RELATION OPERATOR-PATIENT:

CAN OSTEOPATH CHARACTERISTICS

INFLUENCE THE TREATMENT?

E. Ratti1, C. Arienti 1, S. Daccò1 1Department of Research, Istituto Superiore di

Osteopatia, Milan, Italy

INTRODUCTION 1/5

• Clinical research is based on use of “randomized controlled

trials” (RCTs)

Difficulties:

- Select the control group;

-Develop a “false” treatment appropriate,

credible, ineffective and indistinguishable from

active treatment

PLACEBO EFFECT

Fulda K. G., Slicho T., Stoll S. T. Patient expectations for placebo treatments commonly

used In Osteopathic Manipulative Treatment (OMT) clinical trials: a pilot study.

Osteopath Med Prim Care. 2007; 1:3.

INTRODUCTION 2/5

PLACEBO EFFECT

• There is a response;

• It depends on the non-specific effects of the treatment - Length of trial - The doctor - the placebo itself - unconscious wishes of the subject - the quality and strength of the relationship

between Operator and Patient

They may influence the response, and affect the results of treatment

Licciardone J. C., Russo D. P. Blinding protocols, treatment credibility and expectancy:

methodologic issues in clinical trials of Osteopathic Manipulative Treatment.

J Am Osteopath Assoc. 2006; 106 (8): 457-63.

DOCTOR-PATIENT RELATIONSHIP

This system includes:

*personal beliefs,*previous experience,

*fears, *expectations, *trust and *emotions

(about the doctor and the patient)

The medical professionalism is the heart of this report.

The key elements are:

*“being” of the operator, *his individual characteristics, *his interpersonal qualities and abilities:

-personality

-empathy

Gallagher T. H., Levinson W. A prescription for protecting the doctor-patient relationship.

Am J Manag Care. 2004; 10 (2 pt 1): 61-8.

INTRODUCTION 3/5

INTRODUCTION 4/5

Personality Set of psychical characteristic and

behavior patterns of the operator.

Empathy Ability of the operator to relate to

the patient with compassion,

taking his prospective, becoming

sensitive to the experiences he

previously had.

Haslam N. Humanising medical practice: the role of empathy. Med J Aust. 2007;

188 (4): 263-4.

West C. P., Shanafelt T. D. The influence of personal and environmental factors on

professionalism in medical education. BMC Med Educ. 2007; 7: 29.

GOAL

The objective of the study is to

investigate the influence of

personality and empathic

capacity on the efficacy of the

treatment.

METHODS 1/2

SETTING

“Centro Studi e Ricerca Osteopatica” of the Institute of

Osteopathy in Milan

Since March 2010 to January 2011

PATIENTS

115 volunteers between 18 and 80 years old, male and

female having a musculoskeletal problems or diseases

90 in the first group

25 in the second group

METHODS 2/2

EXCLUSION CRITERIA

Diagnosis of psychiatric disorders and/or

neurological central problems

OPERATORS

Trainees attending the 4th or 5th full-time, male and

female and aged between 20 and 40.

STUDY DESIGN

Operators complete Jefferson Scale

Questionnaire EPQ-R

Treated with black box.

Patients first visit (T0)

5 treatments (T1-T2-T3-T4-T5)

Request the NRS

Before the OMT Before and after the OMT

First group Second group

TEST

• NRS.

• JEFFERSON SCALE: questionnaire for the empathy.

20 statements with a level of agreement based on a 7-

point Likert scale (between 1 = disagreement and 7=

very agreement).

• EPQ-R: personality questionnaire.

106 questions with binary responses (yes or no).

It was considered only the extroversion.

Glaser K.M., Markham F., Adler H.M., McManus R.P., Hojat M.

Relationships between scores on the Jefferson Scale of physician

empathy, patient perceptions of physician empathy, and humanistic

approaches to patient care: a validity study. Med Sci Monit, 2007; 13(7):

CR291-294.

