathic Physicians and Surgeons of California board until he returned to MSUCOM in 2016 to take up his current position. Dr. Nicodemus earned his PhD in Biomedical Engineering from the University of California at Davis in 1993. He had a previous career as a research engineer in Rehabilitation in California, in Bioastronautics with Lockheed Engineering and Sciences Company at NASA/ Johnson Space Center in Houston, Texas. Here he was a Principal Scientist for six (6) years and spine biomechanics research where he was Assistant Professor of Orthopedics and Director of Orthopedic Spine research at the University of Texas Medical Branch Galveston for seven (7) years.
Manual Drainage of the Gallbladder: Alleviating Gastrointestinal Symptoms in Older Adults with Gallbladder Dysfunction | (Co-branded award funded in collaboration with The American Osteopathic Foundation) Angelica Perry, DO, was the valedictorian of her undergraduate class in 2004. Before her medical career, she practiced and taught massage therapy for six (6) years. Dr. Perry graduated from the Virginia campus of Edward Via College of Osteopathic Medicine (VCOM) in 2009. She then completed a residency in Family Practice with Riverside Medical Group(RMG) in Newport News, VA. Dr. Perry went on to join RMG, providing rural primary care on the Eastern Shore of Virginia. She had the responsibility and honor of caring for the residents of Tangier Island, a unique community of watermen(and women) in the Chesapeake Bay. Dr. Perry also served as clinical faculty for VCOM and Eastern Virginia Medical School (EVMS) during this time. On June 30, 2021, she completed her second residency in Osteopathic Neuromusculoskeletal Medicine (ONMM) at VCOM. During her ONMM residency, her research on osteopathic manual drainage of the gallbladder won first place for original research done by a resident at the 2021 VCOM – Virginia Research Day and second place in the same category at the 2021 American Academy of Osteopathy(AAO) Convocation Louisa Burns Osteopathic Research Competition.
The Efficacy of Osteopathic Manipulative Treatment on Decreasing the Severity of Migraine Headaches | Abby Rhoads, DO, is a Family Medicine Physician and core faculty member in the department of Family Medicine at St. Luke’s University Health Network, as well as Director of Osteopathic Education for Family Medicine and Internal Medicine Program at Anderson Campus. In her role as Faculty, she has demonstrated commitment and advocacy for both the Osteopathic profession as well as Accreditation Council for Graduate Medical Education (ACGME) residency training. She has worked closely with American College of Osteopathic Family Physicians (ACOFP) in the past year to improve osteopathic care during the global COVID 19 pandemic with multiple publications and webinars. She was recently accepted as a member in the Osteopathic Recognition Milestones 2.0 work group, as she strongly advocates osteopathic education to continue in the ACGME learning environment. She is also involved in research as the Principle Investigator for two novel OMT clinical trials that are ongoing. In her practice, she advocates for principles of osteopathic medicine, preventative health and women’s health. She is often treating her patients with Osteopathic Manipulative Therapy to promote healing or teaching residents and medical students how to incorporate OMT into their daily practice.
2020 Research Grant Recipients
The Effect of Osteopathic Manipulative Interventions on Opioid Use in Patients with Acute Pancreatitis | Cherylene Abalos, DO, is an Arizona native, obtaining her Bachelors of Science in Microbiology from Arizona State University in 2013. She completed medical school training at Rocky Vista University, College of Osteopathic Medicine, Colorado campus in 2018. She is a Health Professions Scholarship Program recipient with the Air Force and will serve the needs as a Captain of the Air Force after residency.
Dr. Abalos and her colleague, Matthew Robinson, are in the second Internal Medicine Residency class at MountainView Regional Medical Center in Las Cruces, New Mexico. They have been appointed the role of Chief Residents for the 2020-2021 academic year. Together they have been the trailblazers to establish a research relationship with MountainView and the local medical school, Burrell College of Osteopathic Medicine. They designed their research protocol to address the current opioid crisis with the inquisitive desire to determine a possible relationship between osteopathic intervention to reduce opioid use in treating pain in acute pancreatitis.
Neural Mechanisms of Osteopathic Spinal Manipulation on Opioid-Use Disorder and Associated Hyperalgesia | Kyle Bills, PhD, received his bachelors in exercise physiology and PhD in neuroscience from Brigham Young University and his doctorate in chiropractic (DC) degree from Parker University. He was awarded a Ruth L. Kirtchstein National Research Service Award from the National Center of Complementary and Integrative Health division of the National Institutes of Health as a post-doctoral fellow. His research focuses on peripheral mechanoreceptor-driven modulation of mesolimbic circuitry in the context of substance use disorders. Before full time research, Dr. Bills founded three different outpatient clinics focused on migraine headaches and traumatic brain injuries and served as a subject matter expert in the California Department of Workers’ Compensation Medical Unit. He is currently the Associate Dean for Research at Noorda College of Osteopathic Medicine and holds research and teaching appointments in the Department of Psychology at Brigham Young University and in the Department of Neurology at Parker University respectively.
The Role of Osteopathic Manipulative Medicine in Recovery from Concussions | DJacek Cholewicki, PhD, is a Walter F. Patenge Professor in spinal biomechanics. He directs the Michigan State University Center for Orthopedic Research (MSUCOR). Dr. Cholewicki received his PhD degree in Kinesiology from the University of Waterloo in Canada in 1994. From 1993 to 2007, Dr. Cholewicki worked in the Biomechanics Research Laboratory at Yale University School of Medicine, before being recruited to Michigan State University College of Osteopathic Medicine. His research interests lie in the areas of lumbar and cervical spine function, spine injury mechanisms, tissue loading, and biomechanical modeling using EMG. His current projects study motor control of the spine in the context of low back and neck pain, and optimal rehabilitation strategies, including OMM. Dr. Cholewicki is the recipient of the Bioengineering Research Prize Award for 2005 from the International Society for the Study of the Lumbar Spine (ISSLS) and the Rose Excellence in Research Award for the best research article of 2007 in the area of Orthopaedic Physical Therapy.
Assessing the Impact of Physician Pain on Motivation to Provide Longitudinal Osteopathic Manipulative Therapy to Patients and its Correlation to Opioid Prescribing (Co-branded award funded in collaboration with The American Osteopathic Foundation) | Erin Kay Jefferson, DO, completed her undergraduate studies at Indiana University Bloomington, where she received a Bachelor of Arts in Chemistry in 2007. After discovering her passion for medicine, she had the opportunity to attend Midwestern University Chicago College of Osteopathic Medicine in Downers Grove, Illinois. Following medical school graduation in 2011, Dr. Jefferson moved back to Indiana to complete her residency at Fort Wayne Medical Education Program. During her time in residency, she served as both Curricular Co-Chief and Co-Chief Resident and developed a love for academic medicine and mentor-ship. Upon completion of her residency training in 2014, Dr. Jefferson worked in both rural and suburban clinical practice for five years. In 2019, she elected to return to Fort Wayne Medical Education Program as Medical Director and Associate Program Director. Dr. Jefferson is enthusiastic about returning to a teaching environment that will foster both clinical acumen and compassionate care. She is passionate about her role in the Osteopathic profession and looks forward to engaging young physicians with an emphasis on scholarly activity.
The Functional Role of FUNDC1-Mediated Mitophagy in Doxorubicin-Induced Cardiotoxicity | Student Doctor Nguyen is a first year osteopathic medical student from the New York Institute of Technology College of Osteopathic Medicine (NYITCOM) who is deeply passionate about biomedical research. He has been working in a lab ever since he was an undergraduate student at Columbia University in the department of biomedical engineering. After graduation, Student Doctor Nguyen worked as a research technician at the Massachusetts General Hospital (MGH) Cancer Center in Dr. David Ting’s lab studying next generation sequencing of RNA from circulating tumor cells to further confirm my interest in a career in academic medicine. His drive for research stems from my deep curiosity in finding new answers to complex biological problems. After finishing his time in that lab and prior to starting at NYITCOM, Student Doctor Nguyen was fortunate enough to start working in his current lab under the guidance of Dr. Qiangrong Liang, the summer before his first semester of medical school. Overall, Student Doctor Nguyen is proud of his osteopathic roots and hopes to use all the skills learned one day and translate it effectively into a career of taking great care of patients while also tackling the many mysteries to be discovered in medicine.
2019 Research Grant Recipients
Exploring Osteopathic Medicine as an Effective Adjunctive Therapy for Pediatric Oncology Patients (OMET) | Jennifer Ashley Belsky, DO, MS, is a hematology/oncology/BMT physician fellow at Nationwide Children’s Hospital in Columbus, Ohio, and a graduate of the Ohio University Heritage College of Osteopathic Medicine. Her current research focuses on providing better supportive care options for children suffering from chemotherapy side effects. Special funding for this project was provided by the Dale Dodson Educational Fund.
Executive summary: This project was successful at achieving our primary endpoint of describing the benefit of OMT in hospitalized children and adolescents (CAYA) with cancer. Hospitalized CAYAs with cancer received OMT safely, with no adverse events per CTCAE version 5.0 criteria reported during, immediately after or 24 hours post-OMT Providing OMT in the pediatric oncology inpatient setting was feasible, with 100% of OMT encounters meeting our feasibility criteria. Additionally, OMT treatments were quick, lasting an average of 9.8 minutes. There was a trend toward efficacy, with improved median FACES scores for all patients and improved or unchanged FACES scores for each OMT encounter. Future studies should investigate the feasibility and safety of OMT in the pediatric oncology inpatient setting across a larger number of patients and broader pediatric oncology population Future prospective studies should focus on investigating the efficacy of OMT on improving chemotherapy-induced toxicities and HRQoL in the pediatric oncology population.
The Effect of Facial Effleurage on Complement C3 in Patients with Acute Rhinosinusitis | Kyle Burke received his undergraduate degree in Biomedical Sciences from the Rochester Institute of Technology in May of 2015. Currently, he is a second-year osteopathic medical student at the Edward Via College of Osteopathic Medicine – Carolinas Campus (VCOM–CC). Burke worked at the Brigham and Women’s Hospital in Boston, MA for two years following graduation. He worked with Clemens Scherzer, MD, on the Harvard Biomarkers Study as a Translational Study Coordinator where he performed clinical research visits and sample processing. Burke is currently working with Jillian Bradley, OD, at VCOM–CC as an Osteopathic Student Researcher on her project “The Effect of Facial Effleurage on Acute Rhinosinusitis.”
Abstract: Acute rhinosinusitis (RS) is one of the most common conditions treated in ambulatory care, affecting one in seven. adults in the U.S. annually. The etiology for this condition is most often viral; however, physicians across the country commonly provide antibiotics, contributing to an increase in antibiotic resistance. Facial Effleurage (FE) is an osteopathic manipulative treatment (OMT) that aims to promote the self-healing capabilities of the human body. FE decreases sinus congestion by mobilizing lymphatic flow and increasing circulation through rhythmic pressure applied by osteopathic physicians over the sinuses. The underlying mechanism of action for FE has not been elucidated. To clarify this mechanism, we assessed changes in serum complement component 3 (C3), an important part of the innate immune system key to fighting off various pathogens, five before and after FE treatment.
For this study, 91 participants were randomized into one of eight treatment groups following their diagnosis as healthy or RS. Blood was drawn directly before, one hour after, and seven to ten days following their initial clinic visit. We assessed the serum C3 concentration of participants via enzyme-linked immunosorbent assay (ELISA). RS patients who received FE had significantly lower serum C3 concentrations one hour after treatment compared to those who received the sham treatment (-373 ± 778 vs. 761 ± 1346 µg/mL, p = 0.0320). There was no significant difference in serum C3 concentration between any groups 7-10 days after treatment. Therefore, FE rapidly changes serum C3 concentrations in RS patients. This novel finding is the first evidence of a potential mechanism of action for FE and how it can provide this benefit to patients suffering from RS. We suggest FE, and other forms of OMT, should be used as an additional RS treatment.
