journal: Journal of Osteopathic Medicine

Impact Factor: 1.4

Open Access Published since January 1, 1900

Journal of Osteopathic Medicine

ISSN: 2702-3648

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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.

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Ahead of Print / Just Accepted

Volume 124 (2024)

Volume 123 (2023)

Volume 122 (2022)

Volume 121 (2021)

Volume 120 (2020)

Volume 119 (2019)

Volume 118 (2018)

Volume 117 (2017)

Volume 116 (2016)

Volume 115 (2015)

Volume 114 (2014)

Volume 113 (2013)

Volume 112 (2012)

Volume 111 (2011)

Volume 110 (2010)

Volume 109 (2009)

Volume 108 (2008)

Volume 107 (2007)

Volume 106 (2006)

Volume 105 (2005)

Volume 104 (2004)

Volume 103 (2003)

Volume 102 (2002)

Volume 101 (2001)

Volume 100 (2000)

Volume 99 (1999)

Volume 98 (1998)

Volume 97 (1997)

Volume 96 (1996)

Volume 95 (1995)

Volume 94 (1994)

Volume 93 (1993)

Volume 92 (1992)

Volume 91 (1991)

Volume 90 (1991)

Volume 89 (1989)

Volume 88 (1988)

Volume 87 (1987)

Volume 86 (1986)

Volume 85 (1985)

Volume 84 (1984)

Volume 83 (1983)

Volume 82 (1982)

Volume 81 (1981)

Journal Impact Factor	1.4	2023, Journal Citation Reports (Clarivate, 2024)
5-year Journal Impact Factor	1.4	2023, Journal Citation Reports (Clarivate, 2024)
Journal Citation Indicator	0.38	2023, Journal Citation Reports (Clarivate, 2024)
CiteScore	2.2	2023, Scopus (Elsevier B.V., 2024)
SCImago Journal Rank	0.360	2023, SJR (Scimago Lab, 2024; Data Source: Scopus)
Source Normalized Impact per Paper	0.564	2023, CWTS Journal Indicators (CWTS B.V., 2024; Data Source: Scopus)

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The JOM is the official scientific publication of the American Osteopathic Association (AOA) and the premier peer-reviewed, indexed, scholarly publication of the osteopathic medical profession.

The JOM's mission 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.

Article Types and Subject/Domain Areas

The JOM accepts the following article types for peer review:

Original Article
Review Article
Brief Report
Case Report
Clinical Practice
Clinical Image
Commentary
Letter to the Editor

The JOM gives priority to original research, systematic reviews, and meta-analyses. Authors may select from the following topic/domain categories when submitting an article to the JOM:

Behavioral Health
Cardiopulmonary Medicine
General
Innovations
Medical Education
Musculoskeletal Medicine
Neuromusculoskeletal Medicine/Osteopathic Manipulative Treatment (OMT)
Obstetrics/Gynecology
Pediatrics
Public Health and Primary Care

Submission and Peer Review Process

To submit a manuscript to us, visit our manuscript tracking system on ScholarOne https://mc04.manuscriptcentral.com/jomed.

You may upload manuscripts and accompanying materials to the ScholarOne site referenced above, and you will receive all correspondence regarding their submissions through the site. You may use this site to check the status of your manuscript at any time.

Failure to follow these Instructions for Authors and include all required components will result in your manuscript being returned to you before peer review. The JOM will consider the manuscript after all items are formatted properly.

Generally speaking, first decisions are returned within 30 days of submission. If you feel your publication warrants rapid review, please email us at editorial@osteopathic.org.

The JOM employs a single-blinded peer review process. Submissions are assigned directly to a Section Editor familiar with your particular area of study, who may issue an immediate decision or decide to forward your manuscript for full peer review. During peer review, your work will be reviewed by experts in a relevant specialty.

Authors who are considering submitting multiple manuscripts that will convey the progression of a study or that are part of a series of articles intended to be published at the same time are strongly encouraged to contact JOM staff before submitting such articles.

