Happy National Osteopathic Medicine Week! JOIN THE CELEBRATION
Get to know the projects and researchers whose work has earned AOA funding.
The AOA has funded 47 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 two designated focus areas:
Grant periods range from 6 to 18 months. Recipients are strongly encouraged to submit their research for publication in The Journal of the American Osteopathic Association.
2020 Research Grant Recipients
The Effect of Osteopathic Manipulative Interventions on Opioid Use in Patients with Acute Pancreatitis | Dr. Abalos 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 | Dr. Bills 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 | Dr. Jacek Cholewicki 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) | Dr. Jefferson 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) | Dr. Belsky 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.
The Effect of Facial Effleurage on Complement C3 in Patients with Acute Rhinosinusitis | Student Doctor Burke is a second-year osteopathic medical student at the Edward Via College of Osteopathic Medicine–Carolinas Campus, where he is working with Jillian Bradley, PhD, as an osteopathic student researcher on her project “The Effect of Facial Effleurage on Acute Rhinosinusitis.” Special funding for this project was provided by the Dale Dodson Educational Fund.
Clearance of Brain Metabolic Waste in a Natural Animal Model of Alzheimer’s Disease by Cranial Osteopathic Manipulation | Dr. Costa 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.
Umbilical and Amniotic Fluid Stem Cell Injections for the Management of Chronic Spine Facet Pain | Dr. Defendorf is an Internal Medicine resident physician at Bluefield Regional Medical Center and a graduate of Rowan University School of Osteopathic Medicine. During medical school, he pursued research interests including a double-blinded study to investigate osteopathic pedal pump efficacy for leg edema. Special funding for this project was provided by the Dale Dodson Educational Fund.
Effects of OMT on Biomarkers and Substance Abuse Treatment Outcomes in Patients with Chronic Pain and Opioid Abuse | Dr. Ford is a Clinical Assistant Professor at Oklahoma State University Center for Health Sciences in the Department of Psychiatry & Behavioral Sciences. Her clinical and research interests include the cognitive effects of medical and psychiatric disorders and cognitive improvement interventions for persons with substance abuse disorders.
Determining the Effect of Biological Sex and Therapy on Diet-Induced Alterations in Liver and Kidney Health in Mice | Dr. Gigliotti 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.
Predictors of Stress, Anxiety, and Depression in Female Osteopathic Medical Students: A Prospective Cohort Study | Dr. Krishnamachari 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.
Osteopathic Manipulative Treatment vs. Standard Therapy in the Management of Acute Neck and Low Back Pain in the Emergency Department | Dr. LaPietra 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.
Optimizing Chronic Pain Management through Patient Engagement with Quality of Life Measures: A Randomized Controlled Trial | Dr. Licciardone 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.
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.
Biochemical Effects of Osteopathic Manipulation on Neuronal Function and Survival | Dr. Rzigalinski 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.
Anti-Inflammatory Actions of OMT – Role of the Cholinergic Anti-Inflammatory Reflex and Translocation of Immune Cells from Reticular Organs to the Systemic Circulation | Dr. Stauss 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.
Leveling the Playing Field: Evaluating How Prerequisite Classes Affects Perceived Stress Levels in Medical Students | Dr. Ackert 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.
Role of LPT in wound healing of colitis
Edward Via of College of Osteopathic Medicine
Meditation, Alignment with the Osteopathic Philosophy and Empathy in Osteopathic Medical Students: A Randomized Controlled Interventional Trial | Dr. Balentine 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 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.
The Effect of Facial Effleurage on Acute Rhinosinusitis
Edward Via College of Osteopathic Medicine – Carolinas Campus
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
Effect of Palpatory Neuromodulation of the Trigeminal Nerve for Tenderness in the Posterior Neck Musculature
University of North Texas Health Science Center/Texas COM
The Effects of Lymphatic Pump Treatment on The Immune Response During Acute Pneumonia | Lisa Hodge, Ph.D., 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.
Oral Fluid Pain Biomarkers as Objective Measures of OMT Outcomes for Cervicogenic Headache (CGH)
Prospective, Multicenter, Cohort Study of the Cost Effectiveness of Osteopathic Manipulative Treatment for Chronic Low Back Pain
Rowan School of Osteopathic Medicine
Effects of OMT on Return to Play Post Concussion | Dr. Posey 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
Achieving a High Level of Wellness by Focusing on the Impact of Diabetes Distress in Rural Appalachia | Elizabeth A. Beverly, Ph.D., 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, D.O., 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.
Head Impact Biomechanics, Concussion and Osteopathic Structural Diagnosis, and Treatment
Edward Via College of Osteopathic Medicine
Effects of Osteopathic Manipulative Treatment on Gait Biomechanics in Parkinson’s Disease | Dr. King 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 | Dr. Licciardone 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
Michigan State University
Reducing Inflammation with Osteopathic Treatment (RIOT Study) | Dr. Pearce 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.
Development of a Serum Biomarker-Based Approach to Monitor Opioid Adherence and Minimize Substance Misuse in Chronic Pain Management | Dr. Venkat Venkataraman 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.
The Effect of OMT on Functional Outcomes and Anti-inflammatory Biomarkers in Mild- to Moderate Traumatic Brain Injury | Dr. Rebecca Wyatt 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.
Use of the Lymphatic Pump Technique as a Novel Therapy for Inflammatory Bowel Disease (IBD)
Edward Via College of Osteopathic Medicine
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
University of North Texas Health Science Center Texas College of Osteopathic Medicine
Osteopathic Clinical Care: A Multi-Level Analysis |
Dr. Kemper 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 | Dr. Lewis 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 |
Dr. Licciardone 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 | Dr. Nevins 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 | Dr. Speelman 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 | Dr. 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 | Dr. Sheldon Yao 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