Clearance of Brain Metabolic Waste in a Natural Animal Model of Alzheimer’s Disease by Cranial Osteopathic Manipulation | Blaise M. Costa, PhD, is an associate professor of pharmacology at Edward Via College of Osteopathic Medicine in Virginia. He received a PhD degree in Psychopharmacology from the National Institute of Mental Health and Neurosciences, India in 2005. In this AOA funded project, Costa and his co-workers will study the molecular mechanism of Cranial Osteopathic Manipulative Medicine (COMM) and its potential to serve as an adjunct treatment strategy for Alzheimer’s disease.
Executive summary: Thank you very much for supporting our research project entitled “Clearance of Brain Metabolic Waste in a Natural Animal Model of Alzheimer’s Disease by Cranial Osteopathic Manipulation.” Upon receipt of AOA grant support, we have conducted the proposed work and duly submitted the progress reports once every six months. Despite challenges related to COVID19, our preliminary findings from the naturally aged rat model of Alzheimer’s disease reveal COM-induced improvements in cognitive function, reduction in brain Aβ level and altered expression of proteins involved in lymphangiogenesis and water homeostasis. Further outcomes from an intramurally and AOA grant supported pilot study, using transgenic rat (TgF344-AD) model of Alzheimer’s disease corroborate each component of the results obtained from aged rats. As published in the following peer-reviewed journals:
Additionally, the following manuscript based on our further transcriptome work supported by this AOA grant has been submitted for publication and is under review:
We anticipate additional publications and presentations as outcomes from the grant as data analysis continues. As noted in our progress reports, while pursuing AOA grant-related activities, we have been applying for National Institutes of Health (NIH) grants to secure funds to continue and extend the project. Fortunately, we have been awarded a three-year NIH R15 (PAR-19-134) grant to start from July 1st, 2021. Since there is a scientific overlap between the AOA and NIH projects, we will need to terminate the AOA grant on June 30th, 2021. We will submit a final progress report by August 30, 2021.
This NIH R15 award comes to VCOM because of our successful efforts in advancing osteopathic manipulative medicine research. Further, obtaining this NIH grant fulfills the purpose of the AOA seed grant mechanism to support osteopathic medical school faculty to conduct nationally recognized research projects. Particularly, this groundbreaking research on the molecular mechanisms of cranial osteopathic manipulative medicine will pave the foundation for many more similar works and advancements in osteopathic research in the future. This has been made possible in large part by this grant, for which we are grateful to have received. If you have any questions, please do not hesitate to contact me. Thank you.
Determining the Effect of Biological Sex and Therapy on Diet-Induced Alterations in Liver and Kidney Health in Mice | Joseph Christopher Gigliotti, PhD, is an Assistant Professor of Physiology at Liberty University College of Osteopathic Medicine. He has received recognition for past research projects from several organizations, including the Institute of Food Technologists and National Kidney Foundation. Dr. Gigliotti’s current research is focused on understanding the immunopathology of kidney and liver diseases and how poor diet influences these processes.
Executive summary: It is well-known that proper nutrition is an important determinant of health and a reduced risk of disease. Unfortunately, the definition of “nutrition” is not fully appreciated by the biomedical community and is poorly represented in medical research. Here we described how diet influences metabolic outcomes (glucose, insulin, cholesterol) as well as injury to the liver and kidneys in mice, a common animal model in medical research. Using a novel diet that better models dietary habits of Americans, and a combination of tissue and molecular analyses, we were able to delineate the effects of consuming a high-energy diet (high sugar and fat) versus an Americanized diet that is high in energy and contains a variety of nutritional inadequacies (such as high-salt and low vitamins). Our research found that high-calorie diets lead to metabolic dysfunction (obesity, high cholesterol and insulin levels), and fatty liver disease, whereas the Americanized diet caused an intermediate degree of metabolic dysfunction and direct injuries to the kidneys. Molecular analyses highlight the immune system as playing a critical role in both liver and kidney injury. Mice were then subjected to two different treatment strategies (drug combination or dietary modification) to reduce metabolic dysfunction and injury to the liver and kidneys. Administration of drugs caused a moderate reduction in metabolic dysfunction and liver and kidney tissue injury; however, dietary modification causes a robust protection in almost all measured outcomes. These effects occurred in both male and female mice, although it was often more severe in males. Taken together, our data confirms previous reports that high-calorie diets lead to metabolic dysfunction and fatty liver disease. The finding that the Americanized diet causes similar injury plus direct injury to the kidneys is very exciting and offers never-before seen connections between diet and disease. Future studies will further define the mechanism by which the Americanized diet causes kidney dysfunction and how long-term consumption of these diets influence chronic disease processes.
We are very pleased with the results of this study despite many complications over the past 2-years. The COVID pandemic caused many setbacks, including an inability to receive technical support on several key pieces of equipment, and the untimely death of a close contact of our statistician who was unable to participate in the study as planned. The project also required a full-time research technician to oversee the day-to-day operations of the laboratory and manage the 16-month animal studies. This individual and his family contracted COVID during the first 2 months of the study and caused significant alterations in our study design. We were able to overcome all of these obstacles to complete the study and generate a tremendous amount of information to be used in future applications for extramural funding. The research technician hired for this project performed exceptionally well and is now fully employed as the lead research technician at the Center for Research at Liberty University College of Osteopathic Medicine.
Predictors of Stress, Anxiety, and Depression in Female Osteopathic Medical Students: A Prospective Cohort Study | Bhuma Krishnamachari, PhDbu, serves as Assistant Dean of Research and an Associate Professor of Clinical Specialties at the New York Institute of Technology College of Osteopathic Medicine. She recently completed a Health Policy Fellowship with Ohio State University. Special funding for this project was provided by the Dale Dodson Educational Fund.
Executive summary: Medical school can be a challenging and stressful endeavor, which may place students at risk for burnout and associated mental health issues. Other factors may play a role in defining the level of burnout experienced by a student, including demographic factors. Additionally, life altering public health events such as the COVID-19 pandemic may significantly add to this stress. The aims of this study were to:
This study used a repeated measures design spanning two academic years (39 weeks each). The study was approved by the New York Institute of Technology College Institutional Review Board (IRB) with required written informed consent. The study included 163 students who were sent a series of surveys over the course of the school year. The following surveys were administered: Perceived Stress Scale (PSS-10), Depression Anxiety Stress-Scale (DASS-21) and Medical Education Hassles Scale (MEHS). In addition to these validated surveys, demographic variables on age, gender and race were collected. Once the pandemic hit, students were also asked to what extent their stress level changed specifically due to the pandemic. Out of the students who consented to be a part of the larger survey study, 20 students in each cohort were selected to participate in a pilot study looking heart rates and heart rate variability during the acute stress situation of taking medical school exams. In the first cohort (2019), 20 individuals were recruited to wear Hexoskin™ Smart shirts. In the second academic year, due to the COVID-19 pandemic the protocol was modified to accommodate exams taken at home and Apple watches were used to collect heart rates and heart rate variability. Our results suggested that female medical students consistently report more stress than male medical students. Racial differences in stress were not observed in the study. Our results also suggest that the gender differences may not come from biological/physiological gender differences. Our results did find that acute stressors like exams may have a biological effect on students. Additionally, those students who are already experiencing baseline anxiety and depression may be apt to feel the stressful effects of an event such as a pandemic to a greater extent. This study provides valuable evidence in terms of what factors may add to stress in medical students. Medical schools must be proactive in addressing the mental health needs of students and future studies should investigate optimal stress reduction methods in Osteopathic medical students.
Osteopathic Manipulative Treatment vs. Standard Therapy in the Management of Acute Neck and Low Back Pain in the Emergency Department | Alexis Marie LaPietra, DO, FACEP, FAAEM, is the Medical Director of the Emergency Medicine Pain Management Program and the Fellowship Director of the Emergency Medicine Pain Management Fellowship and Emergency Medicine Mental Health and Addiction Medicine Fellowship at St Joseph’s Health in Paterson, New Jersey. Co-branded award funded in collaboration with The American Osteopathic Foundation.
Executive summary: The Department of Emergency Medicine at St Joseph’s Health sought to investigate the effectiveness of osteopathic manipulative therapy in the management of acute neck or low back pain compared to ibuprofen 400 mg. There were a total of 35 patients ages 18-65 enrolled in this study and those who were randomized to the OMT group received five minutes of myofascial release and muscle energy. Our results reveal there is no difference in pain reduction, patient satisfaction, perceived reduction in pain, need for rescue analgesia, or adverse effects between the OMT and ibuprofen group. The St Joseph’s Health team consisted of Alexis LaPietra, DO, as the PI, with co-PIs including Katherine Vlasica, DO, Scott Wilder, DO, and Steven Hochman, DO. At the start of the study all emergency medicine residents and faculty, who were on the study, attended a one-day OMT refresher course provided by David Mason, DO. This course provided both didactics and hands on instruction regarding muscle energy and myofascial release techniques for acute neck and low back pain. Each year of this study an internal review course was conducted by Dr. LaPietra with didactics and simulation. This research is an important reminder that non-pharmalogical interventions have a place in emergency medicine for the treatment of musculoskeletal pain. In light of the opioid epidemic and the rising number of senior presenting to the ED physicians and providers should be well versed in how best to manage pain in patients with contraindications to NSAIDs, opioids or other medications. OMT is a viable tool for ED pain management.
Optimizing Chronic Pain Management through Patient Engagement with Quality of Life Measures: A Randomized Controlled Trial | John C. Licciardone, DO, MS, MBA, holds the Osteopathic Heritage Foundation Richards-Cohen Distinguished Chair in Clinical Research at the University of North Texas Health Science Center. He directs the Osteopathic Research Center and its PRECISION Pain Research Registry, which studies precision medicine and biopsychosocial aspects of pain.
Executive summary: Health-related quality of life (HRQOL) represents a new paradigm for guiding chronic pain management. This study aimed to assess the value and utility of an eHealth intervention for patients with chronic low back pain (CLBP) that was based on HRQOL measures and to assess clinical outcomes associated with its use. Subgroup analyses according to the type of physician (i.e., osteopathic vs. allopathic physician) who provided medical care for CLBP were also conducted to identify and further explore any significant interaction effects.
The Optimizing Chronic Pain Management through Patient Engagement with Quality of Life Measures Trial (OPTIQUAL) was conducted by the Osteopathic Research Center using its Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation. Registry participants with CLBP were screened for eligibility from Nov. 2019 through Feb. 2021. Trial participants were randomized to the experimental treatment group that received an eHealth intervention consisting of a HRQOL report and interpretation guide, or to the control treatment group that was placed on a wait list to receive the eHealth intervention after completing the trial. The eHealth intervention on HRQOL involved the SPADE cluster (sleep disturbance, pain interference with activities, anxiety, depression, low energy/fatigue).
The eHealth intervention was assessed by surveying the experimental treatment group about the value and utility of the HRQOL report. The overall value of the report was rated from 0 (worst score) to 100 (best score). The clinical outcome measures in the trial were recommended by the National Institutes of Health Task Force on Research Standards for Chronic Low Back Pain. The primary outcomes involving HRQOL were derived from the SPADE cluster of the Patient-Reported Outcomes Measurement Information System. The two secondary outcome measures involved low back pain intensity and back-related functioning. A numerical rating scale was used to measure low back pain intensity. The Roland-Morris Disability Questionnaire was used to measure back-related disability.