Editorial

AOA EDITOR IN CHIEF

Ross D. Zafonte, DO
Spaulding Rehabilitation Hospital Harvard Medical School
Boston, Massachusetts

EDITORIAL BOARD

BEHAVIORAL HEALTH
Section Editor:
Eileen Ryan, DO
The Ohio State University Wexner Medical Center
Columbus, Ohio

Associate Editors:
Justin Faden, DO (Philadelphia, Pennsylvania)
R. Gregory Lande, DO (Silver Spring, Maryland)
Jed Magen, DO, MS (East Lansing, Michigan)
Stephen M. Scheinthal, DO, CS (Mount Laurel, New Jersey)

CARDIOPULMONARY MEDICINE
Section Editor:
Kenneth J. Steier, DO, MBA, MPH
Touro College of Osteopathic Medicine
Middletown, New York

Associate Editors:
Olalekan Ogunsakin, MD, PhD, MBA, MPH (New York, New York)
Tanchun Wang, PhD (Middletown, New York)

MEDICAL EDUCATION
Section Editor:
Nadege Dady, EdD
Touro College of Osteopathic Medicine
New York, New York

Associate Editor:
Albert H. O-Yurvati, DO, PhD (Fort Worth, Texas)

MUSCULOSKELETAL MEDICINE AND PAIN
Associate Editors:
Mary E. Caldwell, DO (Henrico, Virginia)
Jonathan W. Lowery, PhD (Indianapolis, Indiana)
R. Dallin Thomas, DO, MPH, CAQSM (Bethesda, Maryland)

NEUROMUSCULOSKELETAL MEDICINE/OMT
Section Editor:
Kimberly Wolf, DO
Touro University California College of Osteopathic Medicine
Vallejo, California

Associate Editor:
Sheldon C. Yao, DO (Old Westbury, New York)

OBSTETRICS AND GYNECOLOGY
Section Editor:
Meaghan Nelsen, DO
The University of North Texas Health Science Center
Fort Worth, Texas

Associate Editors:
Kiran Kavipurapu, DO, JD, MPH (San Francisco, California)
Daniel J.S. Martingano, DO, PhD (Rockaway, New York)
DeEtte Vasques, DO (Fort Worth, Texas)

PEDIATRICS
Section Editor:
Amanda Foster, DO
Oklahoma State University
Tulsa, Oklahoma

Associate Editors:
Michael A. Baxter, DO (Tulsa, Oklahoma)
Alissa Craft, DO, MBA (Scottsdale, Arizona)
Colony S. Fugate, DO (Tulsa, Oklahoma)
Tami Hendriksz, DO (Vallejo, California)
Muhammad Waseem, MD, MS, CHSE-A (Bronx, New York)

PRIMARY CARE AND PUBLIC HEALTH
Section Editor:
Elizabeth A. Beverly, PhD
Ohio University Heritage College of Osteopathic Medicine Athens, Ohio

Section Editor:
Kevin M. Pantalone, DO, ECNU
Cleveland Clinic
Twinsburg, Ohio

Associate Editors:
John Ashurst, DO, MSc (Scottsdale, Arizona)
Craig S. Boisvert, DO (Lewisburg, West Virginia)
John J. Dougherty, DO (Provo, UT)
Lisa M. Hodge, PhD (Fort Worth, Texas)
Kim Pfotenhauer, DO (Vallejo, California)

CME EDITOR
Alissa Craft, DO, MBA (Scottsdale, Arizona)

INTERNATIONAL ADVISORY BOARD

Yasir Rehman, MD, MsC, PhD (Ontario, Canada)
Cleofás Rodríguez Blanco, PhD, DO (Madrid, Spain)
Loic Treffel, DO, PhD (Toulouse, France)

STUDENT, RESIDENT AND FELLOW ADVISORY BOARD

Emily Chin, OMS IV, MBA, MHA (Auburn, Alabama)
Jantzen J. Faulkner, OMS II (Tulsa, Oklahoma)
Divakara Gouda, OMS I (Stratford, New Jersey)
Matthew Mayeda, OMS IV, MPH (East Lansing, Michigan)

