Open Access Published by De Gruyter

Volume 124 Issue 1

January 2024

Issue of Journal of Osteopathic Medicine

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Publicly Available January 4, 2024

Frontmatter

Page range: i-iii

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Editorial

Open Access October 6, 2023

The role of osteopathic principles and practice in upper extremity injuries of the overhead athlete

Arthur Jason De Luigi

Page range: 1-4

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General

Original Article

Open Access August 15, 2023

Delayed discovery: the COVID-19 pandemic’s influence on osteoarthritis clinical trials

Nicholas B. Sajjadi, Jon Michael Anderson, Griffin K. Hughes, Christena E. Abraham, Jamal Malik, Micah Hartwell, Matt Vassar

Page range: 5-11

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Abstract

Context The COVID-19 pandemic disrupted clinical research in many medical and surgical fields, resulting in research waste and loss of treatment for patients. Although other areas have been explored, the extent of the pandemic’s influence on osteoarthritis (OA) trials is currently unknown. Objectives This study aims to explore the reasons for termination of clinical trials investigating OA during the COVID-19 pandemic. Methods We searched ClinicalTrials.gov for OA trials and characterized their reason for discontinuation, noting where trialists directly cited the COVID-19 pandemic as the reason for trial discontinuation. We also coded other common reasons for trial discontinuation. Descriptive and inferential statistics were performed to determine the difference in enrollment, funding source, trial phase, allocation, and intervention type between the trials terminated early due to pandemic and nonpandemic reasons. Results Out of 135 clinical trials, 119 were included and 27 (22.7 %) of them reported the COVID-19 pandemic as a primary reason for discontinuation, which was the overall most common reason for OA trial discontinuation during the study period. We found statistically significant differences for trials discontinued due to pandemic vs. non–pandemic-related reasons, with trials having sites outside the United States, randomized allocation, and drug or device intervention type being most affected. However, there was no statistically significant difference between groups regarding trial phase, funding source, or enrollment. Conclusions This study highlights the impact of the COVID-19 pandemic on the clinical trials related to OA. We found that many trials reported discontinuation directly due to the pandemic, which may lead to the loss or delay of novel treatments for OA. To avoid such discontinuation in the future, alternative methods for conducting OA-related clinical trials should be explored and implemented.

Medical Education

Original Article

Open Access September 13, 2023

Cognitive empathy of osteopathic students: a longitudinal study with data comparisons to the Project in Osteopathic Medical Education and Empathy (POMEE)

Bruce W. Newton, Zachary T. Vaskalis

Page range: 13-20

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Abstract

Context Establishing an empathic bond of trust with patients is a characteristic that physicians need, because patients feel that physicians are more caring if they sense that they are empathetic. Former cross-sectional studies have shown an erosion of cognitive empathy as medical students progress through their education. Objectives This study aims to measure the changes in student cognitive empathy as they progress through their undergraduate osteopathic medical education. Cognitive empathy scores are compared to the nationwide norms established by the Project in Osteopathic Medical Education and Empathy (POMEE) study by Mohammadreza Hojat, PhD, and colleagues. Methods During orientation to medical school, and at the beginning of each subsequent academic year, and just before graduation, the graduating classes of 2017–2019 participated in this longitudinal study by filling out the Jefferson Scale of Empathy-Student Version (JSE-S). A total of 345/459 Osteopathic Medical Student (OMS) I-IV students (75.2 % of the graduates) filled out the forms for all five time points. Desired specialty choice and sex were also collected. Specialty choice was divided into Core and Non-Core groups. Core specialties are “people-oriented” and have a large amount of patient contact and continuity of care, while Non-Core specialties are “technical- or procedure-oriented” and have little or no patient contact and/or continuity of care. Results Men selecting Non-Core specialties had significant drops in JSE-S scores (p=0.001); whereas men who selected the Core specialties did not have a significant decrease. For women, there was no significant drop in JSE-S scores for those selecting either Core or Non-Core specialties. When compared to POMEE norm data, none of the Campbell University School of Medicine students had JSE-S scores that were above the 50th percentile. Conclusions Students selecting Core specialties do a better job of maintaining their cognitive empathy, which aids their ability to establish an empathic bond of trust with patients, when compared to students who desire Non-Core specialties. JSE-S scores not above the POMEE 50th percentile is concerning and indicate either a curricular change to better enhance empathic communication skills and/or better applicant selection.