A total of 331 participants were randomized, including 166 and 165 in the experimental and control treatment groups, respectively. The survey for value and utility of the eHealth intervention was completed by 158 (95.2%) of participants randomized to the experimental treatment group. The mean overall value of the report was 63.7 (SD, 26.7). A total of 36 (23%) participants shared the report with the physician who treated their CLBP.
The primary and secondary outcome measures were available for 326 (98.5%) trial completers, including 164 (98.8%) and 162 (98.2%) completers in the experimental and control treatment groups, respectively. There were no significant differences between the experimental and control treatment groups for changes over time in any primary or secondary outcome measure. Correspondingly, there were no clinically important differences between treatment groups on any measure. No serious adverse events were reported during the trial. An intention-to-treat analysis was not performed because there were virtually no missing data attributable to attrition during the trial.
There are at least two possible explanations for the negative findings of the study. The prior feasibility trial recruited participants from August 2019 through January 2020, when all registry participants resided in Texas. However, the OPTIQUAL participants were recruited from the 48 contiguous states and District of Columbia. Nevertheless, it is seems unlikely that clinical outcomes of CLBP would have been substantially affected by this research design enhancement. More likely, the clinical outcomes were impacted by onset of the COVID-19 pandemic on March 13, 2020. Because almost three-fourths of participants in the trial were enrolled during the pandemic, they may have had limited access to CLBP treatments. This may have attenuated differences in outcomes between the experimental and control treatment groups that would otherwise have been observed if the pandemic had not occurred.
There were no significant subgroup differences observed in the reported value and utility of the eHealth intervention, or in the primary or secondary outcome measures, based on the type of physician provider for CLBP. Again, it is possible that decreased access to health care (including osteopathic manipulative treatment) during the COVID-19 pandemic may have attenuated any osteopathic vs. allopathic physician interaction effects relating to the association between treatment group assignment and outcomes for HRQOL, low back pain intensity and back-related functioning.
Despite several strengths attributable to using the registry to conduct this randomized controlled trial, the validity and generalizability of its findings may have been limited by the unforeseen onset and impact of the COVID-19 pandemic shortly after beginning the trial.
Role of ERAP1 in Tr1 Cell Biology and Ankylosing Spondylitis | Student Doctor O’Connell is a fourth year DO-PhD student at Michigan State University College of Osteopathic Medicine. He is working to uncover mechanisms underlying chronic autoimmune disorders, notably, Ankylosing Spondylitis. These studies will focus on the role of an important anti-inflammatory cell termed Type 1 Regulatory T cells (Tr1 cells), which potentially play an important role in joint inflammation. Special funding received from the AT Still Foundation.
Abstract: Single nucleotide polymorphisms (SNPs) in the ERAP1 gene have been linked to increased susceptibility to the autoimmune disease multiple sclerosis (MS). While potential mechanisms explaining the associations for SNPs in ERAP1 with other autoimmune diseases (Ankylosing Spondylitis (AS), Bechets disease, colitis and others) have previously been investigated, no studies have yet looked at the mechanism underlying the association with MS. Here, using mice lacking ERAP1 (ERAP1-KO), we show that ERAP1 deficiency leads to increased susceptibility in the murine model of MS, experimental autoimmune encephalomyelitis (EAE). Investigation of the entire CNS immune compartment during EAE using high-dimensional single-cell spectral cytometry revealed that ERAP1-KO mice have an elevated frequency of NK cells infiltrating the CNS as compared to WT mice. These results confirm the genetic association of ERAP1 SNPs with MS in a well validated mouse model and set the stage for further studies to clarify the precise molecular underpinnings of this association.
Biochemical Effects of Osteopathic Manipulation on Neuronal Function and Survival | Beverly A. Rzigalinski, PhD, is a professor of Pharmacology at the Edward Via College of Osteopathic Medicine. In this current grant, she is working to decipher the biochemical effects of osteopathic manipulation on the neuron, to unravel the cellular mechanisms by which osteopathic manipulation exerts its beneficial effects on the human. Special funding received from the AT Still Foundation.
Executive summary: Despite the increasing use of OMT in musculoskeletal injuries and other pathologies, there are few reports detailing the biochemical and cellular mechanisms of action. Hence, there is a large knowledge gap between bedside and bench. In these studies, we narrowed this gap by Identifying some of the potential biochemical mechanisms altered by myofascial release (MFR) and repetitive motion injury (RMI). In order to effectively examine changes at the cellular level, the Flex Cell system for cell strain was utilized. Although OMT is thought to affect primarily the musculoskeletal system, peripheral nerves abundantly innervate these areas and are critical to the transmission of pain. Therefore, we utilized Dorsal Root Ganglia (DRG) neurons, a model for peripheral sensory neurons, in these studies. DRG neurons were isolated from the rat, and were cultured on a flexible substrate which was then exposed to the forces of strain and stretch to simulate both RMI and MFR. Although no in vitro model can precisely replicate an in vivo system, this model provides a starting point for examining OMT- like forces at the level of the cell, which is difficult to do in vivo.
We found that DRB neurons exposed to a single in vitro MFR procedure had lower levels of basal intracellular free calcium compared to neurons cultured without MFR. Further, in vitro, MFR treated neurons displayed a decreased response to neurotransmitters, had decreased levels on inflammatory mediators, and lower levels of oxidative stress. Further, MFR-exposed DRG neurons had increased levels of filamentous actin, suggesting a stronger cytoskeleton. Taken together, these results suggest that in vitro MFR may result in a neuron that has a stronger cytoskeleton and is less susceptible to conditions that produce pain.
Using the Flex Cell system, we also mimicked RMI. Exposure to in vitro RMI resulted in an increase in basal intracellular free calcium, enhanced responses to neurotransmitters, an increase in inflammatory mediators, and a decline in the filamentous actin cytoskeleton. These changes were mitigated, in part, by delivery of in vitro MFR 24 hours after the RMI.
Taken together, these results suggest that MFR may decrease cellular biochemical effects associated with injury to neurons, providing a biochemical basis for the effects of OMT at the cellular level. Future experiments should pursue the durability of in vitro MFR, and the effects of multiple rounds of MFR after RMI, to provide a clearer picture of the cellular processes associated with OMT and further narrow the gap between bench and bedside.
Anti-Inflammatory Actions of OMT – Role of the Cholinergic Anti-Inflammatory Reflex and Translocation of Immune Cells from Reticular Organs to the Systemic Circulation | Harald Martin Stauss, MD, PhD, is an Associate Professor of Pharmacology at Burrell College of Osteopathic Medicine. In the AOA-funded research project, Dr. Stauss will test the hypothesis that cranial OMT techniques elicit anti-inflammatory actions by increasing parasympathetic activity and thereby activating the cholinergic anti-inflammatory pathway. Special funding received from the Dale Dodson Educational Fund.
2018 Recipients
Leveling the Playing Field: Evaluating How Prerequisite Classes Affects Perceived Stress Levels in Medical Students | Kathleen Ackert, OMS II, graduated from the Philadelphia College of Osteopathic Medicine in 2020 and is currently a resident in Obstetrics & Gynecology at St. Luke’s University Health Network in Bethlehem, PA. In addition to working and studying hard to be a well-rounded and compassionate physician, she is also interested in research, mainly QI projects surrounding medical education. She credits her start in research to the AOA training grant that she received as a second-year medical student. When Dr. Ackert is not holding down the fort on labor & delivery or in the operating room, you can find her at local independent coffee shops writing narrative medicine pieces, at her CrossFit gym, or working on her power ranking of Philadelphia’s best brussels sprouts. Feel free to follow along on Instagram at @CaffeineWithKathleen or on Twitter at @AckertKathleen.
Abstract: The TISSUE (Teaching Introductory Study Skills Utilizing Experience) program was created to provide exposure to the anatomical sciences for students who had not taken courses in anatomy and/or histology, had received an undergraduate degree in a non-science concentration and/or who had not been involved in an academic setting for some time. This program was developed for incoming medical students by current medical students. The main goal of TISSUE was to mitigate the perceived academic, emotional and personal stress of the incoming first year medical students. The program touched upon academics, study strategies, time management and student wellness and was offered to the incoming Philadelphia College of Osteopathic Medicine Class of 2021 Doctor of Osteopathic Medicine students, with the option to participate in an in-person or online cohort. Outcomes assessment was measured by surveying the students post-course in reference to stated learning outcomes related to both anatomical sciences and transitioning to medical school. Supplemental research projects will investigate the effect of participating in the TISSUE course on perceived academic and transitional stress in first year medical students. This research will contribute to a growing body of data collected by the administration and mental health counselors to better tailor mental health counseling opportunities, student support groups and a curriculum that supports the health and happiness of medical students.
Abstract: Inflammatory bowel disease (IBD) is known to have a multifactorial process involving the immune, lymphatic and gastrointestinal systems. It is comprised of both genetic and environmental causes; however, the exact pathophysiology of IBD is unknown. In the gut, the lymphatics have been shown to control tissue edema, leukocyte trafficking and chemokine clearance. Therefore, lymph stasis is thought to be a major contributing factor to the disruption of the normal immune and wound healing response to the tissue damage seen in IBD. If the lymph flow can be restored, then lymphatic remodeling and the body’s natural self-healing mechanisms can overcome the innate immune response. We hypothesize that osteopathic manipulative treatment (OMT), specifically lymphatic pumping techniques (LPT), can be used to increase immune cell mobilization, antigen and cytokine clearance, while also promoting proper wound healing in an IBD mice model.
In this study, we used C57BL6 mice treated with a 3% solution of dextran sulfate sodium (DSS). The mice were divided into four groups: control with normal water, control with 3% DSS, anesthesia with 3% DSS and anesthesia with LPT and 3% DSS. All groups received the respective fluid intake for five days, with euthanasia and colon collection on the fifth day. Anesthesia and the LPT were performed one day after the DSS solution was given and continued for four days. The LPT group received daily treatment by contacting the abdomen and pumping at a rate of 1/seconds for 4 minutes. Following euthanasia and colon collection, all samples were homogenized or fixed in formalin. The homogenized colons were analyzed using ELISA for multiple inflammatory markers including, but not limited to, IL-1 β, IL-2, IL-5, IL- 12 p70, IL-17 A Homodimer, IL-22, IL-23, and TGF- β.
While full data analysis of this larger study has not been completed, preliminary studies have shown significant differences between the OMT groups and the control groups. The mice that received OMT showed less weight loss and a decreased innate response shown by analyzing TNF-α and IFN-γ levels. The broader analysis of inflammatory markers, along with a larger sample size will allow us to further explore the dynamics between the lymphatic system and inflammatory bowel disease.
Meditation, Alignment with the Osteopathic Philosophy and Empathy in Osteopathic Medical Students: A Randomized Controlled Interventional Trial | Jerry Balentine, DO, received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine, graduating in 1983. He completed his internship at St. Joseph’s Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident. In 1992 Dr. Balentine started practicing Emergency Medicine at St. Barnabas Hospital in the Bronx where he served as Residency Director and Department Co-Director.
Dr. Balentine served as Chief Medical Officer and Executive Vice President of St. Barnabas Hospital and Healthcare System in the Bronx until 2014. He is Past-President of the New York Chapter of the American College of Emergency Physicians and Vice Chair of the New York State Board of Medicine. He has authored and edited many web and textbook chapters and was the founding medical editor of newyorkmedicaljournal.org.
