The Interpretation of Intention in Osteopathy An exploratory qualitative study

by

ACKNOWLEDGEMENT

I would take this opportunity to thank my research supervisor, family and friends for their support and guidance without which this research would not have been possible

DECLARATION

I, [type your full first names and surname here], declare that the contents of this dissertation/thesis represent my own unaided work, and that the dissertation/thesis has not previously been submitted for academic examination towards any qualification. Furthermore, it represents my own opinions and not necessarily those of the University (Bardhan, 2001, 467).

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ABSTRACT

Patients commonly report mild to moderate effects following all forms of manual therapy. These are often regarded as adverse events by practitioners but there is limited evidence on how patients view their post treatment experiences, and what meaning they ascribe to them. This qualitative study used three focus group discussions (19 participants) to explore osteopathic patients' perspectives; a frame work approach was used to analyze the data. There were four emergent themes (and 23 sub-themes). Interpretative (level two) analysis of the data led to a conceptual model of meaning with four inter-related components: Expectations; Personal investment; Osteopathic encounter; Clinical change, under an overarching construct, the 'global osteopathic experience'. These four components can have a profound impact on a patient's post-treatment experiences and their perception of what is adverse. This model suggests there is disparity between patient perceptions and clinical definitions of adverse events; awareness by practitioners of this disparity is essential for effective clinical management.TABLE OF CONTENTS

CHAPTER 1: INTRODUCTION7

1.1Background and context7

1.2 Significance of the Study8

1.3 Osteopathic relevance9

1.4 Aim of the study11

CHAPTER 2: LITERATURE REVIEW13

2.1 Psychotherapeutic Relationship18

CHAPTER 3: METHODOLOGY20

3.1 Research Approach20

3.2 Definition of Qualitative Research21

3.3 Consideration of Qualitative Research21

3.4 Ethical Concerns21

3.5 Study design22

3.6 Participants and recruitment23

3.7 Topic guide and data collection23

3.8 Analysis and rigor24

CHAPTER 4: RESULTS AND ANALYSIS27

4.1 Participant characteristics27

4.2 Emergent themes27

4.2.1 Theme I: patient-practitioner encounter27

4.2.2 Theme II: environment29

4.2.3 Theme III: treatment after-effects29

4.2.4 Theme IV: expectations of the osteopathic encounter30

4.2.5 Conceptual model: interpretation of patients' perceptions of post-treatment experiences34

4.3 Analysis37

CHAPTER 5: CONCLUSION43

References45

CHAPTER 1: INTRODUCTION

Background and context

For much of its nearly 125-year history, the osteopathic profession has had an uneasy, sometimes bitter, relationship with the M.D. community (Guglielmo 1998). For many years, doctors of medicine (M.D.s) looked upon doctors of osteopathy (D.O.s) as cultists practicing a pseudoscientific form of medicine according to the osteopathic principles laid out in 1874 by founder Andrew Taylor Still. As a result of being shut out by the MD community, D.O.s started their own schools, hospitals, and practices, including their own version of the AMA - the American Association for the Advancement of Osteopathy, renamed the American Osteopathic Association (AOA) in 1901. Thus, D.O.s and M.D.s inhabited two parallel and, in many ways, distinct spheres of American medicine.

In the 1930s, however, D.O.s began to adopt more and more allopathic practices and standards in order to have a greater scope of practice and to achieve parity with M.D.s with respect to the minimum standards governing undergraduate and graduate education (Gevitz 1994). As a result, in an effort to ...