REPRESENTATIVE FROM THE AOA BOARD OF TRUSTEES
Geraldine T. O'Shea, DO (Jackson, California)

AOA LEADERSHIP

President:
Teresa Hubka, DO

President-elect:
Robert Piccinini, DO

Chief Executive Officer:
Kathleen S. Creason, MBA

EDITORS IN CHIEF EMERITUS
Robert Orenstein, DO
Mayo Clinic
Phoenix, Arizona

Thomas Wesley Allen, DO, MPH
Oklahoma State University Center for Health Sciences College of Osteopathic Medicine
Tulsa, Oklahoma
University of Oklahoma College of Medicine
Oklahoma City, Oklahoma

Gilbert E. D'Alonzo Jr, DO
Temple University School of Medicine
Philadelphia, Pennsylvania

EDITORIAL STAFF

Director:
Hunter Alexander

Volume 124 Issue 12

December 2024

Publicly Available September 23, 2024

Frontmatter

Page range: i-iii

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General

Original Article

Open Access August 7, 2024

Predictors of a positive attitude towards rural practice in female osteopathic medical students

Dana E. Kahl, Kevin M. Roessger

Page range: 521-527

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Abstract

Context Women outnumber men in medical school. Given the growing need for rural physicians and the underrepresentation of women in rural medicine, understanding predictors of rural practice among female students is imperative for addressing future healthcare workforce shortages in rural areas. Utilizing current evidence, medical schools should seek to admit students with a rural background and interest in pursuing a primary care specialty; however, whether this holds true for female osteopathic medical students is unknown. Objectives This study aims to determine if a rural background, a plan to practice family medicine, and motivation toward civic duty are associated with attitudes toward eventual practice of rural medicine in female osteopathic medical students. Methods An anonymous online survey was administered to actively enrolled female students at Arkansas Colleges of Health Education College of Osteopathic Medicine. The survey assessed the respondents’ presence of a rural background, degree of civic-mindedness, intention to practice family medicine, and attitudes to rural work and life. Demographics of ethnicity and year of study in medical school were also collected. In total, 129 students responded to the survey, with 97 complete responses for analysis. Hierarchical regression was utilized to compare nested models and interpret interactions. Results Of the 97 survey respondents, 34.0 % described themselves as first-year students, 37.1 % as second-year students, 16.5 % as third-year students, and 12.4 % as fourth-year students. Linear regression modeling indicated that for female medical students at Arkansas Colleges of Health Education, having a rural background had no relationship with their attitude toward practicing in a rural setting, β=−0.97, standard error (SE)=1.96, t =−0.49, p>0.05, CI [−4.86, 2.92]. Civic-mindedness had a positive relationship with their attitude toward practicing in a rural setting, β=0.17, SE=0.07, t =2.44, p=0.016, CI [0.03, 0.31], accounting for 4.57 % of its variance. Plan to practice family medicine was positively associated with a student’s attitude toward practicing in a rural setting, β=4.38, SE=0.85, t =5.15, p<0.001, CI [2.69, 6.07], accounting for 20.25 % of its variance. Civic-mindedness appeared to moderate the relationship between planning to practice family medicine and attitudes toward practicing in a rural setting, F (1, 91) = 3.91, p=0.05, R 2 =0.31. The p value for this interaction term was 0.05, but its effect size measure and graphical representation revealed a substantive effect. Conclusions The regression analysis showed that, for the women in this study, the greater the student’s civic-mindedness, the more favorable her attitude toward practicing in a rural setting. Additionally, the stronger the student’s plan to practice family medicine, the more favorable her attitude toward eventual rural practice was. Lastly, the student’s civic-mindedness influenced the predictive value of having a plan to practice family medicine.