Dr. Balentine is currently Dean, NYIT College of Osteopathic Medicine; Vice President, Health Sciences and Medical Affairs at the New York Institute of Technology.
Executive summary: Physician empathy is a major factor in attaining positive clinical outcomes for patients. Fostering empathy in medical students is particularly important as they are the future of the healthcare workforce. Empathy is affected by both stress and burnout. Additionally, it is possible that alignment with the Osteopathic Philosophy may be associated with empathy as the philosophy emphasizes person-centeredness and holistic thinking. Research shows that meditation may be an avenue to promote positive student attitudes including empathy. Using validated measures, we investigated whether use of a meditation app will have an effect on alignment with osteopathic philosophy, empathy, burnout and stress. A randomized repeated-measures clinical trial study design at the New York Institute of Technology College of Osteopathic Medicine was used to the effects of the Headspace meditation app on osteopathic philosophy, empathy, burnout and stress using validated survey measures. 65 Osteopathic medical students were randomized into either an intervention group that would use the Headspace meditation app or a control group with no use of an app. Students were asked to use the app 3 days a week. Subjects then completed validated surveys for measurement of empathy, stress, burnout, and alignment with osteopathic principles at baseline, 3 months, 6 months and 12 months. The second cohort completed an additional set of surveys at 9 months, right after the COVID-19 pandemic started. At this time, the control group was given access to the Headspace app, and 12 month data on this cohort included the intervention group who has been meditating for the previous year and the control group who had been meditating for three months. Statistical analyses included t-tests to determine differences between groups for continuous variables, chi-square tests to determine differences between groups for categorical variables and repeated measures ANOVA to determine effects through time. A p-value of 0.05 was considered statistically significant. We found that use of a meditation app helps reduce stress after 6 months of use (p<0.05). The app may also decrease burnout after 6 months of use, specifically impacting exhaustion (p<0.05 in cohort 2 females). This study suggests that use of a meditation app may be a useful tool in addressing stress and burnout in medical students.
The Cardioprotective Benefits of Prolonged Fasting | Katrina Bantis, OMS IV, is a fourth year medical student at NYIT-COM and will be applying to anesthesiology residency programs this fall. She is very grateful for the AOA’s support of her long-term research project entitled “The Cardioprotective Benefits of Prolonged Fasting.” Katrina is interested in pursuing a career in academic medicine, and, as such, she has pursued various research (both basic and clinical) and teaching opportunities throughout college and medical school. Of special note, Katrina was accepted into a merit-based scholarship program at her medical school (the Academic Medicine Scholars Program) that primes students for careers in academic medicine, providing her with significant protected research time to carry out this AOA-funded project as well as ample graduate-level teaching opportunities. Katrina is looking forward to returning to Dr. Qiangrong Liang’s (her research advisor) lab this fall.to complete her cardiovascular disease project.
Executive summary: Caloric restriction (CR), or fasting, has been shown to protect against cardiovascular disease (CVD) as well as to promote longevity in human and animal studies. The ability of CR to promote longevity was first reported in rats in 1917, and it has subsequently been corroborated using diverse model systems. In this study, we investigated the mechanism that allows for cardioprotection during prolonged fasting (i.e., greater than or equal to 48 hours of fasting).
Mitophagy is a selective form of autophagy that specifically targets mitochondria for degradation. Recent studies have reported that mitophagy plays an essential role in maintaining cardioprotection during times of acute and chronic stress, but the major molecular players involved remain unknown. FUNDC1, is an outer mitochondrial membrane protein that is a known mediator of mitophagy and the focus of this study. In this study, FUNDC1 knock-out mice (i.e., mice that do not express the FUNDC1 protein) and wild-type control mice were assessed by echocardiography and left ventricular catheterization before and after a 48-hour fast. Our results demonstrate that FUNDC1 is as an essential mediator of cardioprotection in mice during fasting, as there was severely exacerbated cardiac function in the knock-out mice after a period of prolonged fasting compared to the fed and fasted wild-type controls.
A Novel Lifestyle Intervention Program to Improve Body Composition and Chronic Disease Biomarkers in Overweight Medical Students: A Randomized Trial
New York Institute of Technology
Executive summary: Medical students often struggle to maintain healthy dietary and lifestyle habits throughout their training and are at increased risk for future cardiovascular events and other health problems including diabetes (Bergeron et al., 2017). Research suggests physical activity habits of medical students influence their counseling practices after graduation and that a physician’s lifestyle can influence the behavior of their patients (Abramson, Stein, Schaufele, Frates & Rogan, 2000; Dacey et al., 2014; Lobelo, Duperly & Frank, 2009). This project aimed to test a novel intervention program in over weight first and second year medical students. The intervention consisted of eight online modules that educated participants on exercise, nutrition and lifestyle modifications. Each participant had body composition analysis done before and after the intervention using dual X-ray absorptiometry, and underwent resting metabolic rate testing using oxygen consumption. Based on these results subjects were given a caloric range to consume daily, and to log their diets in an online application. Weekly emails were sent out to remind subjects to complete their diet log and maintain activity. Each subject was given a Fitbit smart watch and step count was recorded using a Fitabase dashboard. Outcome measures included step count, body composition and a blood lipid profile.
We found no significant change in any outcome measures throughout the study. Our results showed an increase in step count for the first three weeks of the school year in both groups, and then a progressive decline for the remainder of the academic year. Although during an exit interview 87% of our participants felt the smart watch helped motivate them, 40% found it difficult to eat within their recommended caloric range and 46% felt that school commitments prevented them from fully participating in the online education modules.
Effect of Palpatory Neuromodulation of the Trigeminal Nerve for Tenderness in the Posterior Neck Musculature
University of North Texas Health Science Center/Texas COM
Executive summary: Context — The trigeminal nerve coordinates several cranial reflexes including a trigemino-cervical reflex (TCR) that utilizes the posterior neck musculature (PNM) to remove the face from danger with noxious stimuli. The PNM has been identified as a potential cause of neck pain. Osteopathic manipulative treatment (OMT) has many modalities, one of which is using constant palpatory pressure, or inhibition, for relief of discomfort. Inhibition can be a type of neuromodulation, meaning a stimulation used to affect a change in the signaling circuitry of a nerve to affect how sensory inputs are processed via neurotransmitters.
Objective — This study aimed to evaluate whether an OMT-based neuromodulation protocol on the trigeminal nerve where it exits the face could affect the circuitry of the TCR reflex to change the pain levels of the PMN. We hypothesized that the tenderness of the PNM would decrease after the neuromodulatory OMT intervention.
Methods — Seventy-eight subjects with a chief complaint of neck pain were recruited from the University of North Texas Health Science Center campus, and reimbursed with a gift card. Four were deemed ineligible for the study and 19 were excluded from analysis due to lack of posterior neck tenderness as assessed by a visual analog scale (VAS) or trigeminal nerve tenderness upon palpation. The PNM was assessed for tenderness bilaterally using the IsoTouch hand sensors, using up to three lbs. of pressure. The most tender side was noted as the cervical site of tenderness (CSOT). The V1 and V2 branches endings on the face were assessed for tenderness using up to two lbs. of pressure and then given a 30-second constant pressure neuromodulation OMT intervention. The amount of pressure used during assessment and intervention was measured and monitored in real-time using the IsoTouch system. The difference in median pain at CSOT from pre to post was assessed using the Wilcoxon Signed Rank Test.
Results — The average change in tenderness at CSOT based on the VAS was 1.41±1.23. The Wilcoxon-Signed Rank test demonstrated a significant difference in tenderness at CSOT pre and post-intervention (p < 0.000).
The average pressure used to assess CSOT was 1.61±0.24 lbs. (left hand) and 1.46±0.22 lbs. (right hand). The average pressure used for intervention was 1.82±0.26 lbs. (left hand) and 1.87±0.36 lbs. (right hand). The pressures recorded on average were less than our goal pressures.
Conclusion — Given that PNM tenderness is multifactorial, the small yet significant difference in tenderness at CSOT pre and post-intervention indicates that the neuromodulatory OMT intervention may affect PNM tenderness and neck pain. Furthermore, the real-time feedback of pressures being applied from the IsoTouch system helped remove the subjectivity of the OMT intervention. Study limitations included a lack of a control group and the use of a single intervention to assess pre vs. post-change. Including a control group, modifying the length of neuromodulation and the amount of pressure used, and correlating between PNM tenderness and neck pain are possibilities for future research.
The Effects of Lymphatic Pump Treatment on The Immune Response During Acute Pneumonia | Lisa Hodge, PhD, is an Associate Professor in the Department of Physiology and Anatomy and the Director of the Master of Medical Sciences Program at the University of North Texas Health Science Center in Fort Worth, Texas. Her lab researches the effect of osteopathic manipulative medicine therapies (OMT) on the lymphatic and immune systems. By stimulating the lymphatic system, OMT may aid to heal diseased tissue by boosting the immune system and draining inflammatory mediators, dead cells, microbes, and toxins from the tissue. Her research has been supported by the National Institutes of Health, the American Osteopathic Association, and the American Academy of Osteopathy.
Executive summary: Pneumonia accounts for over 1,000,000 hospital admissions each year. While vaccines and medicine have substantially reduced the rate of death from pneumonia, the number of microbes that are resistant to vaccines and drugs has increased, suggesting that in the future treatments may be less effective. Therefore, there is a need to investigate the effectiveness of complementary and alternative medicine therapies for the treatment of pneumonia. The osteopathic medical profession has designed a set of manipulative medicine techniques called lymphatic pump techniques (LPT) that enhance the flow of lymph through the body. Clinical studies support the use of LPT as a therapy for the treatment of pneumonia; however, how LPT protects patients during pneumonia is unknown. The purpose of this study was to determine if the lymph mobilized during LPT would alter immune cell responses. To complete this study, the principal investigator assembled a team of consisting of an osteopathic physician, biostatistician, research technician and an osteopathic medical student. In this study, immune cells from healthy mice or mice with pneumonia were collected and cultured with lymph collected before, during or after LPT. We discovered that all lymph samples suppressed the inflammatory activity of immune cells which could protect the lung tissue from the damage that can arise when immune cells overreact during pneumonia. The redistribution of protective lymph during LPT may provide a scientific explanation for the clinical use of LPT treat infection. Future studies could investigate the impact of the injecting freshly isolated lymph into diseased animals and determine if disease symptoms improve. Studies such as these are essential to support the clinical use of LPT for the treatment of pneumonia. Then, LPT can be optimally applied to patients with pneumonia, which may substantially reduce hospitalization and death from pneumonia.
Prospective, Multicenter, Cohort Study of the Cost Effectiveness of Osteopathic Manipulative Treatment for Chronic Low Back Pain
Rowan School of Osteopathic Medicine
Executive summary: The purpose of this study is to compare the costs of standard of care versus standard of care and osteopathic manipulate medicine in 140 patients in two different states, New Jersey and Michigan. The study included two standard of care sites and two osteopathic manipulative sites. Each patient was consented and followed for four months. The research team collected all costs that the patient incurred during the four months. These costs included osteopathic manipulate medicine visits, interventional therapy, referrals, physical therapy, medication, diagnostic tests and office visits. In addition, the team collected pain data at the beginning of the trial and at the very end.
The research team was able to collect data from 75 standards of care patients and 71 standard of care plus osteopathic manipulative medicine patients. Patients in the standard of care group were more likely to have been treated by interventional therapies, to have used radiological/diagnostic services and to be prescribed opiates compared to the standard of care plus osteopathic manipulative medicine group. In addition, the results showed that self-reported pain levels decreased over time more consistently for the standard of care the plus osteopathic manipulative medicine group than for the standard of care group.
