Get to know the projects and researchers whose work has earned AOA funding.
The AOA has funded 52 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 6 to 18 months. Recipients are strongly encouraged to submit their research for publication in The Journal of Osteopathic Medicine.
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, 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, 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 for six years as a Section Editor of the Journal of the American Osteopathic Association. 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.
Effect of Osteopathic Manipulative Treatment for Acute Post-Craniotomy Pain after Acoustic Neuroma Resection | Alice I. Chen, DO, is a board-certified Osteopathic Neuromusculoskeletal Medicine (ONMM) specialist. She is currently an Assistant Clinical Professor in the Department of Family Medicine at UC San Diego Health. She is also the current Medical Director of Osteopathic Manipulative Medicine (OMM) and the founder of UC San Diego Health’s inpatient OMM consultation service. She teaches osteopathic medicine to medical students, residents and fellows at UC San Diego School of Medicine. Her research interests include using OMM and osteopathic manipulative treatment (OMT) in the hospital setting. Dr. Chen completed her residency in neuromusculoskeletal medicine and osteopathic manipulative medicine (NMM/OMM) at St. Barnabas Hospital Health System in the Bronx, New York. She earned her osteopathic medical degree from A.T. Still University—School of Osteopathic Medicine in Arizona, where she completed an additional year-long teaching fellowship in anatomy and osteopathic principles and practice.
2021 Research Grant Recipients
Lymphatic Osteopathic Manipulative Medicine to Enhance COVID-19 Vaccination Efficacy | Dr. Defendorf is an Internal Medicine physician at The Rowan Medicine Department of Internal Medicine in Stratford, NJ. He completed his residency at Bluefield Regional Medical Center in Bluefield, WV, and is a graduate of Rowan University School of Osteopathic Medicine in Stratford, NJ. Dr. Defendorf pursued research interests during medical school, including a double-blinded study to investigate “Osteopathic Pedal Pump Technique Efficacy For Leg Edema Patients.” The trend of focusing on clinical research continued during residency training investigating “Umbilical and Amniotic Fluid Stem Cell Injections for the Management of Chronic Spine Facet Pain.” A 2019 AOA Physician-In-Training grant funded this research. Dr. Defendorf looks forward to continuing clinical research focused on clinical applications of the osteopathic approach to resolve current health issues facing our community.
Osteopathic vs. Allopathic Physician Opioid Prescribing for Chronic Pain: A Longitudinal Study of Long-Term Outcomes and the Role of Osteopathic Manipulative Treatment | Dr. Licciardone’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 Royal Highness, The Prince of Wales. 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.
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 | Dr. Nicodemus 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) Dr. Perry 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 | 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.
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.
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.
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 | 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.
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 | 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 Program | Dr. Rebecca Malouin 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) | 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.
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 | 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.
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 | 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