Medical Education

Original Article

Open Access July 3, 2024

Preference signaling in orthopaedic surgery: applicant perspectives and opinions

Conner Howard, Victor H. Martinez, Griffin Hughes, Aroob Zaheer, Christian Allen, Chad Hanson, Brent Norris, Jake X. Checketts

Page range: 529-536

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Abstract

Context Orthopaedic surgery has become increasingly competitive over the years, with the COVID-19 pandemic creating additional challenges for applicants and programs. To promote an equitable match experience, the American Orthopaedic Association (AOA) introduced a formal preference signaling (PS) system into the 2022–2023 application cycle. PS allows applicants to indicate their heightened interest in specific programs, which improves the likelihood of receiving an interview and ultimately matching at their desired residency program. Objectives The objective of this anonymous survey is to assess applicants’ opinions and perspectives toward PS in orthopaedic surgery prior to the 2022–2023 match results. Additionally, we sought to evaluate the signaling strategies being utilized by applicants. Methods An anonymous 22-question survey was distributed to applicants of an orthopaedic surgery residency program (34.2 % response rate). Responses were collected after the application submission deadline but before the match lists and results were available. This survey included questions germane to demographics, signal utilization, signaling reasons and strategies, and opinions toward PS. Descriptive statistics were calculated utilizing R (version 4.2.1) and RStudio. Results Most respondents (96.1 %) participated in PS, and 96.7 % utilized all 30 signals. Signaling encouraged 24.2 % of applicants to apply to fewer programs. In accordance with guidelines, 83.2 % of respondents signaled each away rotation program; however, only 53 % signaled their home program. Applicants commonly signaled 1–10 “reach” and “safety” programs each. Proximity to Family and Perceived Operative Experience were the most important reasons for signaling, whereas Program Prestige was the least. A program’s social presence and virtual interview option did not influence many applicants’ decisions for signaling. Most applicants believe that the COVID-19 pandemic and pass/fail licensure examinations influenced PS adoption. Sixty-seven of 149 respondents (45 %) claimed that applicants and programs benefit equally from PS, while 41 % believe programs benefit more. Nearly half (40.94 %) knew very little or nothing about PS. Conclusions During the inaugural introduction of PS in orthopaedic surgery, nearly every applicant utilized all 30 signals, prioritizing factors like family proximity and perceived operative experience over program prestige. This shift reflects the importance of geographic location and presumed training quality. Despite unfamiliarity toward PS, personalized signaling strategies were implemented, accompanied by a slight decrease in application volumes. The 30 allotted signals in orthopaedic surgery may serve as an informal application cap due to the necessity of signaling a program for an interview invite. However, improved educational efforts are needed to enhance the understanding and maximize the benefits of PS for both applicants and programs.

Musculoskeletal Medicine and Pain

Original Article

Open Access July 5, 2024

Assessing osteoporosis screening compliance in total joint surgery: a retrospective chart review

Samuel Shepard, Ania Bartholomew, David Houserman, H. Brent Bamberger, Antonio G. Manocchio

Page range: 537-541

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Abstract

Context Osteoporosis is a prevalent concern, particularly among aging populations, leading to increased risk of fractures, including those related to hip and knee arthroplasty procedures. Screening for osteoporosis, especially with dual X-ray absorptiometry (DXA) scans, is crucial for early detection and management. Objectives This study aimed to assess adherence to osteoporosis screening guidelines among patients aged 65 and older undergoing elective total hip arthroplasty (THA) or total knee arthroplasty (TKA) within a single health network. Factors influencing screening adherence were also explored. Methods A retrospective chart review of 2,160 patients undergoing elective THA or TKA between January 2019 and January 2023 was conducted. Demographic data, osteoporosis screening status, and occurrence of periprosthetic fractures were analyzed. Statistical analysis included descriptive statistics and chi-square tests. Results Only 24.1 % of eligible patients underwent a DXA scan prior to surgery. Females were more likely to undergo screening than males, and race was also associated with screening status. A total of 45 periprosthetic fractures were identified, with no significant correlation between osteoporosis status, DXA screening, and fracture occurrence. Conclusions Adherence to osteoporosis screening guidelines among geriatric patients undergoing elective total joint arthroplasty remains low within the studied health network. Despite the lack of correlation between screening and fracture occurrence in this study, the importance of screening and potential optimization in high-risk patients is emphasized. Further research is needed to assess outcomes associated with different care pathways in bone health screening and management for elective geriatric total joint patients.