Effects of OMT on Return to Play Post Concussion | Alessandra Posey, DO, received her undergraduate degree from Florida International University in Miami, Florida. She attended medical school at Lake Erie College of Osteopathic Medicine in Erie, Pennsylvania. She completed her internship at Broward Health in Ft. Lauderdale and her Family Medicine residency at Palmetto General Hospital in Hialeah, where she served as chief resident before completing her Sports Medicine fellowship at Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine in Ft. Lauderdale.
Dr. Posey currently serves as Chair of the Sports Medicine Department at Dr. Kiran C. Patel College of Osteopathic Medicine and Team Physician of the NSU Sharks. She is also Co-Program Director for the Sports Medicine Fellowship and an Assistant Professor of the Osteopathic Principles and Practice.
One of her goals is to continue to equip all stakeholders with a comprehensive, yet understandable knowledge of concussions and other sports related injuries. As an osteopathic physician, she continues to incorporate OMT into patient care in the athletic realm. This study gives her and her team the opportunity to assess the effectiveness of using Osteopathic Manipulation post-concussion as a standard of treatment.
Diabetes and OMM: A Randomized Controlled Trial
New York Institute of Technology
Inviting Interdisciplinary Input: An Osteopathic Approach to Leveraging Community Support for Prevention and Management of Chronic Disease in Rural and Appalachian Virginia
Edward Via College of Osteopathic Medicine – Virginia Campus
Abstract: Central Appalachian communities continue to experience poor health outcomes in the setting of persistent poverty despite efforts by numerous organizations to address these disparities over the past 50 years. In 2011 Edward Via College of Osteopathic Medicine initiated a longitudinal study with the goal of identifying demographic, geographic, economic and social determinants of health contributing to persistently high prevalence rates of certain chronic health conditions in Appalachian regions in southern Virginia. The overarching goal of this research is to characterize individual communities and target key factors to address in future intervention programs designed to improve the health and well-being of communities in Central Appalachia. Collection and analysis of quantitative and qualitative patient-centered data has been completed and a complementary provider-focused dataset is currently in process of being collected and analyzed. This phase aims to answer questions regarding a) impact of chronic disease b) perceived barriers to improving chronic health conditions in patients and communities of practice, and c) identification of osteopathic tenets employed in practice. These results, in addition to input collected from focus groups in each area will ultimately inform the design of targeted interventions in each of the six regions studied. This project, which aims to look deeply within and engage with each individual community to formulate problems as well as solutions, is osteopathic at its core.
Longitudinal and cohort studies were conducted in rural Virginia through analysis of agency mortality data (Virginia Department of Health) and individual electronic health records. Six facilities in four health disparity regions of southern Virginia were identified and agreements to participate confirmed for a cross-sectional study. An IRB approved protocol provided for the systematic random selection and de-identification of protected medical records of admitted patients aged 18 years and older. An interdisciplinary team designed, pre-tested and revised a survey tool in Qualtrics, LLC, specifically for the efficient extraction of data from selected records with a focus on nine chronic diseases and a non-chronic disease, mild mental illnesses, utilizing International Classification for Disease (ICD) codes. Cases were further reviewed for family histories, lifestyle behaviors, social history, physical exam notes and clinical and laboratory test results. Interdisciplinary steering committees were formed to include healthcare providers and interested parties in each distinct region in order to provide feedback toward the development of a 35-item survey to be distributed to providers across the six regions, and to later convene as focus groups in each region to further provide complementary qualitative data.
Longitudinal data (1960-2012) was obtained from the Virginia Department of Health (n~60,000). Cohort data was extracted from 2012 inpatient electronic health records from six hospitals. Records were selected via systematic randomization (n~1,400). Data analysis controlled for age, gender and ethnicity. Data compared SW VA to comparison areas and identified social, behavioral, environmental and clinical confounders. Nine chronic disease mortality conditions and one non-chronic, external cause of death, were studied. Statistical analyses included paired t- tests, Pearson’s correlations, Rao-Scott chi squared and Nagelkerke’s (NK) analyses, significance, α=0.05 using SPSS software. Results for the electronic health record reviews indicated inpatients in southwest Virginia had greater likelihoods of diagnoses with neoplasms (9.40 vs 7.50%, NK=3.6)(p<0.01) and diabetes (30.40 vs 13.90%, NK=4.3)(p<0.0001) compared to their eastern Virginia counterparts. Prevalence of mental disorders was 42.80% in southwest Virginia and 30.30% in eastern VA (NK=16.8)(p<0.0001). Overall rates of chronic bronchitis were increased in the coal mining region of southwest Virginia when compared to eastern Virginia (29.90 vs 1.50%, NK=21.5) (p<0.0001) while individuals employed as coal miners had lower rates of hypertension, heart disease complications and asthma than non-coal miners. Though inpatients in southwest Virginia were less likely to experience kidney disease than inpatients in eastern Virginia (9.30 vs 10.10%), kidney disease was most prevalent in the south side region at 18.40% (NK=9.4) (p<0.0001). Smoking and alcohol use status yielded no statistically significant differences between regions. Preliminary analysis of qualitative data collected from interviews with primary care providers in the single region of Buchanan County indicates that physicians in this region experience difficulty in securing referrals to specialists, patient compliance, patient transportation and balancing best practice with the financial constraints of the patient population. Preliminary analysis also indicates that physicians are very receptive to assistance in addressing these issues.
While each of the six regions of southern Virginia studied is similar in the presence of poor health outcomes and poverty, the quantitative results from the review of electronic health records highlight the unique and complex interplay between demographic, geographic, economic and social determinants of health faced by each individual community. Providers have indicated that they are struggling to provide optimal care and are open to assistance. It is our hope that identifying and addressing each region as a unique entity will allow for the design of lasting and meaningful interventions that maximize the inherent strengths and minimize the weaknesses of each individual community. Considered as a pilot project, this study will continue to offer valuable insight into next steps to include development of a reproducible modular system to facilitate the efficient and thorough assessment of needs in order to inform individualized interventions toward improved health outcomes in any community.
The authors would like to thank the American Osteopathic Association for their generous support of this research through a student research grant.
2017 Recipients
Achieving a High Level of Wellness by Focusing on the Impact of Diabetes Distress in Rural Appalachia | Elizabeth A. Beverly, PhD, is an Associate Professor in the Department of Primary Care at the Ohio University Heritage College of Osteopathic Medicine and the recipient of the Heritage Faculty Endowed Fellowship in Behavioral Diabetes, Osteopathic Heritage Foundation Ralph S. Licklider, DO, Research Endowment. Dr. Beverly graduated from The Pennsylvania State University with a Doctor of Philosophy degree in Biology and Behavioral Health and a minor in Gerontology in 2008. She completed a five-year postdoctoral fellowship in diabetes at Harvard Medical School with the Joslin Diabetes Center in 2013. Dr. Beverly conducts research focused on chronic disease management, with a specific emphasis on type 1 and type 2 diabetes. Her research program examines diabetes through a psychosocial lens, employing mixed methodology to examine complex challenges in a rural and underserved region in Appalachian Ohio. She is focused on implementing evidence-based interventions, including patient navigation, community health workers, and peer support networks, to address health disparities to improve clinical outcomes. In addition, she has employed focused ethnographic methods to better understand the culture of rural Appalachian Ohio and how this culture influences diabetes self-care. Recently, she examined diabetes distress levels in rural southeastern Ohio. Currently, she is collaborating with the OHIO Game Research and Immersive Design (GRID) Lab to improve healthcare providers’ and health professional students’ cultural self-efficacy, empathy and attitudes towards diabetes using virtual reality simulations.
Executive summary: Despite the increasing use of OMT in musculoskeletal injuries and other pathologies, there are few reports detailing the biochemical and cellular mechanisms of action. Hence, there is a large knowledge gap between bedside and bench. In these studies, we narrowed this gap by Identifying some of the potential biochemical mechanisms altered by myofascial release (MFR) and repetitive motion injury (RMI). In order to effectively examine changes at the cellular level, the Flex Cell system for cell strain was utilized. Although OMT is thought to affect primarily the musculoskeletal system, peripheral nerves abundantly innervate these areas and are critical to the transmission of pain. Therefore, we utilized Dorsal Root Ganglia (DRG) neurons, a model for peripheral sensory neurons, in these studies. DRG neurons were isolated from the rat, and were cultured on a flexible substrate which was then exposed to the forces of strain and stretch to simulate both RMI and MFR. Although no in vitro model can precisely replicate an in vivo system, this model provides a starting point for examining OMT- like forces at the level of the cell, which is difficult to do in vivo.
We found that DRB neurons exposed to a single in vitro MFR procedure had lower levels of basal intracellular free calcium compared to neurons cultured without MFR. Further, in vitro, MFR treated neurons displayed a decreased response to neurotransmitters, had decreased levels on inflammatory mediators, and lower levels of oxidative stress. Further, MFR-exposed DRG neurons had increased levels of filamentous actin, suggesting a stronger cytoskeleton. Taken together, these results suggest that in vitro MFR may result in a neuron that has a stronger cytoskeleton and is less susceptible to conditions that produce pain.
Using the Flex Cell system, we also mimicked RMI. Exposure to in vitro RMI resulted in an increase in basal intracellular free calcium, enhanced responses to neurotransmitters, an increase in inflammatory mediators, and a decline in the filamentous actin cytoskeleton. These changes were mitigated, in part, by delivery of in vitro MFR 24 hours after the RMI.
Taken together, these results suggest that MFR may decrease cellular biochemical effects associated with injury to neurons, providing a biochemical basis for the effects of OMT at the cellular level. Future experiments should pursue the durability of in vitro MFR, and the effects of multiple rounds of MFR after RMI, to provide a clearer picture of the cellular processes associated with OMT and further narrow the gap between bench and bedside.
Head Impact Biomechanics, Concussion and Osteopathic Structural Diagnosis and Treatment
Edward Via College of Osteopathic Medicine
Executive summary: There are an estimated 1.6 to 3.8 million sports-related concussions each year in the United States. As a result of emerging research that links potential long-term neurodegenerative processes to repetitive concussions in sports, we have witnessed an increase in awareness of concussion and an emphasis on better understanding and minimizing the incidence of injury. Between 2001 and 2009, emergency room visits for concussions increased by 62%, likely a result of increased reporting due to more awareness and concern associated with concussions, rather than a rise in injury rate. Injuries that previously would go unreported are now more likely to be diagnosed and treated.
In this study we examined the relationship between head impact biomechanics, the clinical diagnosis of sport-related concussion and the application of osteopathic structural diagnosis and treatment in the clinical management of this complex issue. We conducted a prospective, longitudinal, multi-sport investigation that delineated the typical osteopathic findings in concussion in both men and women participating in varsity collegiate athletics by incorporating a multi-dimensional assessment of standardized clinical measures of post concussive symptomatology, Neuro EEG parameters, performance-based testing, psychological health and osteopathic structural diagnosis and treatment. Additionally, we correlated head and neck impact biomechanics with osteopathic structural evaluation through instrumenting collegiate athletes with accelerometer arrays, allowing us to assess the force and magnitude of head impacts.