Musculoskeletal Medicine and Pain

Original Articles

Open Access July 28, 2023

Retrospective analysis of robotic unicompartmental and total knee arthroplasties: patient demographics and outcomes

Alyssa M. Kendrick, Jill M. Carter, Nathan Gregg, Sarah C. MacNeill, Mark E. Gittins

Page range: 21-25

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Abstract

Context With the growing number of robotic knee arthroplasties being performed, new outcomes must be analyzed to provide a database for comparing robotic and nonrobotic surgeries. These results can be utilized in the future to properly assess the significance of utilizing robotic technology in the operating room regarding patient outcomes and cost. Objectives The aims of this study are to: (1) analyze adverse outcomes from robotic-assisted knee arthroplasty and its relation to sex, body mass index (BMI), and age; and (2) explore any possible differences in outcomes among robotic-assisted unicompartmental knee arthroplasty (UKA) and robotic-assisted total knee arthroplasty (TKA). It is hypothesized that sex, BMI, and age will play a role in adverse events experienced among robotic-assisted knee arthroplasty. It is hypothesized that adverse outcomes will differ in robotic-assisted TKA v UKA. Methods A retrospective analysis was performed utilizing 1,300 patient cases from a single surgeon that underwent robotic-assisted UKA or TKA utilizing a robotic surgical system. Demographics were sorted by age, sex, and BMI. Outcomes were sorted by the type of adverse event. The most common adverse event was further statistically analyzed by age, sex, and BMI and then compared to the total cohort. The most common adverse event was also broken down by TKA vs. UKA. Results The average age of the individuals undergoing this procedure was 63.6 years, with 52.3 % being female. The average BMI was 32.2. Of the 87 patients who experienced adverse events, 111 total events were documented. Manipulation under anesthesia (MUA) was the highest experienced adverse event. Among the MUA events, 79.5 % had a BMI over 30 (p=0.067), 72.8 % were female (p=0.014), and the average age was 59 years (p=0.019). Among the MUA adverse events, 76.9 % (n=30) were following a TKA and 23.1 % were following a UKA. When considering the entire sample (n=1,300), there was a statistically significant 12.6 times greater odds that an MUA occurred among those who had a TKA vs. UKA (p<0.001). Similar results were discovered when only considering those who had experienced an adverse event (n=87) because the odds of an MUA occurring among those who underwent a TKA was 4.67 times greater than those who underwent a UKA (p<0.001). Conclusions MUA was the most common adverse event in this cohort of robotic-assisted knee arthroplasties. The other adverse events did not yield large enough cohort sizes to analyze statistically in relation to specific patient demographics. Younger patients and females were at significantly greater odds of needing MUA. A BMI over 30 was not found to have a statistically significant risk of needing an MUA after robotic-assisted knee arthroplasty. Among the total cohort, those who underwent a TKA were at a 12.6 times greater odds of needing an MUA than those who received a UKA.

Open Access October 19, 2023

Association between steroid use and concussions among high school athletes: a cross-sectional analysis of the Youth Risk Behavior Surveillance System

Kennedy Sherman, Phillip Tyree, Alicia Ito Ford, Anna Mazur, Douglas Nolan, Micah Hartwell