Neuromusculoskeletal Medicine (OMT)

Review Article

Open Access July 29, 2024

Neuropsychiatric considerations in treating anorexia nervosa patients with osteopathic manipulative medicine: a narrative review

Tara Talebi-Talghian, Paulyna Schulz, Teodor Huzij

Page range: 543-548

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Abstract

Osteopathic manipulative medicine (OMM) has a growing recognition in serving as an effective treatment to promote adaptation and homeostasis of the body by addressing musculoskeletal, neural, vascular, and lymphatic structures to promote self-healing and regulation. OMM can treat the musculoskeletal tension and sympathetic hyperactivity resulting from the increased cortisol response and hypersensitivity found in varying psychiatric illnesses, including anorexia nervosa (AN). This paper addresses the considerations necessary for treating AN patients with OMM, emphasizing the need to evaluate their abnormal high-level neuronal processing of sensory information, including differences in touch perception compared to the general population. Current literature was gathered utilizing a combination of the following keywords: anorexia nervosa, perception of touch, and osteopathic manipulative medicine/treatment. No literature was found addressing the effects of OMM on treating AN patients. Eight studies addressed the change in perception of touch found in AN patients. Results of the literature review reveal that the perceptions of touch in AN patients are distorted and can lead to reduced perceived pleasantness encountered in social interactions and touch. Specific changes have been found in C-tactile (CT) afferents responsible for the positive effects of touch, thus influencing emotional regulation. The significance of addressing this topic is to provide insight into the pathophysiological processes of AN and to inform physicians of unconventional stimuli that may exacerbate AN symptoms and behaviors. Further study is required to elucidate the role and mechanism of OMM in patients with AN and whether manual therapy could worsen pathological behavior and thinking patterns seen in AN patients. Such studies could include, but are not limited to, examining biological factors such as cortisol levels in AN patients receiving OMM and collecting data about AN patients’ thinking patterns and behavior during OMM treatment.

Neuromusculoskeletal Medicine (OMT)

Case Report

Open Access September 13, 2024

Treatment of migraine with aura with osteopathic manipulative treatment: a case report with renewed perspectives

Natan Babek, Christopher Fiechter, Rachael Caretti, Trevor Phinney

Page range: 549-554

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Abstract

Migraines make up a significant number of office visits every year, yet their pathophysiology and etiology remain largely elusive. This case report presents a 33-year-old patient who originally presented to the emergency department (ED) as a stroke alert and was later determined to have migraine with aura. The patient experienced an acute onset of headache, dizziness, and new-onset expressive aphasia. Before administration of a migraine cocktail, osteopathic manipulative treatment (OMT) was performed and was able to fully resolve all of her symptoms. In an effort to explain the outcomes in this case, a review of the current literature was performed, which provides an interesting perspective on the interplay of the musculoskeletal system and neuroanatomy. The literature establishes that somatic dysfunctions in the cervical vertebrae and trapezius may play a role in migraines and provide rationale for the use of OMT.

Public Health and Primary Care

Commentary

Open Access August 27, 2024

The rise of advanced practice provider independence bills: a misguided attempt to address the physician shortage

Forrest Bohler, Garrett Peters, Nikhil Aggarwal, Kyle Harvey, J. David Bohler

Page range: 555-558

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Abstract

In the past decade, the rise of state legislation that allows for advanced practice provider (APP) independence has grown steadily across the country. Most recently, Montana has enacted House Bill 313, which allows for physician assistant independent practice in primary care services. This is a concerning trend because there is a multitude of studies that demonstrate worsened patient outcomes and increased healthcare expenditures for care delivered by nonphysicians. There are also many unintended consequences that are likely to occur due to this inappropriate expansion of scope of practice for APPs. In this commentary, we outline the ramifications that are likely to occur in states such as Montana that enact legislation that expands the scope of practice for nonphysicians.