Neck pain is a frequent complaint from athletes who have had concussions, and this study has allowed us to further study neck stresses and strains and the effects of osteopathic manipulation on these complaints as well as the typical signs and symptoms related to sports-induced concussions. Comparisons were performed within a contact athlete cohort, and between contact and non-contact cohorts. Once we have completed data analysis, we anticipate developing a larger multi-site study to determine the clinical outcomes related to the use of osteopathic techniques in the diagnosis, treatment, management and prevention of sport related concussion. We strongly feel that the results of this and future studies will influence both the evaluation and treatment of sports-related concussions, and will have a major impact on the future of sports in America.
Effects of Osteopathic Manipulative Treatment on Gait Biomechanics in Parkinson’s Disease | Hollis King, DO, PhD, is a Professor of Family Medicine at UCSD School of medicine, and staff physician in the UC San Diego Health System OMT Service in the Center for Integrative Medicine, and the Osteopathic Center for Children. He is a Past President and Fellow of the American Academy of Osteopathy. He is the author of the chapter on “Osteopathy in the Cranial Field” in the past three editions of Foundations of Osteopathic Medicine. Dr. King is an active PI researcher on the effect of OMT on intraocular pressure lowering, on post-traumatic migraine cephalgia, and on plagiocephaly.
Executive summary: Parkinson’s disease (PD) is a neurological disorder that puts individuals at high risk for injuries and long-term disabilities as a result of a fall or other trauma. Injuries sustained from falls account for many deaths as well as thousands of hospital admissions and nursing home stays every month. Quality of life and even longevity itself is reduced due to the resulting surgeries, immobility, complications and even cognitive impairments that can follow. This study explored the beneficial impact of a treatment modality (OMM/OMT) that may significantly reduce the morbidity of this condition by comparing 6 weeks of OMT versus 6 weeks light touch intervention versus 6 weeks care as usual to improve gait, cognitive function, and psychological factors in individuals with PD. Gait, cognitive and psychological factors were measured at as baseline, post-treatment and 4-week follow-up. In preliminary analyses, cognition was improved and psychological stress and anxiety were reduced.
The Osteopathic Approach to Chronic Pain Management: Assessing its Biopsychosocial Processes and Relationships to Clinical Outcomes | John C. Licciardone, DO, MS, MBA, is a Regents Professor who holds the Osteopathic Heritage Foundation Richards-Cohen Distinguished Chair in Clinical Research at the University of North Texas Health Science Center. He directs the Osteopathic Research Center and its PRECISION Pain Research Registry, which studies precision medicine and biopsychosocial aspects of pain. He is a Co-Investigator in the PACBACK Trial sponsored by National Institutes of Health (NIH) and served on the Work Group that developed NIH’s Federal Pain Research Strategy. Other achievements relative to NIH include: receiving a Midcareer Investigator Award to direct the OSTEOPATHIC Trial and develop expertise in pain genetics, serving as an expert panelist in chronic pain, and completing a term on its National Advisory Council for Complementary and Integrative Health.
Internationally, he served as a consultant to the World Health Organization on regulatory and safety issues relating to osteopathy, gave the keynote address at the Advancing Osteopathy 2008 conference that celebrated recognition of osteopaths in the United Kingdom’s National Health Service (including a reception with His Royal Highness, The Prince of Wales), and has been recognized by Expertscape as the leading worldwide authority on osteopathic manipulation.
Executive summary: Osteopathic philosophy and practices are fundamentally aligned with the biopsychosocial model of health care. This study aimed to determine if the osteopathic approach to chronic pain management differs from that typically encountered within allopathic medicine and to identify which aspects of osteopathic medical care may mediate its clinical outcomes. A historical cohort study was conducted within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION Pain Research Registry). A total of 796 registry participants with chronic low back pain were included in the study to compare osteopathic and allopathic medical care. The clinical outcome measures included a numerical rating scale for low back pain intensity, the Roland-Morris Disability Questionnaire for back-related functioning, and the SPADE cluster of the PROMIS-29 for overall quality of life. Less than one-half of participants treated by osteopathic physicians reported having ever received osteopathic manipulative treatment for their low back pain. However, participants treated by osteopathic physicians reported lesser back-related disability over 6 months (overall mean RMDQ score, 12.9; 95% CI, 11.9-13.9 for participants treated by osteopathic physicians vs. 14.1; 95% CI, 13.5-14.7 for participants treated by allopathic physicians; P=0.04). This significant association persisted following adjustment for age and gender, but not following additional adjustment for potential mediators. Lesser pain catastrophizing (P<0.001) and greater pain self-efficacy (P<0.001) clearly emerged as the strongest predictors of lesser back-related disability, although the use of osteopathic manipulative treatment was also associated with lesser back-related disability (P=0.01). Osteopathic medical care was not associated with significantly better low back pain or quality-of-life outcomes over 6 months. The better back-related functioning outcomes reported by participants with chronic low back pain who were treated by osteopathic physicians appear to be mediated to a much greater extent by psychological factors (i.e., lesser pain catastrophizing and greater pain self-efficacy) that may have been addressed during medical encounters than by the use of osteopathic manipulative treatment. These findings lend further support to the belief that osteopathic physicians provide chronic pain management that aligns with the biopsychosocial model.
Osteopathic Philosophy and Patient Experience of Care Program | Rebecca Malouin, PhD, MPH, MS, is an associate professor in the Department of Family and Community Medicine and also serves as Director of the Global Health Studies Program at Michigan State University. Dr. Malouin is a health services researcher with a specific interest in the experience of care within primary care. She has authored two books, published by the American Academy of Pediatrics, on the measurement of family and patient-centered care within primary care. She has received K01 and R01 funding from the Agency for Healthcare Research and Quality for research on patient-centered primary care and served as an evaluator for several primary care demonstration projects, both federally and privately funded. She has also served on study sections for the Agency for Healthcare Research and Quality, the National Institutes of Health, the Health Resources and Services Administration, the Patient-Centered Outcomes Research Institute, the American Association of University Women International Fellowships, and the governments of Israel and New Zealand. Dr. Malouin served as an epidemiologist in the Michigan Department of Community Health and the Maryland Department of Health and Mental Hygiene, and as a United States Peace Corps volunteer in Niger. Dr. Malouin received her Ph.D. and M.P.H. in international health from the Johns Hopkins Bloomberg School of Public Health. She also completed a M.S. in epidemiology from Michigan State University.
Executive summary: As the United States struggles to control healthcare costs and achieve the quadruple aim, defined as improved patient experience of care, improved physician experience of care, improved quality of care and reduced or controlled costs, identifying successful care models, or components of care models, is increasingly of interest to health systems, payers, employers, and increasingly, patients. The goal of the research study is to assess whether patient experience of care differs between osteopathic and allopathic primary care physicians as reported by patients. The objective of the study is to assess whether differences exist in how patients rate care provided by osteopathic and allopathic physicians. To achieve the objective, investigators conducted a cross-sectional study of patient data collected using the validated Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group Survey. As one of the Centers for Medicare and Medicaid Services (CMS) Multipayer Advanced Primary Care Practice (MAPCP) demonstration sites, the Michigan Primary Care Transformation (MiPCT) is the largest multipayer PCMH initiative in the country with five participating payers. The participating provider base includes 1900 physicians, physician assistants and nurse practitioners in 350 primary care practices statewide. The MiPCT patient population totals over 1.2M patients or 12% of the state’s population. Stratified random sampling was utilized with an oversample of patients with high medical risk. Data were analyzed to assess outcomes related to access, communication, coordination, office staff, provider rating, and a summative score of all domains. The main analysis was conducted by employing the general linear model (CSGLM) procedure with post hoc comparisons to assess differences among osteopathic and allopathic physicians after adjusting for race, educational level, payer group, health risk, practice size, hospital ownership, and geography. Consistent with previous studies, patients of osteopathic physicians reported higher communication scores than patients of allopathic physicians in primary care practices. No other significant differences were identified in patient scores. The project is significant in that it is the first study to identify differences in patient reported experience of care between osteopathic and allopathic physicians using the CAHPS survey, the most widely utilized patient experience of care survey in the United States.
Reducing Inflammation with Osteopathic Treatment (RIOT Study) | Melissa G. Pearce, DO, is an Assistant Professor at Touro University College of Osteopathic Medicine-California (TUC COM). She is a Touro alumnus Board Certified in Family Medicine through the American Osteopathic Board of Family Practice, in Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine through the American Osteopathic Board of Neuromusculoskeletal Medicine, and a Diplomate of the American Board of Integrative and Holistic Medicine. In addition to teaching and clinical responsibilities, she is the Principal Investigator for the Reducing Inflammation with Osteopathic Treatment (RIOT) trial.
The RIOT study is investigating the effect of Osteopathic Manipulative Treatment (OMT) in patients with subclinical inflammation in the setting of diabetes, metabolic syndrome, or obesity. The study follows inflammatory markers over a 4-6 week interval with either standard of care involving research visits with an osteopathic structural exam (OSE) or an OSE with OMT for the treatment arm. Enrollment of more than half of the intended cohort of 40 participants has been completed. Recruitment is currently on hold until research activities at TUC can resume.
Executive summary: Diabetes, obesity and/or metabolic syndrome produce many negative health effects. These include inflammation that may not be obvious but is affecting the body in general, the heart and blood vessels. The Reducing Inflammation with Osteopathic Treatment (RIOT) study investigated whether Osteopathic Manipulative Treatment (OMT) could reduce inflammation and produce better health outcomes. OMT is a hands-on system of diagnosis and treatment used to promote health and treat dysfunction.
Forty-five participants were divided into two groups – those who had a specialized physical exam (osteopathic structural exam) and those who had an exam and were treated with OMT. The study followed inflammation through blood tests four times over a 4–6-week interval. Participants were also evaluated for their perception of quality of life with a survey (SF-36), vital signs and blood tests ordered by their doctor or clinician during routine health care.
Outcomes from the study will be released following journal article publication.
Development of a Serum Biomarker-Based Approach to Monitor Opioid Adherence and Minimize Substance Misuse in Chronic Pain Management | Venkat Venkataraman, MS, PhD, is an Assistant Professor in the Rowan University School of Osteopathic Medicine. There, he is an educator and Principal Investigator in the Department of Cell Biology & Neuroscience with an appointment in the Department of Rehabilitation Medicine, NeuroMusculoskeletal Institute. His research focuses on a mechanistic understanding of and potential biomarkers for neuronal pathology with emphasis on the role calcium signaling.
Executive summary: Chronic pain accounts for significant direct and indirect healthcare costs and reduces the quality of life as well as overall productivity. It also accounts for more than half of deaths due to opioid used disorder (OUD). An objective approach to monitor opioid prescriptions in pain patients is a much-needed help to physicians and providers in caring for pain patients. This study investigated the feasibility of developing a biomarker-based approach to treat chronic pain, with a special emphasis on opioid adherence and minimizing substance misuse. Outpatients with a diagnosis of Fibromyalgia (and chronic pain) from the NeuroMusculoskeletal Institute were recruited for the study and were followed over two years with data collection at baseline, 6 and 12 months. Several clinical covariates and serum profiles were determined at these points. Significantly, multiple measures of pain were incorporated. The findings demonstrate that such a holistic approach is likely to yield rich dividends. The results have emphasized the relationship between pain and sleep loss, among other findings. Despite a varied population of Fibromyalgia – a disease for which no cause or cure is currently known – the observations are applicable to patients with chronic pain. The studies have also highlighted the calcium binding protein, S100B and its potential link to these pathways at the mechanistic level. Towards learning, many graduate and medical students have participated in various aspects of the project; it has also strengthened the collaborative approach to patient treatment and education. On a larger scale, the study also validates a holistic, patient-centered approach to pain management guided by the tenets of Osteopathic Medicine.