Page range: 27-34

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Abstract

Context In 2017, there were almost 2.5 million high school students who experienced a concussion while playing a sport, raising concern for the neurologic problems that they could face. Some of these athletes may seek to gain a competitive advantage in their sport by utilizing substances like steroids. However, steroid use can cause increased aggression and body mass index (BMI), which might lead to heightened risk for concussions. Despite extensive research, we found no previous evidence linking these two factors. Objectives This analysis aims to investigate steroid use trends in high school athletes and to determine whether there is an association between steroid use and concussions in these athletes. Methods We conducted a cross-sectional analysis of the cumulative Youth Risk Behavior Surveillance System (YRBSS). Respondents were added if they participated in sports and answered the steroid and concussion prompts. Demographic variables were assessed including age, grade, BMI, gender, and race/ethnicity. Results We found that 3.7 % (n=2991) of high school athletes reported previous steroid use and that 20.7 % (n=2273) reported having sustained a concussion. There was a statistically significant difference in steroid use by race/ethnicity (p<0.001), with the highest rate of use (7.2 %) among American Indian/Alaska Natives (AI/AN). A significantly higher prevalence of steroid use occurred in athletes who were males (4.7 %) than females (2.5 %) and in athletes with a BMI>95 % (5.2 %) compared with those with a BMI between 85 and 95 % (3.9 %) and <85 % (3.5 %) (χ 2 =135.1, p<0.001 and χ 2 =16.3, p<0.001, respectively). Further, our results showed that the prevalence of steroid use among high school athletes decreased from 3.4 % in 1999 to 1.9 % in 2019, with the most drastic drop occurring between 2015 and 2019—declining 1.9 %. Whereas 19.6 % of athletes reported a concussion without steroid use, 54.6 % of steroid-utilizing athletes reported having experienced a concussion—a statistically significant finding (adjusted odds ratio [AOR]=4.3; 95 % CI: 3.2–5.9). Finally, compared with White athletes, we found that AI/AN athletes were significantly more likely to have sustained a concussion (AOR=2.3; 95 % CI=1.2–4.3). Conclusions Although our study found decreasing rates of steroid use among high school athletes from 1999 through 2019, our results also show that steroid use is significantly associated with sustaining a concussion. Additionally, the data from YRBSS also demonstrates that AI/AN high school athletes are more likely to utilize steroids and sustain a concussion. Given the long-term consequences of traumatic brain injuries, we recommend that coaches should be aware of potential steroid use among players, and that coaches, athletic trainers, and physicians should all be aware of concussion protocols and remove players from games for evaluation when a concussion is suspected.

Neuromusculoskeletal Medicine (OMT)

Clinical Practice

Open Access September 13, 2023

Supine counterstrain technique for rhomboid tender point

Olivia C. Matz, Hannah C. Gustafson, Lauren E. Hartwell, Laura J. Rudberg-Post, Adrian L. Woolley

Page range: 35-38

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Abstract

Because poor posture is a common instigating factor in back, shoulder, and neck pain, the rhomboid muscles should be considered in a complete physical evaluation. Previous techniques for treating a rhomboid tender point have addressed only one of the two main actions of the muscle, specifically retraction of the scapula utilizing shoulder abduction. This modified supine counterstrain technique for the rhomboid tender point incorporates both scapular retraction as well as superior, medial rotation of the inferior border of the scapula without abduction, providing a comprehensive treatment to accommodate patients with shoulder movement restrictions. This article discusses indications, contraindications, treatment, and a list of problem-solving strategies for the rhomboid tender point.

Public Health and Primary Care

Commentary

Open Access September 12, 2023

Issues of informed consent for non-specialists conducting colorectal cancer screenings

Forrest Bohler, Allison Garden

Page range: 39-42

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Abstract

The United States is currently facing a physician shortage crisis including a lack of specialist providers. Due to this shortage of specialists, some primary care providers offer colorectal cancer screenings in communities with few gastroenterologists, especially in under-resourced areas such as rural regions of the United States. However, discrepancies in training and procedural outcomes raise concerns regarding informed consent for patients. Because osteopathic physicians play a critical role in addressing the physician shortage in these under-resourced communities, this commentary may be especially useful because they are likely to encounter these ethical complexities in their day-to-day practice.

Clinical Image

Open Access September 13, 2023

Raynaud’s phenomenon

Olivia Humpel, Robert Hostoffer

Page range: 43-44

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About this journal

The Journal of Osteopathic Medicine, founded in 1901 and known for 119 years as the Journal of the American Osteopathic Association, is the premier scholarly, peer-reviewed publication of the osteopathic medical profession. The mission of JOM is to serve as an international forum for the dissemination of scientific literature that incorporates an integrative, comprehensive, patient-centered approach to clinical care and improving health. JOM conducts double-blind peer review of academic research manuscripts from a wide variety of medical specialties, covering the full spectrum of clinical settings in which osteopathic physicians practice. All submissions are vetted by a distinguished group of Section Editors led by Editor-in-Chief Ross Zafonte, DO, and supported by a full Editorial Board.

JOM publishes original research, narrative and systematic review articles (including meta-analyses), clinical practice descriptions, and a very limited number of case reports, all of which are described fully in our Instructions for Authors. JOM is particularly interested in original scientific research that provides quantitative analysis of and contributes significantly to the evidence base underpinning current practices in osteopathic medicine, including but not limited to neuromusculoskeletal medicine. We also accept research submissions documenting trends and changes in education for osteopathic medical students. The ultimate focus of all material published in JOM is to support, enhance, and advance patient care through evidence.