STATISTICAL ANALYSIS

• To value the efficiency of the treatment

• To value the correlation between empathy/

extroversion and pain level.

p<0,05 was considered statistically significant;

p<0,001 was considered high statistically

significant.

Table 2

Operators’ features

Features No.

Age 24

3

Sex (M:F) 10:12

Study year(5

:4

) 8:14

Estimated hours of practice 200,23

200,73

Psychological therapies 5:22

EPQ-R results (ESTROVERSION) 14,91

3,61

Jefferson Scale results (EMPATHY) 108,54

9,08

RESULTS 1/5

Values0-20: extroversion levels

Values1-22: operators

Values0-140: empathy levels

Values1-22: operators

RESULTS 2/5

Table 3

Patients’ features

(first group)

Features No. (90)

Age 45,73

16,77

Sex (M:F) 48:42

Symptomatology

Neck pain 26

Low back pain 36

Back pain 9

Sholder pain 6

Knee pain 4

Sacro-iliac pain 4

Thigh and hip pain 2

Ankle and foot pain 2

Wrist pain 1

Pain:

Acute (< 3 month) 10

Cronic (> 3 month) 80

Drug therapies (YES:NO) 30:60

Medications as needed (YES:NO) 53:37

Manual therapies (YES:NO) 10:80

Table 4

Patients’ features

(second group)

Features No. (25)

Age 46,12

17,88

Sex (M:F) 10:15

Symptomatology

Neck pain 1

Low back pain 15

Back pain 3

Sholder pain 0

Knee pain 1

Sacro-iliac pain 0

Thigh and hip pain 2

Ankle and foot pain 2

Wrist pain 1

Pain:

Acute (< 3 month) 3

Cronic (> 3 month) 22

Drug therapies (YES:NO) 7:18

Medications as needed (YES:NO) 14:11

Terapie manuali (YES:NO) 0:25

RESULTS 3/5

No. P

T0-T2 2.44

2.22 < 0.001

T0-T5 4.17

2.46 < 0.001

EXTROVERSION EMPATHY

T0-T2 - 0.14 0.02

T0-T5 - 0.01 - 0.29

Differing levels of pain between the times 0 and 2 and between times 0 and 5

Results of the correlation between the delta and the previously calculated values of

extroversion and empathy of the operators, obtained through the test (EPQ-R and

JSPE)

RESULTS 4/5

FIRST GROUP

No. P

T0 i-T0 f 0.92

1,22 < 0,001

T1 i-T1 f 1.56

1,00 < 0,001

T2 i-T2 f 1.21

1,04 < 0,001

T3 i-T3 f 1.40

1,11 < 0,001

T4 i-T4 f 1.46

1,71 < 0,001

T5 i-T5 f 0.92

0,83 < 0,001

ESTROVER

SIONE

EMPATIA

T0 i-T0 f - 0,41 0,23

T1 i-T1 f - 0,09 - 0,05

T2 i-T2 f 0,35 -0,18

T3 i-T3 f 0,03 -0,22

T4 i-T4 f 0,15 0,21

T5 i-T5 f -0,12 0,25 Differing levels of pain collected at the

beginning and end of treatment with T-Test

Results of the correlation between the delta and the

previously calculated values of extroversion and

empathy of the operators, obtained through the test

(EPQ-R and JSPE)

RESULTS 5/5

SECOND GROUP

DISCUSSION 1/2

There is an high significance in reducing the

symptoms of the patient, confirming the efficacy of

Osteopathic Treatment

DISCUSSION 2/2

There is not correlation between the reduction of the

symptomatology referred and empathy/extroversion of the

operator.

LIMITS

The values obtained from the

tests are too similar each other

and very high.

The relationship is based on

several components:

• The patient

• The operator

• The communication.

TIPS

Operators of both genre

with different ages.

Single-blind.

Control group with only

relational treatment.

THANKS

•Students of Clinica ISO

•Patients

•D.O. Arienti Chiara

•Dott. Daccò Silvia