The Effect of OMT on Functional Outcomes and Anti-inflammatory Biomarkers in Mild- to Moderate Traumatic Brain Injury | Rebecca Wyatt, DO, completed an undergraduate degree at Central Michigan University with a Bachelor of Science in Athletic Training/Sports Medicine in 2004. She graduated with a degree at Michigan State University College of Osteopathic Medicine in 2008. She completed her traditional rotating internship at MetroHealth Hospital in Grand Rapids Michigan in 2009. She completed her residency at Michigan State University in Physical Medicine and Rehabilitation from 2009-2012. Dr. Wyatt currently works at Michigan State University in the Department of Physical Medicine and Rehabilitation as an Assistant Professor. She serves as teacher and trainer for PMR at Michigan State University College of Osteopathic Medicine and is familiar with the testing population. She is the Medical Director at the Origami Traumatic Brain Injury Rehabilitation Center as well as the Sparrow Specialty Hospital, Medilodge of Okemos, Willows of Okemos and the MSU MDA clinic.
Executive summary: The impact of our proposed research lies in our attempt to establish a foundation for the basis of using OMT procedures to accelerate recovery of patients following mild to moderate brain injury and to find correlations between cognitive functions, biochemical markers and self-reported assessments of quality of life. The subjects for our study were recruited with the following criteria: diagnosis of mild to moderate traumatic brain injury with chief complaint of headache and/or dizziness. The subjects were randomized into one of three groups. The Treatment Group received weekly Osteopathic Structural Exam (OSE) before and after OMT in addition to the standard rehabilitation program. The patients in Control Group A (sham) received rehabilitation as well as weekly OSE and sham (not OMT) protocol, thereby controlling for the effect of touch. The patients in Control Group B (Physical Therapy) went through the standard rehabilitation program and did not receive either OMT or sham. We tested the following five OMT procedures as a set: (i) thoracic spine soft tissue (~5 min); (ii) cervical spine soft tissue (~3 min); (iii) subocciptal release (~2 min); (iv) occipital condyle condylar decompression (~2 min); and (v) cranial venous sinus release (~5 min). This set of five will was performed in sequence (total 15-20 min). These OMT procedures were administered by DO physicians in practice trained in this study’s OMT procedures. The outcome measures were reassessed during Week 6 and Week 12. These outcome measures included vestibular function tests such as stability, balance, gait as well as questionnaires on headache, dizziness, and quality-of-life. In total, 29 patients sustaining a traumatic brain injury were enrolled. The OMT Group showed more improvement in only two of the nine functional tests (the VOMS Horizontal VOR and VOMS Vertical VOR scores), comparing week 12 to week zero. This OMT Group performed the worst in six other tests. The Sham Group showed greatest improvement in one test (Headache Impact survey) and worst improvement in six tests. The Physical Therapy Group, showed greatest improvement in six tests and worst in two. The number of subjects in each group is simply too small to derive statistically significant results.
2016 Recipients
Patient Experience of Osteopathic Physician Distinction and Empathy | Walter Hartwig, PhD, is an Associate Dean of Academic Affairs at Touro University College of Osteopathic Medicine in Vallejo, CA. He joined TUCOM at its inception in 1997 and has served in the roles of a faculty member (ongoing), Department Chair of Basic Sciences (2003-2009), Assistant Dean of Clinical Education (2010-2013), and Associate Dean of Academic Affairs (2013 – present). He served as Chair of Admissions from 2012-2017. He has published three books in research (The Primate Fossil Record, Cambridge University Press, 2002), teaching (Fundamental Anatomy, Lippincott, Williams and Wilkins, 2007) and service (Med School Rx: Getting In, Getting Through, and Getting On With Doctoring, Kaplan, 2009, 2011). His research interests include physical anthropology, pedagogy and the history of science.
Executive summary: Our study examined whether patients perceive their physicians as empathetic and whether this perception is aligned with an osteopathic approach to patient care. Patient perceptions of empathy and expressions of satisfaction were measured with regard to physician behaviors that are “osteopathic” by reference to the four tenets of osteopathic principles and philosophy. Prior research has indicated that distinct aspects of osteopathic care include demonstrations of empathy and positive interpersonal and communication skills. While empathy has been studied from the physician and student perspective, it has not been studied directly in terms of how patients perceive it during an interaction with their physician. The results of this study indicate that patients are more likely to perceive their physicians as empathetic based on the degree to which their physicians treat them within an osteopathic paradigm. Patients in this study responded more positively to their interactions with physicians if the physicians adhered to osteopathic tenets.
Effects of Osteopathic Manipulation on Gait Kinematics and Postural Control in Parkinson Disease | Kendi Hensel, DO, PhD, received her DO from Oklahoma State University College of Osteopathic Medicine. After completing a traditional rotating internship, she moved to the University of New England in Biddeford, Maine, and was one of the first graduates from a combined Family Practice and Neuromusculoskeletal Medicine residency. She returned to her native Texas in 2004 to join the faculty of the Texas College of Osteopathic Medicine (TCOM) at the University of North Texas Health Science Center. She has been an investigator and treatment provider on several OMM research studies. In 2006, she became the first DO to receive a K23 Award from the NIH-NCCIH. This project studied the effects of OMM on pregnant women. She received her PhD in OMM Clinical Research and Education in 2009 from UNTHSC-Graduate School of Biomedical Sciences. She served as the 2019-2020 President of the American Academy of Osteopathy, and served for six years as a Section Editor of the Journal of Osteopathic Medicine. She is currently involved in clinical, educational and research activities at TCOM and in national efforts to improve the evidence base and utilization of OMM. Her research interests include mechanistic and clinical effectiveness studies of OMM.
Executive summary: This study has been completed, and all study aims were met. One resident and one graduate student have used the data to craft posters that were submitted to the AAO-LBORC research poster competition, and one won. The graduate student wrote his thesis on the data and a manuscript is in progress, and will be submitted to the JOM in 2021.
Introduction/background — Tens of thousands of people are diagnosed with Parkinson’s disease (PD) each year, making it the second most common neurodegenerative disorder. PD results in a variety of gait disturbances that increase the fall risk of those afflicted. The overarching goal for this project is to examine the efficacy of Osteopathic Manipulative Treatment (OMT) and Osteopathic Cranial Manipulative Medicine (OCMM) in improving Parkinsonian gait.
Objective — The purpose of this study was to compare joint range of motion (ROM) and joint angle waveforms before and after OMT to determine the effects of OMT and OCMM on Parkinsonian gait, as well as to compare the relative effects of each treatment protocol. We hypothesized that the application of a single OMT protocol on adults with PD will acutely increase joint ROM, and the addition of OCMM to the OMT treatment protocol will further improve gait kinematics.
Methods — An 18-camera motion analysis system was used in conjunction with 54 reflective markers on the body to capture three-dimensional position data in a short treadmill walking trial before and after the application of a whole-body (OMT-WB), neck-down (OMT-ND), or sham OMT protocol. Ankle, knee, and hip joint ROM and waveforms in the sagittal plane during the gait cycle were compared before and after treatment, and across experimental groups.
Results — No significant differences were found in baseline ROM and joint angle waveforms of the hip, knee and ankle joints across experimental groups, or in post-treatment joint waveforms across experimental groups. Knee ROM increased significantly following OMT-ND and OMT-WB protocols (p=0.018, p=0.032). Waveform analysis revealed no significant differences at the hip, knee, or ankle joints.
Discussion/conclusion — Comparison of baseline measurements validates participant randomization and an increase in sagittal knee ROM in individuals with PD following OMT and OCMM may have important implications for decreasing potential fall risk. However, waveform analysis shows no significant change in gait pattern as evidenced by sagittal joint angles following OMT-WB, OMT-ND or SHAM treatments.
Osteopathic Clinical Care: A Multi-Level Analysis |
Lori Kemper, DO, MS, FACOFP, is Dean of Midwestern University, Arizona College of Osteopathic Medicine, and is a family physician at the MWU Multispecialty Clinic. Previously, she held the positions of Family Practice Program Director and Director of Medical Education at the Tempe St. Luke’s Hospital Family Practice Residency Program. She has served as dean of the Arizona College of Osteopathic Medicine at Midwestern University since 2007 and continues to practice family medicine a half-day per week at the Midwestern University Multispecialty Clinic.
Executive summary: This project, a partnership between Midwestern University Arizona College of Osteopathic Medicine and Arizona State University Center for Health Information and Research (CHiR) uses a large database of information relating to medical care delivered to patients in Maricopa County, Arizona by DOs and MDs to compare the quality of care provided. It demonstrates that differences in training between DOs and MDs do not result in meaningful differences in care.
Prognosis ATSU-SOMA Choosing Wisely – Antibiotics | Joy H. Lewis, DO, PhD, FACP, is a Professor of Public Health and Internal Medicine at A.T. Still University, School of Osteopathic Medicine in Arizona (ATSU SOMA), where she chairs the Department of Public Health and directs the National Center for Community Health Research. She is the Director of SOMA’s DO/MPH Program and Course Director for OMSII Epidemiology, Biostatistics and Preventive Medicine courses. Dr. Lewis conducts community-based applied research in her areas of interest: social determinants of health, patient safety and preventive medicine. She also focuses on research related to technology-enhanced active learning and inter-professional education. Her work in Community Oriented Primary Care (COPC) combines Public Health and Primary Care. She has mentored Students and Residents on over 100 COPC projects. Dr. Lewis is the PI representing SOMA as part of the AMA Accelerating Change in Medical Education Consortium. She is the Principal Investigator for an approximately $2 million dollar 5-year Primary Care Training Enhancement grant from the Health Resources and Services Administration (HRSA). She is also a member of the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC), which provides independent guidance and expert advice to the Centers for Medicare and Medicaid Services on specific clinical topics.
Executive summary: Researchers at ATSU-SOMA worked with Medical Joyworks to develop, disseminate, and evaluate the use of a novel mobile game application entitled “Prognosis ATSU SOMA Choosing Wisely – Antibiotics.” This was widely disseminated. Over 1,200 people utilized the app and completed at least one of the cases presented. The app was well received with the vast majority of physicians and students reporting that they felt that games such as the ones presented were helpful for them to gain knowledge related to overused treatments and procedures in general and about antibiotic stewardship specifically. Further, the majority of those who completed the evaluation felt the use of these games could improve their clinical practice, could improve the clinical practice of others, and they would like to use this platform to learn about other topics.
The Osteopathic Difference in Treating Patients with Low Back Pain |
John C. Licciardone, DO, MS, MBA, is a Regents Professor who holds the Osteopathic Heritage Foundation Richards-Cohen Distinguished Chair in Clinical Research at the University of North Texas Health Science Center. He directs the Osteopathic Research Center and its PRECISION Pain Research Registry, which studies precision medicine and biopsychosocial aspects of pain. He is a Co-Investigator in the PACBACK Trial sponsored by National Institutes of Health (NIH) and served on the Work Group that developed NIH’s Federal Pain Research Strategy. Other achievements relative to NIH include: receiving a Midcareer Investigator Award to direct the OSTEOPATHIC Trial and develop expertise in pain genetics, serving as an expert panelist in chronic pain, and completing a term on its National Advisory Council for Complementary and Integrative Health.
Internationally, he served as a consultant to the World Health Organization on regulatory and safety issues relating to osteopathy, gave the keynote address at the Advancing Osteopathy 2008 conference that celebrated recognition of osteopaths in the United Kingdom’s National Health Service (including a reception with His Royal Highness, The Prince of Wales), and has been recognized by Expertscape as the leading worldwide authority on osteopathic manipulation.
Executive summary: This study compared perceptions of the interpersonal manner, empathy, and communication style of osteopathic physicians and allopathic physicians reported by their patients, and their clinical status and outcomes over 6 months of treatment for low back pain. A total of 313 patients in the Pain Registry for Epidemiological, Clinical, and Intervention Studies and Innovation (PRECISION Pain Research Registry) within the Osteopathic Research Center at the University of North Texas Health Science Center participated in the study from April 2016 through December 2018. Patients treated by osteopathic physicians reported more favorable perceptions of their physicians relating to interpersonal manner and empathy than did patients treated by allopathic physicians. Patients treated by osteopathic physicians also reported significantly lesser pain catastrophizing and greater pain self-efficacy than patients treated by allopathic physicians. Also, patients treated by osteopathic physicians reported lesser low back pain intensity and lesser back-related disability over 6 months. However, physician interpersonal manner, empathy, and communication style did not contribute significantly to the benefits of osteopathic medical care for low back pain. Osteopathic manipulative treatment contributed significantly to the benefits of osteopathic medical care relating to low back pain intensity and back-related functioning.
Identifying Risk Factors Associated with Declining Emotional Quotient (EQ) Traits During DO Training | Natalie A. Nevins, DO, MSHPE, serves as the Assistant Dean of Clinical Education at Western University of Health Sciences/College of Osteopathic Medicine of the Pacific. She is Board Certified in Family Medicine, Neuromusculoskeletal Medicine, and Osteopathic Manipulative Medicine. She holds a Masters Degree in Health Professions Education and is a Clinical Associate Professor of Family Medicine and Clinical Professor of Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine at Western University of Health Sciences, College of Osteopathic Medicine of the Pacific. She also serves as the Medical Director for the Amrit Davaa Wellness Center in West Hollywood, CA, where she maintains her private practice in NMM/OMM. Dr. Nevins is currently a Lieutenant Colonel in the US Army Reserve serving as the Command Flight Surgeon for the Army Reserve Aviation Command.
Executive summary: Emotional Intelligence (EI) encompasses psychosocial capacities for self-regulation. Lower EI is linked to physician burnout, which can manifest as depression, anxiety, reduced empathy, poor outcomes, and suicide. Studies suggest burnout may take root in medical school. At Western University of Health Sciences’ College of Osteopathic Medicine of the Pacific (WesternU/COMP), DO student EI trends were studied to identify risk factors. Students in DO 2014-18 were given the EQ-i online inventory, which measures 5 domains and 15 subscales. It was offered at 3 junctures: incoming, midway, and graduation. Early analyses from students in DO 2014-2016 who took all surveys showed downward trends with significant drops in Empathy and Self-Regard in the first two years. With AOA grant support, data collection continued with interest in confirming these trends. Changes took place to the curriculum impacting DO 2017-18 which served as an intervention. The main impetus was the incorporation of self-directed adult learning models to increase student responsibility for their own professional development. Results for DO 2017-18 demonstrated a new trajectory. Overall, EI, Empathy, and Self-Regard were non-significant from baseline to midway, then all increased significantly by graduation. With DO 2014-2018 combined, a distinctive downward-upward trend was revealed, with Overall EI, Empathy, and Self-Regard falling significantly, then rebounding significantly by graduation. Independence was particularly influential. DO trends were compared to findings from other health profession colleges at WesternU to include Dentistry, Podiatry, Optometry, Graduate Nursing, and Physical Therapy. Only DOs exhibited the downward-upward trend with the exception of Podiatry, which had a downward trend in their first 2 years having shared 83.5% of their curriculum with COMP. This suggests that DO students may go through a unique process of professional identity formation that involves deep levels of self-examination. While this may be desirable given their future responsibilities, if not properly addressed, it could create vulnerability. Findings further suggest that the curriculum may be influential. The prominence of Self-Regard, Empathy, and Independence suggests that self-compassion and physician autonomy may be worth investigation. Inter-institutional research is needed to determine if results reflect trends in the broader population.
Use of Osteopathic Principles for Nonpharmacologic, Therapeutic Interventions in Obese Women with Polycystic Ovary Syndrome | Diana L. Speelman, PhD, is an Associate Professor of Biochemistry and Director of Research for the College of Medicine at Lake Erie College of Osteopathic Medicine in Pennsylvania. She earned her Ph.D. in Medical Biochemistry from the University of Maryland. Her research interests are in endocrinology and metabolism, including adipose tissue dysfunction in obesity, metabolic dysfunction in polycystic ovary syndrome (PCOS), and nonpharmacologic therapies for women with PCOS.
Executive summary: Polycystic ovary syndrome (PCOS) is the most common hormone disorder in women of reproductive age, and it affects reproductive, cardiometabolic, and psychological health. Women with PCOS have elevated androgen levels, irregular and unpredictable menstrual cycle length, and have an elevated risk for developing obesity, insulin resistance, type 2 diabetes, cardiovascular disorders, anxiety, and depression. Acne and hirsutism are common, as is subfertility and greater risk of miscarriage. Women with PCOS also tend to exhibit hyperactivity of the sympathetic nervous system, which may exacerbate symptoms associated with the disorder. In this study, we investigated the use of non-pharmacological methods (3 months of either weekly osteopathic manipulative treatment or thrice-weekly yoga) to treat women with PCOS. Our findings can be summarized as follows: (1) Osteopathic structural assessment was able to identify increased sympathetic tone in women with PCOS, correlating with physiologic measures of sympathetic hyperactivity. Routine use of osteopathic assessment may help physicians quickly identify increased sympathetic tone in women with PCOS, and perhaps before physiologic signs manifest. (2) Weekly osteopathic manipulative treatment (OMT), including manipulation of Chapman points and rib-raising, improved some measures of sympathetic tone in women with PCOS (heart rate recovery and blood pressure post-exercise). (3) Thrice weekly yoga practice improved free testosterone and DHEA levels in women with PCOS, as well as anxiety and depression scores. Some participants also reported improved menstrual cyclicity and less acne. Together, these findings suggest that non-pharmacological treatment modalities may complement current treatment options for women with PCOS. Weekly OMT may improve some aspects of sympathetic tone, whereas regular yoga practice may help to improve some of the reproductive (menstrual cycle length), hormonal (androgen levels), and psychological (anxiety and depression) aspects of PCOS.
Lymphatic Pump Treatment of Inflammation in Rat-Adjuvant-Induced Arthritis | Michael V. Volin earned his Ph.D. in Pathology from The University of Chicago in 1996, followed by a post-doctoral fellowship at the Feinberg School of Medicine at Northwestern University until 2000. He then became a faculty member at the Illinois College of Optometry. In 2004 he moved to Midwestern University, where his research laboratory studies potential mediators and therapies of rheumatoid arthritis, and he teaches immunology and infectious disease to multiple graduate and medical professional programs. In 2011 he was appointed as Chair of the Microbiology and Immunology Department and in 2012, he was promoted to Professor. He is a member of The American Association of Immunology, The American College of Rheumatology, The American Society for Investigative Pathology, and The Association of Medical School Microbiology and Immunology Chairs. He was awarded funding from the National Institutes of Health for his work studying mediators of arthritis and The American Osteopathic Association for his work studying osteopathic manipulative therapy in rat models of arthritis. He has published over 50 articles and has been an invited speaker at national conferences.
Executive summary: Rheumatoid arthritis (RA) is an immune-inflammatory disorder characterized by chronic inflammation. Rat adjuvant-induced arthritis (AIA) is a rodent model of RA that is well characterized to have many similarities with human RA along with dysfunctional lymphatics and aberrant cell-mediated immunity. Previous studies using rat AIA have demonstrated that an increase in circulation of T regulatory lymphocytes (Tregs) can decrease clinical parameters of arthritis. Preliminary studies suggest that the lymphatic pump technique (LPT) can successfully be applied to rats to increase lymph flow, decrease joint swelling, and inflammatory mediators. In this report, we show that lymphatic pump treatment administered prophylactically before the appearance of inflammation or arthritis in AIA rats results in decreased development of ankle swelling and other clinical symptoms of arthritis. Additionally, in this report, we show that lymphatic pump treatment of AIA rats with developing arthritis have reduced joint swelling and other clinical symptoms of arthritis. We show that the reduced clinical signs of inflammation seen in the preventative LPT animals were accompanied by a reduction of peripheral blood lymphocytes. Alternatively, in the animals that had established arthritis, LPT resulted in a significant increase in peripheral blood lymphocytes, including Tregs. This increase may be the result of freeing up the lymphocytes sequestered in the inflamed joints. Finally, ankle joint tissue from rats treated with LPT after the establishment of arthritis showed an increase in both the size and number of lymphatic vessels, however, there was no change in the expression of the primary lymphatic vessel growth factor VEGFc. In conclusion, this study shows that LPT of rats with AIA results in changes in the animals consistent with enhanced lymphatic function resulting in normalization of lymphatic flow allowing for either a reduction of the development of arthritis when given prophylactically or an increase in circulating lymphocytes, including Tregs, resulting in decreased clinical parameters of arthritis when given therapeutically.
Effect of Osteopathic Manipulation on Balance Function, and Biomarkers in Parkinson’s Disease | Sheldon Yao, DO, is professor and chair of the Osteopathic Manipulative Medicine (OMM) department at The New York Institute of Technology -College of Osteopathic Medicine (NYIT-COM). He directs the NYIT – Center of OMM which conducts medical education and research focused on OMM. Dr. Yao is the principle investigator in several research studies investigating the effects of OMM on neurology disorders including Parkinson’s disease and sports related concussions.
Executive summary: Parkinson’s disease is a long term neurodegenerative disorder that effects nerve cells in the brain that produce dopamine. The disease mostly effects motor function, which can result in stiffness, muscle rigidity, changes in gait and posture, and tremor. Parkinson’s disease has a considerable effect on the quality of life that progresses along with disease manifestation. Osteopathic Manipulative Treatment (OMT) is a hands-on approach that engages the patient’s musculoskeletal system to decrease muscle tension and improve joint range of motion. An OMT protocol was utilized to treat Parkinson’s disease subjects twice a week for six weeks to decrease muscle spasms and joint restrictions in the spine and extremities. Measurements for improvement in motor function and balance were performed. The OMT group was compared to a control group that received counseling on Parkinson’s disease topic without any hands-on manipulation but received the same doctor-patient interaction time as the OMT subjects.
Falls and immobility are the most common leading causes of decreased quality of life with Parkinson’s disease. The OMT group and the control group did not demonstrate any statistically significant differences when comparing the standardized measurements for balance and motor function, but the OMT group demonstrated an average 17.2 point improvement on the quality of life questionnaire (PDQ-39) compared to 9.2 point improvement in the counseling group. PD subjects reported that the improvement in the quality of life was related to their increase in mobility and ability to perform tasks on their own. OMT was thus shown to potentially allow for a better quality of life in PD subjects.
We also investigated different biomarkers levels in our subjects that could help to explain the mechanism of action of manual treatment in Parkinson’s disease. Research has shown that Parkinson’s disease is commonly associated with an increase in inflammation and oxidative stress. High levels of oxidative stress, especially over a prolonged time, can lead to further problems with muscle and neural function. In addition to decreasing musculoskeletal restrictions, osteopathic manipulative treatment (OMT) can also improve circulation of fluids to reduce inflammation in individuals with PD. Our pilot data demonstrated changes to biomarker levels acutely but over a 6 week period, the pilot data has not shown any statistical significance. The investigators are continuing the study by recruiting and running additional subjects and further analyzing the data taking into account different cofounding variables.
*Completed an AOA Research Project